How Does Laser Stone Surgery Work
The surgery is minimally invasive and requires no incisions on your body. Once you are asleep, a small lighted instrument is placed into your urethra and bladder to access your ureter and kidney.
Once the stone is seen, a laser fiber is used to transmit Holmium energy to break up your kidney stones. The surgeon removes some pieces through the urethra with a small basket, and smaller pieces can be passed later with urination. The surgeon may also use a high-powered holmium laser with high-frequency emissions that “dust” the stones into a fine powder. You can then pass the fine particles in your urine after surgery. An even more efficient way of transmitting the holmium laser is by modulating the pulse using the Moses effect, which may result in more efficient stone dusting or fragmentation.
The surgeon will likely insert a tube called a stent between the kidney and urethra. This promotes healing and lets small stone fragments pass more easily. Most importantly, this stent allows your kidney to drain during the healing process. The stent is removed about 1 week after surgery. The length of surgery is generally under 1 hour, depending on the size and number of your kidney stones. Use of the dusting technique combined with the Moses effect may decrease the need to remove stones with a basket, thereby minimizing the need to use a stent.
Laser Settings And Technique
All the aforementioned settings and modalities relate to contact lithotripsy, which constitutes the first stage of the lithotripsy procedure. However, when numerous smaller fragments result, which are still big enough to need treatment, but too time-consuming to chase individually, a second stage non-contact lithotripsy can be performed. The aim of non-contact lithotripsy is to pulverize these fragments and allow their spontaneous passage , preferably in a smaller and enclosed space such as a calix to increase the efficiency . Two different techniques can be employed. One is the pop-corn technique, whose optimal settings have been confirmed by using a higher pulse energy , usually associated with a high-frequency , long-pulse mode, as well as a small-diameter laser fiber, and taking as much time as possible to produce clinically insignificant fragments . The other one is the pop-dusting technique, quite similar to the pop-corn technique but using a lower pulse energy , resulting in finer fragments without compromising fiber tip burn-back .
Ureteroscopy Procedure Involves Looking In The Ureter And Kidney With A Small Camera
Most of the time, fragmentation of kidney stones with laser is performed during ureteroscopy or uretero-pyeloscopy procedure. Once patient goes to sleep, a small camera is introduced into the urethra and then into the urinary bladder. Semirigid or flexible ureteroscope is then advanced to kidney or ureteral stone which may be located in the ureter or in the kidney. Once kidney stone is visualized by the surgeon, the laser is activated and is brought into direct contact with the stone. Kidney stone is fragmented into very small pieces 1-2 mm in diameter using Holmium laser. At this point, fragments may be retrieved by the surgeon for biochemical analysis.
The end of the procedure, most of the time, a ureteral stent which is a small plastic tube is positioned between the kidney and the bladder in order to allow proper healing after the procedure. While some patients may not even know they have a ureteral stent, other patients may experience stent pain. Stent pain typically occurs during urination as the urine is pushed back into the kidney.
Many patients who work in jobs that are not physically demanding may go back to routine activities the next day after the procedure. The ureteral stent is typically removed in the office, usually within 1-2 weeks after the procedure but may be left for longer after complex procedures.
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Get Rid Of Kidney Stones With Scarless Laser Treatment
Retrograde Intrarenal Surgery is an endoscopic surgery performed to remove renal stones. The procedure is done using a flexible ureteroscope, which is placed through the urethra into the bladder and then through the ureter into the kidney . Through this device, a laser fiber is used to treat the stones.
How kidney stones are treated with RIRS?
The ureteroscope has a small camera fitted at its end which is used to inspect the kidney stones. A monitor screen present in the surgery room displays the entire anatomy of the patients kidney captured by the ureteroscope. Through an ultrasound wave or a laser probe, the stones are crushed into fine powder or pieces. These fine pieces can pass easily through the urination process.
What are the advantages of RIRS over older techniques like PCNL ?
RIRS is definitely less invasive than older techniques like PCNL, laparoscopic or open surgery as it is completely scarless. Because we enter the kidney passing through normal urinary tract and there is no need to make any cuts on skin or hole into the kidney , there is lesser risk of severe bleeding, hospital stay is very short , there is markedly shorter period of recovery and patient can very soon get back to his normal routine.
Who can perform RIRS?
RIRS is performed by a urologist with special expertise in RIRS.
What is the advantage of using a high power laser in RIRS?
Is a stent required to be placed after RIRS? Is it a permanent stent?
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.
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How Do I Know That I Have Kidney Stones
Patients often present with symptoms, such as the following:
- Pain during urination
- You have cloudy and foul-smelling urine
- Severe pain in the side and back
- Shooting pain down the groin and legs
- Fever if an infection is present
On occasions, kidney stones may stay within the kidney and do not cause any blockage or pain.
