Kidney stones are one of the commonest problems. They present in flank pain, blood in urine, and fever. Though there is no definite cause of stone formation but the commonest cause is decreased water intake. If stones left untreated, they can potentially damage the kidneys also.
Percutaneous nephrolithotomy is the most commonly employed minimally invasive method of kidney stone removal. Typically it is used for stones more than 2 cm and can be done under spinal or general anesthesia. A small incision less than 1 cm is made on the back/flank through which using serial dilators a tract is established into the kidney, leading up to the stone. A nephroscope is then passed into the kidney and the stone is fragmented into small pieces and removed. A DJ stent is then placed in the kidney which can be removed after a week. The patient needs to admit to the hospital and stay around 1 to 2 days. Bleeding is a risk of this surgery which can happen even after 2-3 weeks of uneventful surgery although the incidence is very low ( around 5%).
With refinements in techniques and miniaturizing of instruments, mini and ultra mini PCNL are the true KEY-HOLE surgeries. These techniques can be used to remove stones as small as 7-8 mm (provided that they are visible in X-rays) using smaller probes and laser. The post-operative recovery is early, blood loss is less, the hospital stay is short and patients can resume their routine work as early as they will recover.
In this technique, a flexible ureteroscope is passed through the urinary passage, through the bladder into the kidney directly. Using a Holmium laser, under direct vision the kidney stones can be broken into small fragments and removed with miniature baskets. No cut in the skin is given in this procedure. It is especially useful to remove stones in difficult locations inside the kidney. There are minimal bleeding and early recovery of patients using this technique.
Stones that are stuck in ureters( a thin tube that carries urine from kidney to the bladder) are treated using a rigid ureteroscope which is as thin as a pen. The ureteroscope is passed through the urinary passage and no cut is given on the skin. Once the ureteroscope reaches up to the stone, it is fragmented into small pieces using Holmium laser or a pneumatic lithoclast. The stone fragments are ten removed using a forceps. At the end of the procedure, a stent is placed in the ureter which is but a safety device. The stent is removed around a week later through the urinary passage.