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The Kidney Stone Page |
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SURGICAL PROCEDURES
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Lithotripsy:
One of the triumphs of medical science in recent years has been the introduction of a highly effective way of breaking up dangerous kidney stones by focusing sonic waves precisely at the right point to shatter them into pieces. The machinery which produces and focuses the waves does so from outside the body, so it is called Extracorporeal Shock Wave Lithotripsy. In the early days of this procedure, the patient was immersed in a tub of water to facilitate the safe transfer of energy into the body. Now, however, most ESWL is carried out with the patient on his back with an absorption chamber of some kind below him in the table, depending on the manufacture of the lithotriptor.
The benefits are immediately obvious. There is no dangerous incision into the tissue of the kidney or the skin, so recovery time is vastly reduced over traditional surgical removal. In fact, it is most often done on an out-patient basis, and patients go home only a few hours after the procedure.
Remember however, it is a surgery. The patient is usually under general anesthesia (totally asleep). The shock waves do not necessarily cause much pain, at least for the first 1000 pulses, but the next 2000 could get really uncomfortable! Over the course of an hour or so some 2400 to 4000 shockwaves are focused on the stone and then on its pieces as it breaks up. A radiology monitor can actually track the pieces of the stone as it breaks up. The ESWL unit keeps firing at them until they are hopefully rendered small enough to pass easily out of the kidney, down the ureters and into the bladder, where they may pass painlessly in a stream of urine over the next few days and weeks.
Patients undergoing ESWL should expect to pass blood and stone material over the first few days. As the kidney heals, less blood should show up in the urine, but stone fragments or sand may take longer to pass, up to six weeks or longer. Hopefully the majority of the stone matter will pass within the first few hours of the procedure. ESWL is usually done on an out-patient basis, so patients go home the same day in relative comfort. A moderate pain medication is often prescribed for the first 48 hours after surgery, but don't take aspirin: (As with any surgery, prospective ESWL patients should avoid taking aspirin for three weeks prior to the procedure, since it "thins" the blood and makes bleeding worse than it should normally be. Talk to your doctor about what other advice you should know.)
Sometimes the supervising doctor will also insert a stent during surgery. It is a narrow tube of flexible plastic which is carefully inserted up through the ureter into the kidney, the theory being that stone fragments from lithotripsy will pass more easily through the tube. There is considerable controversy about their use, and since current clinical research does not show any measurable benefit from stent use, some urologists are giving up the practice.
Percutaneous lithotripsy:
When stones become too large to be broken up by ESWL (above) a urologist may elect to remove the stone directly through a small incision or hole in the patient's back. This is stone removal through the skin, which is what is meant by percutaneous. The goal is to directly enter the kidney through a small tube inserted in the back. The tube allows the insertion of specialized tools for finding and grabbing the stone. The principal tool for this job is often called a basket, so sometimes the procedure itself is referred to by medical staff as a "basket."
The advantage to this type of surgery is that there is only a small incision, or hole in the skin and that the delicate tissue of the kidney is left relatively undisturbed. The key to successful basket procedures is to know exactly where the stone is at the time of surgery. If the stone cannot be located quickly, then the doctor has to decide whether or not to try to search for it through the kidney tissues, and to what extent the search may cause more problems than it is worth.
Once the stone is found, it may often be removed by the doctor. If it is too large for the tool to grasp, another instrument may be inserted that acts as a miniature jack-hammer to break the stone into smaller pieces. Some of these instruments work on the principle of sonic shock waves, and others work on compressed air, and others have a hard (diamond) tip used to break the stone. (One doctor we know calls this tool "Big Bertha.")
Recovery from Basket surgery is usually relatively quick and easy, perhaps three to seven days. Often Percutaneous stone surgery is employed to try to avoid full kidney surgery, which is a serious prospect.indeed.
Kidney Stone Surgery:
If the above procedures do not work, then the final option may be to remove a threatening stone by opening up the kidney and removing the stone. This is major surgery, no doubt about it. Some studies indicate that each surgery to open the kidney and remove a stone may destroy 20% of kidney function. This decision must not be made lightly, but when a patient gets to this point, there is often little choice in the matter. Of course, you do indeed have two kidneys, and it's great that Mother Nature gave us a backup system that can carry the load in most cases. But on the other hand, it should come as no surprise that if a person loses one kidney that is producing stones, the remaining kidney, which may have been stone-free for years, may begin producing stones as well and the problem becomes even more critical.
Recovery from kidney surgery is no picnic and can last for several weeks. We suggest you discuss every detail about it with your doctor, if you are looking at that prospect.
Parathyroid Surgery:
About 5 out of every 100 calcium stone formers have hyperparathyroidism and can be cured by neck surgery that removes the abnormal gland or glands. Before surgery, the diagnosis should be secure through repeated measurements of blood and urine calcium as well as blood levels of the parathyroid hormone. The surgeon is asked to cure the disease, never to explore the neck in order to make or even confirm the diagnosis. Parathyroid surgery is challenging, and best done by surgeons who have a special interest in neck surgery and considerable experience in the treatment of parathyroid disease.
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This information is not intended to diagnose, treat, cure or prevent any disease.
If you need medical attention, consult your health care professional.
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