What Is Ursl Surgery Cost In India
The average cost of Ureterorenoscopic Lithotripsy in India is approximately Rs. 68,700 . However, ursl procedure cost in India may vary depending upon the different hospitals in different cities.
URSL surgery cost in Hyderabad ranges vary from Rs 45,000 to 65,000 . However, ursl procedure cost depends upon the multiple factors such as hospital, room selection and insurance or corporate approvals for cashless facility.
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When Should You Call For Help
anytime you think you may need emergency care. For example, call if:
- You passed out .
- You have chest pain, are short of breath, or cough up blood.
or seek immediate medical care if:
- You have pain that does not get better after you take pain medicine.
- You have new or more blood clots in your urine.
- You cannot urinate.
- You have symptoms of a urinary tract infection. These may include:
- Pain or burning when you urinate.
- A frequent need to urinate without being able to pass much urine.
- Pain in the flank, which is just below the rib cage and above the waist on either side of the back.
- Blood in the urine.
What Is Lithotripsy Cost In India
The average cost of Extracorporeal Shock Wave Lithotripsy in India is approximately Rs. 65,500 . However, lithotripsy cost in India may vary depending upon the different hospitals in different cities.
Lithotripsy cost in Hyderabad ranges vary from Rs. 40,000 to Rs. 55,000 . However, Extracorporeal Shock Wave Lithotripsy cost depends upon the multiple factors such as hospital, room selection and insurance for cashless facility.
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What Are The Side Effects Of Kidney Stone Laser Treatment
As such, if performed meticulously there is zero side effects of kidney stone laser treatment. So we do not have any side effects with these treatments, and almost all the procedures are 100% curative. Unless there are some interaoperative setback like, if at all the laser burns the mucosa of the ureter or the kidney then the chances of bleeding or the stricture formation are the possibilities and even sometimes when there is infection prior to surgery, if the urine culture is positive when we go ahead with the kidney stone laser treatment. So ideally we are supposed to perform urine culture and treat the culture accordingly and then go ahead with the stone treatment. Other side effects such as stricture urethra or bleeding can be avoided if the procedure is done meticulously.
Laser Operation For Kidney Stones
Soltive SuperPulsed Laser System , the first major innovation in fiber laser technology in the past twenty years, has been generating.
The removal of kidney stones with a laser is performed if the patient has the following indications: Often recurrent renal colic or non-occlusive colic. The main condition for carrying out the operation is a diagnostically proven presence of calculus in the kidney.
Laser surgery is also used to break up kidney stones that are stuck in the kidney, ureters, or bladder, that laser is called a Holmium laser. Miami urologists Dr Alan Nieder and Dr Fernando Bianco both perform the green light laser procedure for enlarged prostate and the Holmium laser procedure for kidney stones.
A PNCL procedure is a key-hole surgery which is performed to treat larger and more complicated kidney stones. This takes place under general anaesthetic, and is.
The catheter will remain in place for around one to three days after the operation TURP may also be performed to treat or prevent any further complications as a result of blocked urine flow, including recurring UTIs, kidney and bladder damage, bladder stones, blood in the urine and difficulties in urination. Laser prostate surgery
ureteroscopy and laser stone fragmentation This is a commonly performed procedure to eliminate urinary tract stones from the ureter or the kidney. It is a very safe and precise procedure with a very low complication rate and a high success rate.
Percutaneous nephrolithotomy .
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Ureteroscopy And Laser Lithotripsy
Kidney stones affect 1 in 500 Americans each year, causing significant pain and healthcare expense.
Surgical options for patients with symptomatic kidney stones include extracorporeal shock wave lithotripsy , ureteroscopy, and percutaneous nephrolithotomy . Your renal anatomy, stone composition, and body habitus all play major roles in determining outcomes and operative approach.
The role of ureteroscopy over the last ten years has undergone a dramatic evolution, due to improvements in the ureteroscope size and deflection capabilities, video-imaging, miniature baskets and instruments, and in lithotripsy with the advent of holmium laser. Over 25% of all kidney stone surgeries are now done using small ureteroscope technology.
Percutaneous Nephrolithotomy Or Percutaneous Nephrolithotripsy
If your stone is large or lithotripsy doesn’t break it up enough, this surgery is an option. PCNL uses a small tube to reach the stone and break it up with high-frequency sound waves.
You will be given something so that you wonât be awake during this surgery. Your surgeon will make a small cut in your back or side and place a thin scope into the hole.
The surgery can be done in one of two ways:
Nephrolithotomy: Your surgeon removes the stone through a tube
Nephrolithotripsy: Your surgeon uses sound waves or a laser to break up the stone and then vacuums up the pieces with a suction machine.
