What Happens On Surgery Day
Your surgeon will give you specific instructions on what to do with your medications and diet before the date of your procedure. Most laser kidney stone treatments are done on an outpatient basis, so you can go home the same day.
You will have general anesthesia, so you will sleep through surgery. This helps make sure that you are still when the small instruments are inside your body. Newer lasers are precise and powerful which can make it easier for the surgeon to control and fragment the stone. This helps reduce the time of your surgery, so you can spend less time asleep and get back to your normal routine faster.
How Common Are Kidney Stones
Researchers have concluded that about one in ten people will get a kidney stone during their lifetime. Kidney stones in children are far less common than in adults but they occur for the same reasons. Theyre four times more likely to occur in children with asthma than in children who dont have asthma.
How Long Will You Bleed After Kidney Stone Surgery
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Purpose Of Kidney Stone Surgery
The purpose of kidney stone surgery is to remove a stone in order to reduce symptoms and/or reverse a medical condition associated with the presence of the stone .
Specific indications for kidney stone surgery include:
- Ureteral stones greater than 10 mm
- Uncomplicated distal ureteral stones less than 10 mm that have not passed after four to six weeks of observation
- Symptomatic kidney stones without any other explanation for the patient’s pain
- Ureteral or kidney stones in pregnant women that have not passed after an observation period
- Persistent kidney obstruction related to stones
- Recurrent urinary tract infections linked to stones
Aside from the above indications, emergency surgery to remove a kidney stone may be warranted in the following cases:
- If the flow of urine from both kidneys is blocked and there is acute kidney injury
- If a patient has acute kidney injury from an obstructing stone and only one functioning kidney
- If a patient has an obstructing stone and a urinary tract infection
How To Prepare For Kidney Stone Surgery
When we meet with you, we will give you specific instructions to prepare for your surgery. They may include the following.
- Stop smoking, if you smoke, well in advance of surgery.
- Stop taking certain medications that can make it hard for your blood to clot, such as blood thinners like Coumadin, Plavix, Xarellto, and the like.
- Do not eat or drink anything after midnight prior to your surgery.
- Make sure you have someone to drive you home after your procedure.
We may also place a stent in your ureter up to a few weeks prior to your surgery. This stent, which is completely internal, allows your ureter to dilate or enlarge and makes stone removal easier. Stents may also relieve acute pain from a stone, enable any infection to drain, and allow antibiotic treatment before surgery.
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What Is A Kidney Stent
After kidney stone removal, a soft and thin tube-like stent with J-shaped endings is placed extending from the kidney to your urinary bladder. That is why it is called a double-J stent .
The J-shape of the endings of stent helps to prevent displacement and also ensures unobstructed passage of urine into the bladder.
This stent is supposed to be removed by 3 months duration by undergoing a minor cystoscopy procedure.
The stents are made of pellethane or blended polymers of polyutherane
How Do I Know If My Kidney Is A Match For The Recipient
The transplant team will check your blood type as well as the recipient blood type to see if they are compatible. A unique blood test also needs to be done which is called crossmatch.
It is possible that the recipient of the kidney has an allergy to the donated kidney so the recipients body may reject the donated kidney. Such allergy is due to some substances called antibodies which are present in the recipients blood. In order to make sure that the recipient does NOT have those antibodies against your kidney tissue, the crossmatch test is performed. Briefly, a sample of your blood is combined with a sample of the recipients blood. If the recipient has antibodies to the donor, this will cause a positive reactivity during the crossmatch test. This may mean your recipient is incompatible to you. In the case that you and your recipient are not compatible, you may participate in UCLAs Kidney Exchange Program. This program allows the recipient and donor to enter a paired exchange registry, where the donor will donate to another recipient that is matched, and the recipient will recieve a matched kidney from a compatible donor in return.
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How Are Kidney Stones Diagnosed
Your healthcare provider will discuss your medical history and possibly order some tests. These tests include:
- Imaging tests: An X-ray, CT scan and ultrasound will help your healthcare provider see the size, shape, location and number of your kidney stones. These tests help your provider decide what treatment you need.
- Blood test: A blood test will reveal how well your kidneys are functioning, check for infection and look for biochemical problems that may lead to kidney stones.
- Urine test: This test also looks for signs of infection and examines the levels of the substances that form kidney stones.
How Can I Prevent Kidney Stones
There are several ways to decrease your risk of kidney stones, including:
- Drink water. Drink at least six to eight 8-ounce glasses every day . Staying hydrated helps you urinate more often, which helps flush away the buildup of the substances that cause kidney stones. If you sweat a lot, be sure to drink even more.
