Treatment of Kidney Stones
Kidney stones are small masses of salts and minerals that form inside the kidneys and may travel down the urinary tract. Kidney stones range in size from just a speck to as large as a ping pong ball. Signs and symptoms of kidney stones include blood in the urine, and pain in the abdomen, groin, or flank. About 5% of people develop a kidney stone in their lifetime.
The kidneys regulate levels of fluid, minerals, salts, and other substances in the body. When the balance of these compounds changes, kidney stones may form. There are four types of kidney stones, each made of different substances. Uric acid and cystine are two compounds that may comprise kidney stones. Factors known to increase the risk of kidney stones include dehydration, family history, genetics, and the presence of certain medical conditions. Having one or more family members with a history of kidney stones increases the risk of the condition.
|Type of kidney stone||Possible medicines prescribed by your doctor|
|Uric Acid Stones||
Kidney stone treatment in Ghaziabad varies, depending on the type of stone and the cause.
Small stones with minimal symptoms
Most small kidney stones won’t require invasive treatment. You may be able to pass a small stone by:
- Drinking water. Drinking as much as 2 to 3 quarts (1.9 to 2.8 liters) a day may help flush out your urinary system. Unless your doctor tells you otherwise, drink enough fluid — mostly water — to produce clear or nearly clear urine.
- Pain relievers. Passing a small stone can cause some discomfort. To relieve mild pain, your doctor may recommend pain relievers such as ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others) or naproxen sodium (Aleve).
- Medical therapy. Your doctor may give you a medication to help pass your kidney stone. This type of medication, known as an alpha blocker, relaxes the muscles in your ureter, helping you pass the kidney stone more quickly and with less pain.
Large stones and those that cause symptoms
Kidney stones that can’t be treated with conservative measures — either because they’re too large to pass on their own or because they cause bleeding, kidney damage or ongoing urinary tract infections — may require more-extensive treatment. Procedures may include:
- Using sound waves to break up stones. For certain kidney stones — depending on size and location — your doctor may recommend a procedure called extracorporeal shock wave lithotripsy (ESWL).
ESWL uses sound waves to create strong vibrations (shock waves) that break the stones into tiny pieces that can be passed in your urine. The procedure lasts about 45 to 60 minutes and can cause moderate pain, so you may be under sedation or light anesthesia to make you comfortable.
- Surgery to remove very large stones in the kidney. A procedure called percutaneous nephrolithotomy involves surgically removing a kidney stone using small telescopes and instruments inserted through a small incision in your back. You will receive general anesthesia during the surgery and be in the hospital for one to two days while you recover. Your doctor may recommend this surgery if ESWL was unsuccessful.
- Using a scope to remove stones. To remove a smaller stone in your ureter or kidney, your doctor may pass a thin lighted tube (ureteroscope) equipped with a camera through your urethra and bladder to your ureter. Once the stone is located, special tools can snare the stone or break it into pieces that will pass in your urine. Your doctor may then place a small tube (stent) in the ureter to relieve swelling and promote healing. You may need general or local anesthesia during this procedure.
- Parathyroid gland surgery. Some calcium phosphate stones are caused by overactive parathyroid glands, which are located on the four corners of your thyroid gland, just below your Adam’s apple. When these glands produce too much parathyroid hormone (hyperparathyroidism), your calcium levels can become too high and kidney stones may form as a result.
Hyperparathyroidism sometimes occurs when a small, benign tumor forms in one of your parathyroid glands or you develop another condition that leads these glands to produce more parathyroid hormone.
Prostate Laser Surgery
Prostate laser surgery is used to relieve moderate to severe urinary symptoms caused by an enlarged prostate — a condition known as benign prostatic hyperplasia (BPH). During prostate laser surgery, your doctor inserts a scope through the tip of your penis into the tube that carries urine from your bladder (urethra). The prostate surrounds the urethra. A laser passed through the scope delivers energy that shrinks or removes excess tissue that is preventing urine flow.
Lasers use concentrated light to generate precise and intense heat. There are several different types of prostate laser surgery, including:
- Photoselective vaporization of the prostate (PVP). A laser is used to melt away (vaporize) excess prostate tissue and enlarge the urinary channel.
- Holmium laser ablation of the prostate (HoLAP). This procedure is similar to PVP but uses a different type of laser.