The surgery takes 20 to 45 minutes. You’ll typically have to stay in the hospital for a day or two afterward. Usually, a stent will have to stay in your kidney for a few days to help urine drain.
Your doctor might do an X-ray or ultrasound a few weeks later to see whether any parts of the stone are left. They might also send the stone fragments to a lab to find out what they’re made of.
Risks from this surgery include:
- Infection
- Damage to the bladder, bowel, ureter, kidney, or liver
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What Is Laser Kidney Stone Surgery
If the stone is larger and cannot dispose while urination and gets stuck in the urinary tract, then surgery becomes the obvious choice.There are different kinds of procedures available to treat the problem and one such treatment procedure is the Laser Kidney Stone Surgery.removal of the stonesAn advanced and more powerful energy can be employed to break the stone to dust or powder. This too shall pass through the urine.Read : Kidney Stone Treatment During Pregnancy
Risks And Side Effects
People often experience bruising and soreness after shock wave lithotripsy.
Fever or chills may occur after ureteroscopy and shock wave lithotripsy. These may indicate an infection, so a person should speak with a doctor if they experience fever or chills.
Heavy bleeding after lithotripsy is uncommon.
If stone fragments get stuck, there may be a blockage in the ureter. If this is the case, a doctor may perform an additional procedure with a ureteroscope to remove the fragments.
Prolonged pain may also indicate a blockage. If a person has severe pain or does not get relief from taking pain medications, they should contact a doctor.
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Laser Treatment For Kidney Stones
Laser treatment is now very effective in clearing kidney stones. A miniature camera, in the form of a tiny black tube , can be passed up through the ureter, to the kidney by following the passage of the urinary tract. In this way, there is no cutting involved in the operation. The procedure is carried out under general anaesthesia.
The endoscope allows the surgeon to see where to direct the laser to blast the kidney stones. The laser can be set to blast the stones into a tiny powder or into chunky fragments. Stones that are broken down into powder can be drained naturally, passing through the urine. The stones broken into chunky fragments can be removed by a special miniature grasping basket.
With the latest laser equipment, a skilled surgeon can remove all the kidney stones in over 90% of cases in just one session and render the patient stone-free.
Risk Factors Of Kidney Stones
A family history of forming kidney stones puts you at higher risk for developing them yourself. If you have suffered from gout, constant UTIs, or some other hereditary disease, you may also be more likely to form stones that dont pass easily. Certain foods, such as dairy and highly acidic foods, are thought to aid in the forming of these mineral deposits. If you have risk factors for developing kidney stones, make sure you drink lots of water to keep everything moving through your urinary tract more easily and prevent the deposits from sticking together to form stones.
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Anyone Who Has Suffered From A Kidney Stone Will Tell You That The Pain From Passing One Is Excruciating
Kidney stones are a common occurrence, sending over three million Americans to the doctor each year. These buildups of minerals within the kidneys can be harmless and pass unnoticed when you urinate.
When they are too large to pass, they may become painful and necessitate treatment.
What Causes Kidney Stones In A Healthy Person
Did you know that more men suffer from kidney stones than women?
While thats an established fact, there are other conditions that can lead to formation of Kidney stones in another wise healthy individual.
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Are There Any Complications Related To The Surgery
- Stent pain is the most common form of complaint which the patients have post surgery. The stent rubs on the inside of the bladder which causes discomfort while urinating.
- Residual stones are found even after the surgery. Thus it is very important to have a clear idea about the procedure and the results before indulging in the surgery.
- There may be instances of ureteral injury.
- Infections may develop post surgery which can be treated with medications including antibiotics.
What To Expect At Home
It is normal to have a small amount of blood in your urine for a few days to a few weeks after this procedure.
You may have pain and nausea when the stone pieces pass. This can happen soon after treatment and may last for 4 to 8 weeks.
You may have some bruising on your back or side where the stone was treated if sound waves were used. You may also have some pain over the treatment area.
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Extracorporeal Shock Wave Lithotripsy
All shock wave lithotripsy machines deliver shock waves through the skin to the stone in the kidney. Most but not all of the energy from the shock wave is delivered to the stone.
Stone size is the greatest predictor of ESWL success. Generally:
- stones less than 10 mm in size can be successfully treated
- for stones 10 to 20 mm in size, additional factors such as stone composition and stone location should be considered
- stones larger than 20 mm are usually not successfully treated with ESWL.
Stones in the lower third of the kidney can also be problematic because, after fragmentation, the stone fragments may not be cleared from the kidney. Due to gravity, these fragments dont pass out of the kidney as easily as fragments from the middle and upper thirds of the kidney.
Obesity also influences whether ESWL treatment will be successful. The urologist will calculate the skin-to-stone distance to help determine whether this treatment is likely to be effective.
The possible complications of ESWL include: