Kidney stones are the final result of a conglomeration of crystals that form from urinary salts. They can be caused through heredity, medications, diet, or even geographical location.
Stones can grow to a significant size within the kidney, where they are usually not a problem, but if they begin moving down the ureter they become problematic. When this happens, blockage of the urine flow can occur, resulting in significant flank and abdominal pain, blood in the urine, and sometimes fever. Initial treatment for the symptoms of acute stone-related episodes includes hydration, pain control and the treatment of any associated infection.
While kidney stones probably cannot be prevented, the risk of forming a stone can be minimized by keeping hydrated. Keeping the urine diluted will not allow the chemical crystals to come out of solution and form the nidus of a stone. Making certain that the urine remains clear and not concentrated (yellow) will help minimize stone formation.
For patients with larger stones or stones that fail conservative management, surgical intervention is required. Renal and ureteral stone surgical procedures may include, but are not limited to, shock wave lithotripsy (SWL), ureteroscopic laser fragmentation utilizing a Holmium laser, and percutaneous nephrolithotomy (PNL) treatment through a single, small 1 cm "keyhole" incision. Most stone surgery treatments are now performed in the outpatient setting or during a 23-hour admission stay.
Ureteroscopic laser fragmentation with the Holmium laser is a form of lithotripsy that uses a laser mounted on the end of a fiberoptic scope. The scope is inserted into the patient's body through the urethra and bladder up to the ureter. Once the scope is advanced to the level of the stone, the laser is turned on and the stone is pulverized.
The advantages of uteroscopic laser fragmentation surgery over shock wave lithotripsy are that there is a higher first-time rate of success with laser surgery than with shock wave lithotripsy methods, and the laser is more effective on complex stones, while the shock wave method is more effective on single stones. Patients can resume their daily routine within one to two days of the procedure.
Ureteropelvic Junction (UPJ) Obstruction
Ureteropelvic junction obstruction is a blockage at the junction of the ureter and the kidney. This results in decreased flow of urine to the ureter and an increase of fluid pressure inside the kidney, which can cause a decrease in kidney function. UPJ obstruction can be either congenital (the patient is born with it) or it can develop over time due to trauma or change in body shape with age. The blockage can be caused by scar tissue, kinking, a blood vessel and in rare cases a tumor. Infection can occur in association with the obstruction, with patients becoming quite ill and having high fevers. This condition may require hospitalization, emergency drainage of the urine and treatment with intravenous antibiotics. In some instances, the condition is incidentally detected by scans or x-rays for unrelated problems.
While conventional open surgery has been the treatment for UPJ obstruction, newer, less invasive treatment options have been developed.
Endopyelotomy uses a telescope or balloon with an electric wire on it, which is passed to the level of the kidney. The scar tissue is then cut open from the inside. These procedures can be done in a short period of time as an outpatient, with minimal anesthetic and with a much shorter recuperation than with open surgery.
Laparoscopic pyeloplasty is a minimally invasive surgery using laparoscopic instruments and several small incisions to remove scarring or obstruction without the need for a large incision as in conventional open surgery. Postoperative pain is less, recuperation is quicker, and scarring is minimal when compared with open surgery.