- Holmium laser enucleation of the prostate (HoLEP). A laser is used to cut and remove the excess tissue that is blocking the urethra. Another instrument is then used to cut the prostate tissue into small pieces that are easily removed. HoLEP can be an option for men who have a severely enlarged prostate.
The type of laser surgery your urologist in Ghaziabad recommends will depend on several factors, including:
- The size of your prostate
- Your health
- The type of laser equipment available
- Your doctor’s training
Why it’s done
Prostate laser surgery helps reduce urinary symptoms caused by BPH, including:
- Frequent, urgent need to urinate
- Difficulty starting urination
- Slow (prolonged) urination
- Increased frequency of urination at night
- Stopping and starting again while urinating
- The feeling you can’t completely empty your bladder
- Urinary tract infections
Laser surgery might also be done to treat or prevent complications due to blocked urine flow, such as:
- Recurring urinary tract infections
- Kidney or bladder damage
- Inability to control urination or an inability to urinate at all
- Bladder stones
- Blood in your urine
Laser surgery can offer several advantages over other methods of treating BPH, such as transurethral resection of the prostate (TURP) and open prostatectomy. The advantages can include:
- Lower risk of bleeding. Laser surgery can be a good option for men who take medication to thin their blood or who have a bleeding disorder that doesn’t allow their blood to clot normally.
- Shorter or no hospital stay. Laser surgery can be done on an outpatient basis or with just an overnight hospital stay.
- Quicker recovery. Recovery from laser surgery generally takes less time than recovery from TURP or open surgery.
- Less need for a catheter. Procedures to treat an enlarged prostate generally require the use of a tube (catheter) to drain urine from the bladder after surgery. With laser surgery, a catheter is generally needed for less than 24 hours.
- More-immediate results. Improvements in urinary symptoms from laser surgery are noticeable right away. It can take several weeks to months to see a noticeable improvement with medications.
Kidney and Urologic Disease
- Kidney- Infection, Stone, Tumor, Congenital problems like UPJ obstruction, Cyst
- Ureter- Stones, Structure, Infection like TB, Ureterocele, Megaureter, Vesicoureteric reflux
- Bladder- Infection, Stone, Tumour, Diverticulum
- Prostate- Benign enlargement of prostate, Prostatitis, Cancer of prostate
- Urethra- Posterior urethral valve, Stricture urethra, Meatal stenosis,
- Testis-Infection, Torsion, Hydrocele, Cancer of testis
- Sexual inadequacy, impotence, premature ejaculation
- Male infertility
- Female urinary incontinence
- Kidney Failure
- Percutaneous Nephrolithotomy (PCNL)
- Ureteroscopic Removal of Stone ( URSL)
- Laser Optical Internal Urethrotomy (OIU)
- Laser Prostatectomy
- Hypospadias repair
- Laparoscopic Radical Nephrectomy
- Laparoscopic Pyeloplasty
- Microscopic Varicocelectomy
- Penile Implant
- Kidney Transplant
- Robotic Assisted Urological Procedures
What is a Pediatric Urologist?
If your child has an illness or disease of the genitals or urinary tract (kidneys, ureters, bladder), a pediatric urologist has the experience and qualifications to treat your child.
What Types of Treatments Do Pediatric Urologists Provide?
Pediatric urologists are surgeons who can diagnose, treat, and manage children’s urinary and genital problems. Pediatric urologists generally provide the following services:
- Evaluation and management of voiding disorders, vesicoureteral reflux, and urinary tract infections that require surgery
- Surgical reconstruction of the urinary tract (kidneys, ureters, and bladder) including genital abnormalities, hypospadias, and disorders of sex development
- Surgery for groin conditions in childhood and adolescence (undescended testes, hydrocele/hernia, varicocele).
- Evaluation and surgical management of kidney stone disease
- Surgical management of tumors and malignancies of the kidney, bladder, and testis
- Evaluation and management of urological tract problems identified before birth
- Evaluation and management of urinary tract problems associated with neurological conditions such as spina bifida.
Where Can I Find A Pediatric Urologist?
Today, pediatric urologists can be found in almost every state and in virtually all of the major cities in India.
Pediatric Urologists — The Best Care For Children
Children are not just small adults. They cannot always say what is bothering them. They cannot always answer medical questions, and are not always able to be patient and cooperative during a medical examination.
