PCNL
Endoscopic removal of kidney stones is a procedure to remove one or more kidney stones using an endoscope (a tube containing a small camera, a light and a device to break up the stone).
It is also called percutanousnephrolithotomy (PCNL).
The procedure usually takes two to three hours.
Kidney (or renal) stones are clusters of tiny crystals that can form in the kidneys. Most clusters are too small to cause any problems and pass out of the body in the urine.
PCNL/URS
Larger stones in the kidney are preferably removed by PCNL. In this method, the patient needs to be admitted to the hospital. A small puncture is made from the back directly into the kidney, the stone is identified, fragmented and completely removed. Stones lower down in the urinary tract may be treated either by ESWL or again, by endoscopic methods, viz URS. In this, the stone is visualised and fragmented by passing a small endoscope through the urinary opening.
Illustration Showing How PCNL is Performed
Generally, an incision, that is 1 cm or less than 1 cm, is made in the flank. A guide wire is passed through this incision into the kidney. This is performed under fluoroscopy or x-ray control.
A passage is then created around this guide wire by dilatation. Through this passage, a nephroscope is passed into the kidney to visualise the stone and remove it. Larger stones can be fragmented by different methods and removed. Stones are therefore cleared easily. Once the procedure is complete, a tube is left through this tract as drainage for one or two days.
The main advantage of this approach is that, unlike traditional open surgery, only a 1 cm incision is made in the flank. The stones can be visualised directly and removed. The stay in the hospital is only for 3-4 days.
UreterorenoscopicLithotrispy with Holmium Laser : is performed under epidural and spinal anaesthesia to treat stones located in the middle or lower ureter. A small, fiberoptic instrument (ureteroscope) is passed into the ureter. Large stones are fragmented using 100-Watt Coherent Holmium Laser. The laser fragments the stone into sand like particles, which are then flushed out through the natural urinary passage. The advantage of Holmium Laser is its ability to fragment stones of all compositions with precision. Thus, it is the most effective laser for the treatment of urinary stones. Patients are generally admitted on the same day of the treatment and are discharged next day, which means only 24 hours of hospitalization is required.
Prevention of Stone formation : Uric acid stones, which are generally seen only on the ultrasound, and not on the x-rays, if less than 1 cm, can easily be dissolved by simple alkalinisation of the urine.
Most patients with urinary stones need to make certain minimal changes in their diet that may help in the prevention of a recurrence. These include:
High intake of neutral fluids such as water, tender coconut water, diluted buttermilk, citrus juices, etc., is required unless contraindicated for some other reason. Patients should limit the amount of coffee, tea or milk taken to 1-2 cups a day.
Food must preferably be vegetarian, and high in fibre.
Meat eaters should restrict the amount of meat they eat, so that their total protein intake is limited to 1 gram per kilogram per day.
Cool drinks and soft drinks that contain a high amount of sugar, and calcium-rich foods such as sweets, sweets made using milk as an ingredient, etc., should be avoided, especially on an empty stomach.
Separate and specific changes in the diet may be suggested in the case of other conditions associated with urinary stones.
Patients who are suspected to have other metabolic or endocrine problems will need to undergo detailed testing. These are generally reserved for those patients who have recurrent stone formation.
Gynecologic laparoscopy is an alternative to open surgery. It uses a laparoscope to look inside your pelvic area. Open surgery often requires a large incision. A laparoscope is a slender, lighted telescope. It allows a doctor to see inside your body.