Division of Stone Disease
Initial treatment will focus upon the relief of pain. After this, the next step will be to facilitate the passage of the stone or the removal of the stone itself.
80-90% of all stones smaller than 5 mm will pass out on their own. If the stone is smooth, even stones of 7-8 mm may pass out on their own.
Stones larger than this will invariably need to be removed by one of the many methods available. If there is an anatomical abnormality, the priority will be to correct that abnormality while removing the stone.
1-2 cm solitary stones in the kidney can preferably be treated by ESWL. This is a method by which the stone is powdered when pressure waves from a machine are focused on the stone. The stone fragments will then pass out in the urine stream over a period of 1 to 12 weeks.
Larger stones in the kidney are preferably removed by PCNL. In this method, the patient needs to be admitted to the hospital. A small puncture is made from the back directly into the kidney, the stone is identified, fragmented and completely removed.
Stones lower down in the urinary tract may be treated either by ESWL or again, by endoscopic methods. In this, the stone is visualised and fragmented by passing a small endoscope into the urinary tract from outside.
Open surgery for stones in the ureter is used only in complicated cases.
Uric acid stones, which are generally seen only on the ultrasound, and not on the x-rays, if less than 1 cm, can easily be dissolved by simple alkalinisation of the urine.
Rare complications include persistent uncontrolled bleeding due to arteriovenous malformations or pseudo-aneurysms (0.4%), which would need secondary procedures or even a nephrectomy to control the same. When a supracostal puncture (above the 12th rib) is made, complications would then include pneumothorax (commonly called collapsed lung caused due to the accumulation of air or gas in the space surrounding the lungs) or fluid accumulation in the thorax. Again, the incidence of these is only 0-4%.
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