Pediatric urologists are trained to focus care on the special needs of children and their parents – even on potentially sensitive and embarrassing subjects related to genitalia and voiding problems. They know how to examine and treat children in a way that makes them relaxed and cooperative. In addition, pediatric urologists often use equipment specially designed for children. This helps create a comfortable and non-threatening environment for your child.
If your pediatrician suggests that your child see a pediatric urologist, you can be assured that he or she has the widest range of treatment options, the most extensive and comprehensive training, and the greatest expertise in dealing with children and in treating children’s urinary tract disorders.
What is urethral stricture?
The urethra is a tube that carries urine from the bladder so it can be expelled from the body.
Usually the urethra is wide enough for urine to flow freely through it. When the urethra narrows, it can restrict urinary flow. This is known as a urethral stricture.
Urethral stricture is a medical condition that mainly affects men.
What are the risk factors for urethral stricture?
Some men have an elevated risk of developing urethral stricture, especially those who have:
- had one or more STIs
- had a recent catheter (a small, flexible tube inserted into the body to drain urine from the bladder) placement
- had urethritis (swelling and irritation in the urethra), possibly due to infection
- an enlarged prostate
What are the symptoms of urethral stricture?
Urethral stricture can cause numerous symptoms, ranging from mild to severe. Some of the signs of a urethral stricture include:
- Weak urine flow or reduction in the volume of urine
- Sudden, frequent urges to urinate
- A feeling of incomplete bladder emptying after urination
- Frequent starting and stopping urinary stream
- Pain or burning during urination
- Inability to control urination (incontinence)
- Pain in the pelvic or lower abdominal area
- Urethral discharge
- Penile swelling and pain
- Presence of blood in the semen or urine
- Darkening of the urine
- Inability to urinate (this is very serious and requires immediate medical attention)
What are the treatment methods for urethral stricture?
Treatment depends on the severity of the condition.
The primary mode of treatment is to make the urethra wider using a medical instrument called a dilator. This is an outpatient procedure, meaning you won’t have to spend the night at the hospital. A urologist in Ghaziabad will begin by passing a small wire through the urethra and into the bladder to begin to dilute it. Over time, larger dilators will gradually increase the width of the urethra.
Another nonsurgical option is a permanent urinary catheter placement. This procedure is usually done in severe cases. It has risks, such as bladder irritation and urinary tract infection.
Surgery is another option. An open urethroplasty is an option for longer, more severe strictures. This procedure involves removing affected tissue and reconstructing the urethra. Results vary based on stricture size.
Urine flow diversion
In severe cases, a complete urinary diversion procedure may be necessary. This surgery permanently reroutes the flow of urine to an opening in the abdomen. It involves using part of the intestines to help connect the ureters to the opening. Urinary diversion is usually only performed if the bladder is severely damaged or if it needs to be removed.
Robotic surgery is a method to perform surgery using very small tools attached to a robotic arm. The surgeon controls the robotic arm with a computer.
We perform various types of urological procedure with the help of Robotic Assisted surgery
Robotic Surgery is the latest development in the medical field. This surgery is performed with the help of electro-mechanically controlled hands.
Typical problem related to Prostate, Kidney or Bladder, various types of surgical methods is available such as.
- Open Surgery
- Laparoscopy Surgery
- Robotic Surgery
In case of complex problems, surgeries such as prostatectomy, nephrectomy or cystectomy require dexterous approach, because the target is surrounded by complex nerves and organs which are tightly confined to the operating area.
In open surgery, the surgeon has to make a long scar to reach to the specific organ. This results in heavy blood loss lead to chances of infection and take a long time of recovery. Traditional laparoscopic surgery is also a good option to open surgery, but it limits the moments of a surgeon’s hand. In the case of complex surgery, there are chances that other organs get affected which leads to major complication.
Robotic Surgery is an advanced version of laparoscopic Surgeries. If we take the example of radical prostatectomy (Complete Removal of Prostate), then here the target (prostate) is delicate and tightly surrounded by the nerves affecting urinary control and sexual functions. Using the robots, the best robotic surgeon in Delhi has a better control to spare surrounding nerves, which may enhance recovery experience and clinical outcomes.
