Causes
Kidney stones are more common in men. They can result from congenital structural abnormalities of the kidney, insufficient fluid intake, genetic factors, congenital diseases (such as cystinuria, hyperoxaluria, hypercalciuria, hyperuricosuria), previous intestinal surgery, hyperparathyroidism, gout, and sarcoidosis.
Symptoms
– Pain (in the flank, groin, or sometimes the abdomen)
– Nausea and a feeling of abdominal bloating
– Blood in the urine
– Frequent urination
– Difficulty urinating
Diagnosis
– CT Scan
– Ultrasound
Treatment
The treatment plan is determined by the location, size, and hardness of the stones, as well as the congenital anatomical structure of the kidney.
1. What is ESWL?
Extracorporeal Shock Wave Lithotripsy (ESWL) uses shock waves from a device outside the body to break stones into small pieces under X-ray guidance. It is most successful for soft stones up to 1 cm in size located in the middle and upper parts of the kidney. ESWL also plays an important role in treating small residual fragments after Percutaneous Surgery.
2. What is Percutaneous Nephrolithotomy (PNL, PCNL)?
This minimally invasive surgery is performed under X-ray or ultrasound guidance. A pencil-sized hole is made in the flank region, allowing a video camera to access the kidney and stones. The stones are then fragmented and removed. A small segment of this procedure can be seen in the following video.
You can read our study on Percutaneous Surgery, published in an international journal, via the following link:
[Link](http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ArtikelNr=253406&Ausgabe=253867&ProduktNr=231997).
Who is Suitable for Percutaneous Surgery (PNL or PCNL)?
Experienced surgeons can perform Percutaneous Surgery for kidney stones larger than 1-1.5 cm, regardless of their location or size. For very large stones, a tube may be left in the kidney, and a second surgical session may be needed to remove the remaining stones a few days later.
Pre- and Post-Surgery Course for Percutaneous Surgery
Patients are admitted to the hospital early in the morning on the day of surgery on an empty stomach. After completing the necessary tests, the surgery is performed under general anesthesia. A nephrostomy tube is placed in the kidney and a catheter in the urinary tract, which are usually removed on the first or second day post-surgery. About 98% of patients can go home on the third day.
Since there is no need to cut through muscles to access the kidney and stones, as in traditional open surgery, post-operative pain is minimal, and patients can return to normal life within 1-2 days. Additionally, there is no risk of incision hernia (incisional hernia) that can occur after traditional open surgery.
RIRC (RIRS)- What is Retrograde Intra Renal Surgery?
This surgical technique has gained popularity over the past 10 years. It involves accessing the kidney through the urinary tract with a flexible ureterorenoscope, a device that can navigate inside the kidney. Using a video camera, the stones are visualized and fragmented using a laser energy source. Since the surgery is performed through the body’s natural opening, there is no need for incisions. This technique requires specialized training and experience.
Who is Suitable for RIRC?
We successfully apply this technique to stones up to 2-2,5 cm in size in the kidney and stones in the upper part of the ureter. It is ideal for very obese patients and those prone to bleeding due to medication or other reasons, as there is no need for an incision.
For stones in the lower part of the ureter, we use a method called URS, where we enter the urinary tract with a camera and fragment the stones. Stones in the upper part of the ureter can only be treated with the RIRC method.
Post-Operative Course for RIRC
The surgery is performed under general anesthesia. After the surgery, a catheter is usually placed in the urinary tract and removed the next day or the day after. Since there are no incision wounds, patients can return to their normal lives immediately.