Removal of kidney stones.
Kidney stones that do not exceed the size of 5mm may need no  treatment, since in many cases they manage to pass through. However, larger stones may need to be removed, especially if they are the cause of frequent incidents of renal colic, presence of blood in urine (hematuria), urinary track infections or hydronephrosis.
In the past, an open surgery used to be the only option for a kidney stone removal. Nowadays, this method is hardly used, since it involves a prolonged very painful post-operational period, the remaining of a long scar which can easily be 30cm and the risk for hernia in a short term. Open surgery will be selected only as an ultimate solution in a case that the size of the kidney stone does not permit any other means to be used.
The contemporary methods for kidney stone removal include the extracorporeal shock wave lithotripsy (ESWL), laser lithotripsy, pneumatic lithotripsy, percutaneous nephrolithotomy and ureteroscopic removal. The choice depends on the size the position and occasionally, the shape of the stone. All methods require intravenous sedation or anesthesia.
Extracorporeal shock wave lithotripsy (ESWL) for kidney stone removal.
In this method, shock waves are used to break the kidney stone in small parts. The size of the latest is less than 5mm. Thus, they can pass through the urinary track and excreted with urine.
An ESWL device is called lithotripter and it includes a table, carrying a special cushion, an x-ray, ultrasound or fluoroscopy device that helps the operator to find the position of the kidney stone and of course, an external shock wave generator. The patient lies on the table and after the kidney stone is traced, the operator aims at it and activates the generator. The shock waves come through the skin and the underlying tissues, reach the kidney stone and break it.
The advantages of the laser lithotripsy are that no hospitalization is required and the recovery period is short. The patient can return to his/her daily routine within a few days.
The disadvantages include the presence of blood in the urine and incidents of minor renal colics, while the fragmented particles come through. Occasionally, the urologist may put a stent in the ureter, in order to facilitate the passage of these particles. Extracorporeal shock wave lithotripsy is not suitable for large kidney stones. Another drawback is that more than one session may be needed for the elimination of the stone.
Laser lithotripsy for kidney stone removal.
This method involves the use of a flexible laser fiber and an endoscope. The fiber is inserted in the urethra and directed towards the kidney stone.
Laser lithotripsy tends to replace the ESWL, since it presents more advantages. For instance, the post-operative bleeding is less, the rate of success in a single session is higher and the kidney stone can be reached more accurately. Another great benefit is that most of the fragments can be removed with a basket-like tool, during the operation, resulting in fewer complications.
Pneumatic lithotripsy for kidney stone removal.
A pneumatic lithotriptor is consisted of a flexible very thin tube with a tiny mechanical device on its end. The latest carries a probe. Compressed air comes through the tube and activates the mechanical head which, in turn makes the probe to vibrate and break the kidney stone. Alike to laser lithotripsy, the stone is reached through the urethra with the help of an endoscope and a basket-like tool for the removal of the particles. Pneumatic lithotripsy has the same indications and similar characteristics to the laser method.
Percutaneous nephrolithotomy for kidney stone removal.
This is also referred to as tunnel surgery; because the surgeon makes an incision in the patient’s back and after creating a small tunnel he reaches the kidney and removes the stone. This method is preferred for large stones and requires hospitalization.
Uteroscopic kidney stone removal.
If the stone is located in the ureter, it may be removed without the need of fragmentation. In such cases, the urologist will use an ureteroscope. This is a flexible wire-like tube, carrying a tiny camera on the end of it. The operator passes the ureteroscope through the urethra and bladder into the ureter. After he reaches the stone, he removes it with the help of microscopic forceps or a basket-like tool which come through the ureteroscope.
Parathyroidectomy.
This is the removal of one or more of the parathyroid glands. The latest are four altogether and are located underneath the thyroid gland in the neck. These glands secrete the parathyroid hormone which regulates the calcium level in the blood. Due to a benign tumor, called adenoma, one or more glands can get overactive and produce excessive amounts of parathyroid hormone. This condition is known as hyperparathyroidism and it can result in increased amounts of calcium in the blood and kidneys. Among other consequences, kidney stones are likely to occur. The removal of the affected parathyroid glands can prevent recurrent kidney stones.
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