These are the Urologic Procedures which can be performed by the surgeon are :
- Prostatectomy (prostate cancer surgery)
- Partial Nephrectomy (kidney disease/cancer surgery)
- Cystectomy (Bladder Cancer)
- Pyeloplasty (Urinary Reconstruction Surgery)
Laparoscopic Urological Procedure
Laparoscopic surgery, also called minimally invasive surgery (MIS), or keyhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5–1.5 cm) as opposed to the larger incisions needed in laparotomy. Keyhole surgery makes use of images displayed on TV monitors to magnify the surgical elements. Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery.
There are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include reduced pain due to smaller incisions and less blood loss, shorter hospital stay, better cosmetic results and shorter recovery time. Patients are able to go back to work within 1-2 weeks.
Specific applications for benign diseases:
Laparoscopic simple nephrectomy
Virtually all harmless urologic problems happen to be impacted with laparoscopic surgery. Because Clayman’s first laparoscopic nephrectomy within 1990, laparoscopic simple nephrectomy is just about the most common urologic laparoscopic procedure. All benign conditions requiring nephrectomy happen to be handled laparoscopically. Although laparoscopic removals of small atrophic kidneys are ideally suited to the actual less experienced surgeon, simple nephrectomy remains among the great misnomers within urologic surgery.
Open donor nephrectomy has been a viable and safe option for more than 30 years but carries the morbidity of the relatively huge open incision and a long convalescence period. Insufficient living donor continues to be the main cause of ever increasing waiting list of renal transplantation recipients. Ratner within 1995 carried out the very first laparoscopic live donor nephrctomy, extracting the kidney via a 9 inch midline incision. Inside next 11 years, LDN became the gold standard.
There has been a rise in detection of adrenal incidentalomas. NIH consortium recommends excision of such masses if related to biochemical proof of pheochromocytoma, size more than 6 cm, masses more than 4 cm with rapid growth rate, or radiographic findings consistent with adenoma. Laparoscopic adrenalectomy was initially tagged by Gagner in 1992. Lots of data has since gathered to aid the use of transperitoneal or retroperitoneal laparoscopic approach for adrenalectomy as opposed to open surgery. The arguments against laparoscopic approach are longer operating time and higher hospital charges.
Ureteropelvic junction obstruction can be characterized by a functionally significant impairment regarding urinary transport, caused by obstruction in the area where the ureter joins the renal pelvis. Nearly all cases tend to be congenital; however, acquired conditions at the degree of the UPJ could also existing with symptoms and also signs of obstruction. Till recently, open up pyeloplasty and endoscopic techniques happen to be the primary surgical options with the intent of open complete excision, or endoscopic incision from the obstruction. Endoscopic antegrade or even retrograde visually managed incision of the ureteropelvic junction obstruction, or even radiologically managed incision don’t share the high effectiveness that results from open-surgical dismembered pyeloplasty.
Lymphocele complicates 1 to 12% of patients following renal transplantation. Lymphocele also complicates 1 to 10% of sufferers after pelvic lymphadenectomy, because done for proste cancer. Treating option is either percutaneous drainage as well as sclerotherapy, or even transpertoneal laparoscopic marsupialization from the lymphocele. Treatment with percutaneous drainage and sclerotherapy has high morbidity and a high recurrence rate. Hsu reported 91% success in support of 6% recurrence after treating 81 lymphoceles with laparoscopic marsupialization. Laproscopic treatment of pelvic and post transplant lymphoceles has become a preferred approach to management.
Repair of vaginal vault prolapse remains a surgical challenge irreapecive of abdominal, vaginal, and combined procedures being used to fix the problem. The ideal operation remains elusive with regard to outcomes, morbidity, and economics. Being an extension from the abdominal approach, laparoscopy is constantly on the gain favor being an access method, so that as a surgical advancement. Recent studies highlight a number of laparoscopic processes for restoration of apical support that demonstrate feasibility and encouraging results.
Vericocele is found in upto 15% of normal population, but the incidence is really as high as 40% in males with subfertility. Traditional approached for vericocele were retroperitoneal and inguinal. Microsurgical technique has lately been used for vericocele repair to decrease complications like hydrocele and damage to testicular artery, and to decrease the number of cases of vericocele recurrence.
Percutaneous renal biopsy might be contraindicated in some patients because of obesity, coagulopathy, solitary kidney or failed previous percutaneos biopsy. Options during these situations include open surgical biopsy, CT guided biopsy, transvenous biopsy and laparoscopic guided biopsy. Knowledge about laparoscopic renal bopsy has provided an abundant biopsy tissue compared to CT or transvenous biopsy with minimal morbidity in patients wherever percutaneous biopsy was contraindicated.