- Limit salt. Eat less sodium. You may want to connect with a dietician for help with planning what foods you eat.
- Lose weight. If youre overweight, try to lose some pounds. Talk to your healthcare provider about an ideal weight.
- Take prescriptions. Your healthcare provider may prescribe some medications that help prevent kidney stones. The type of medication may depend on the type of stones you get.
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What Happens During A Ureteroscopy
Once the anesthesia takes effect and youâre asleep, your urologist will insert the tip of the ureteroscope into your urethra .
Once the ureteroscope is in the bladder, your urologist releases a sterile solution through the tip of the scope. This fills the bladder so its walls can be seen more clearly. They then gently guide the scope into a ureter. If there is a concern about a kidney, the scope can be moved all the way up into that organ.
It may take up to 30 minutes for them to observe your urinary tract. If a procedure is done to remove or break up a stone, or to take a tissue sample for a biopsy, the ureteroscopy may take longer.
A ureteroscopy that uses a laser to break up small kidney stones may take about 90 minutes. The type of laser used with the ureteroscope is called a âHolmium laser.â A similar procedure uses a tiny basket at the end of the scope to grab and remove a stone.
Who Needs A Ureteroscopy
If you have undiagnosed urinary tract problems, such as urine blockage, a ureteroscopy can help identify the problem.
When you see a doctor because it hurts to pee and youâre not going as often as you should, you may or may not need this procedure. It will depend on your symptoms and what other tests show.
Doctors sometimes use ureteroscopy as part of shock wave lithotripsy, a treatment to break up kidney stones. This is most helpful for:
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What Tests Do I Need During The Evaluation Process
During your evaluation, the transplant team will complete urine and blood tests to assess your kidney function, blood chemistries, blood cell counts, liver function and exposures to infections such as Hepatitis B, Hepatitis C, HIV and tuberculosis. An electrocardiogram needs to be performed to assess the heart. Chest X-ray and abdominal CT scan are the required imaging studies. Other tests such as heart exercise test and cancer screening might be required.
How Long Is A Typical Recovery After Kidney Stone Surgery
Recovery times for kidney stone surgeries range from two days to six weeks depending on the type of surgery the patient has, according to the Urology Care Foundation. Patients who undergo shock wave lithotripsy and ureteroscopy procedures are able to return to normal activities within two to three days.
Patients who undergo invasive kidney stone procedures, such as percutaneous nephrolithotomy and open surgery, must stay in the hospital for as little as overnight and as long as a week, as stated by the Urology Care Foundation.
Shock wave lithotripsy is the treatment used most often for kidney stones, according to the Urology Care Foundation. It involves a noninvasive procedure that requires the patient to lie on a soft cushion connected to a machine that sends ultrasonic shock waves through the skin into the kidneys and stones. The procedure shrinks the stones to the size of sand particles, and the patient is able to leave afterward.
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What Are Percutaneous Nephrolithotomy And Percutaneous Nephrolithotripsy
These procedures are treatments for kidney stones that are used in patients with large or irregularly shaped kidney stones, people with infections, stones that have not been broken up enough by SWL or those who are not candidates for another common stone treatment, ureteroscopy. Stones that are bigger than 2 cm require this procedure.
Both procedures involve entering the kidney through a small incision in the back. Once the surgeon gets to the kidney, a nephroscope and other small instruments are threaded in through the hole. lf the stone is removed through the tube, it is called nephrolithotomy. lf the stone is broken up and then removed, it is called nephrolithotripsy. The surgeon can see the stone, use high frequency sound waves to break up the stone, and “vacuum” up the dust using a suction machine.
This is what the words mean:
- Percutaneous means through the skin
- Nephrolithotomy is a combination of the word roots nephro- , litho-, and -tomy
- Nephrolithotripsy is a combination of the word roots nephro- , litho , and -tripsy
What Does A Full Evaluation Involve
Financial consultation Psychological evaluation Medical Tests
- Medical history. You will be asked to give a complete and thorough history of any illnesses, surgeries, and treatments youve had in the past. You will also be asked about your familys medical history. If any problems or abnormalities are found, they will be investigated further.
- Physical exam. You will be given a physical examination to make sure you are healthy enough to donate a kidney.
- Chest X-ray and electrocardiogram . These tests are done to check for heart or lung disease.
- Radiological testing. These tests allow physicians to look at your kidney, including its blood vessel supply.
- Urine testing. A 24-hour urine sample is collected to make sure you have good kidney function.If it is found that your kidney function is low, they will most likely advise against donation.