In addition to the general benefits of MIS, using laparoscopic procedures for oncologic applications must prove no compromise within the oncologic charge of the disease, whether positive surgical margins, incidence of intraoperative seedings while retrieving the specimen, or long term oncologic control. Histopathological margin positivity has not been higher with laparoscopic oncologic procedures. Long term oncologic control information is gradually appearing, and seems to be equivalent to open surgery. There’s been concern regarding seeding in urologic laparoscopy. In an international survey, the information from 19 institutions performing laparoscopic oncologic procedures was collected for 2,604 radical nephrectomies, 555 partial nephrectomies, 559 nephroureterectomies, 3,665 radical prostatectomies, 1,869 pelvic lymph node dissections and 479 retroperitoneal lymph node dissections. There were no cases of seeding from renal cell cancer despite over 3,400 procedures reported, and also the utilization of morcellation in 40% of the radical nephrectomies.
Nephrectomy and nephroureterectomy
Laparoscopic radical nephrectomy has significant smaller incision having a quick postoperative recovery with less minor and major complication rates than open surgical counterpart. Mean loss of blood is less with LRN. MIS benefits have certainly improved the caliber of life during these patients. As mentioned earlier there’s little risk of peritoneal contamination and port site metastasis after LRN for RCC despite morcellation of specimen before removal. Seems like, as stated earlier, that port-site seeding associated with LRN is an extremely rare and unlikely event, provided that strict surgical technique is applied as well as an entrapment sac is used for specimen removal.
For the incidental small renal lesion, elimination of the entire kidney by open radical nephrectomy or minimally invasive techniques may end up being more detrimental in the long run by leaving behind a limited nephron mass. Several studies have indicated that disease-free survival and oncologic connection between partial nephrectomy are equal to radical nephrectomy in carefully selected patients Regardless of the advantages laparoscopic partial nephrectomy enjoys over conventional open surgery when it comes to perioperative morbidity, blood loss, operative time, and hospital stay, the chance of bleeding and technical difficulty of intracorporeal laparoscopic suturing has prevented the widespread use of laparoscopic partial nephrectomy.
Laparoscopic Radical prostatectomy is of major interest to Urologist in East Delhi especially considering the incidence and clinical significance of prostate cancer. The process comprises several steps of challenging dissection where the preservation of delicate erectile nerves and external sphincter has to be coupled with safe tumor excision. The intervention ends with vesicourethral anastomosis, which is considered probably the most difficult reconstructive procedure in urologic laparoscopy. LRP has gradually been a standardized procedure, and it is now routinely performed all over the world. Data in the literature and available experience demonstrates that oncologic and functional results with LRP seem similar to those of classic open radical retropubic prostatectomy (RRP). In a comparison of LRP with RRP (n 180), the entire positive surgical margin rates were similar (16.9% vs. 20%), however, RRP had a greater positive apex margin rate.
Laparoscopic cystectomy and urinary diversion
Open radical cystectomy remains the defacto standard for nonmetastatic muscle-invasive bladder cancer. Regardless of being first described by Parra in 1992 for benign disease, and later used for invasive carcinoma in 1995 by Sanchez, use of laparoscopic cystectomy has been uncommon. Extensive experience of radical prostatectomy and urethrovesical anastomosis has grown the interest of urologists of late, including the utilization of robotic-assisted techniques. Laparoscopic radical cystectomy has been described as a feasible procedure and is still being evaluated. Gerullis and colleagues from Germany have described recently their initial knowledge about laparoscopic cystectomy with an extracorporeal assisted urinary diversion in 34 patients with a mean operating time of 244min, the mean blood loss of 325ml, along with a transfusion rate of 5.9%.
The danger of missing low-risk metastatic disease in additional than 30% patients despite undetected nodes on CECT abdomen proved the value of RPLND in nonseminomatous testicular tumors. Early open RPLND had significant morbidity during these young patients. With an increase of awareness regarding the disease pass on a pattern, the modified unilateral lymphadenectomy templates have significantly reduced morbidity with preserved ejaculation without compromising the efficacy. Laparoscopic RPLND using four trocars is a low morbidity alternative to open lymphadenectomy and it has been utilized in Oncology Institutions with laparoscopic skills with comparative lymph node positivity.