- Gynecological examination. Female donors may need to have a gynecological exam and mammography.
- Cancer screening. You may also be given some cancer screening tests, which may include a colonoscopy, prostate exam, and skin cancer screening.
Compatibility TestsOther Blood Tests
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Do I Need Surgery For Removal Of Stone
This depends on the location, size of the stone and the damage it is causing to our kidneys. A small stone of size 6 mm or less, which is in the urinary tube not causing much of swelling of the kidney, can be managed medically. You will not require surgery but you have to be under medical supervision.
Small kidney stones of size 5 mm also do not require surgery for removal, until and unless they come down and get stuck in the tube . Larger stones in the ureter causing swelling of the kidney or infection require immediate removal by ureteroscopy and Holmium LASER.
According to Dr. Anupam Bhargava, small obstructing stones in the kidney also require removal by either Shock waves i.e. crushing the stone from outside. Though this method is not so effective in stones of our region because they are hard calcium stones. The other method is by going to the kidney through ureter with flexible scope and crushing the stones with Holmium LASER. This method is called Rentrograde Intra Renal Surgery . Large kidney stones can be removed by a small whole through the skin. This method is called Per Cutaneous Nephro Lithotripsy . Now a days it is extremely rare to do open surgery for kidney stones.
Some Measures To Prevent Recurrent Kidney Stone Formation Are:
There are plenty of ways mentioned above to enhance the process of recovery and reduce the amount of discomfort and pain after kidney stone removal and stent.Yet, you need to contact your doctor immediately if you experience unusual pain or fever not responding to medications and bleeding during urination.
Dr. Himanshi is a Homoeopathic consultant and currently working as a lecturer in Post-graduate faculty of Homeopathy, Parul University, Vadodara. Completed BHMS and MD in Homeopathy in January 2018 and also has a clinical experience of about 6 years. Personal interests include reading, spending time with family and traveling.
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Is There Any Way To Make Them Pass Faster
The best home remedy to encourage the stone to pass is to drink lots of fluids, especially plain water and citrus juices such as orange or grapefruit. The extra fluid causes you to urinate more, which helps the stone move and keeps it from growing. You should aim for at least 2 to 3 quarts of water per day.
Smaller stones are more likely to pass on their own, so you should take steps to keep the stone from growing. This includes eating a diet thats low in salt, calcium, and protein.
However, you need all of these for your body to function properly, so talk with your doctor about an appropriate diet to help you pass the stone.
Passing a kidney stone can be very painful. Taking pain medication such as ibuprofen wont speed up the process, but it can make you a lot more comfortable while passing the stone. A heating pad can also help.
If you have a fever, significant nausea, or are unable to keep down liquids without vomiting, you should seek medical care.
Likewise, if you have only one kidney or known kidney problems or damage, see a doctor immediately.
An infected kidney stone is a surgical emergency. If you notice any signs of infection, go to the hospital.
What Causes Kidney Stones
Kidney stones are formed from substances in your urine. The substances that combine into stones normally pass through your urinary system. When they dont, its because there isnt enough urine volume, causing the substances to become highly concentrated and to crystalize. This is typically a result of not drinking enough water. The stone-forming substances are:
- Cloudy, foul-smelling urine, fever, chills or weakness which might be a sign of a serious infection.
- Blood in the urine.
Most pediatric kidney stones remain in the kidney, but up to a third may migrate from the kidney and get stuck in a ureter. Stones that remain in the kidney, although often painless, can be the source of recurrent urinary tract infections. Those that lodge in the ureter can create severe colicky pain.
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Limit Your Exposure To Germs
Dont have a large number of houseguests during the first 6-8 weeks after surgery. Ask family members and friends who may have colds or infections to stay away. Keep preschool children at arms length, especially if they are in daycare where other children may be sick or infected. Avoid eating from salad bars as they can harbor bacteria.
How Will I Find Out If A Kidney Is Available For Me
If a kidney becomes available from a deceased donor, you will get a phone call from the transplant center asking you to come to the hospital right away. It is therefore very important that you are always reachable by phone. If you intend to travel, tell your transplant team about your travel plans.
When you arrive at the hospital, you will have blood tests to make sure that the kidney is a good match for you. Sometimes people get to the hospital and, after having these tests, have to return home because the donor kidney is not a good match. The transplant could also be canceled if the doctors discover something wrong with the donor kidney. If you are called to the transplant center and then cannot have a transplant, try not to be discouraged. You might get another call soon!
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