Central India-High Belt for Kidney Stone Formation
Live Video of Endoscopic removal of a 15mm kidney stone through World thinnest 3mm endoscope using Holmium laser by Dr.Rajesh Kukreja, Urocare – Indore, INDIA @ National Conference of Urology Society of India 2016
Patient an IT professional was discharged within 24hrs and resumed his job in 72 hrs.
Ankit, Muskaan and Zubedabee who represent the wide age and regional prevelance of kidney and urinary stones in our state.
Case 1: Ankit, a 2 year old boy from Hadpiplia was brought by his parents with complaints of repeated high fever and occasional blood in the urine. Investigations revealed a large 2cm left kidney stone and a 1.5cm urinary bladder stone. Due to repeated fever, the child had suffered significant weight loss.
Case 2: Zubedabee, a 68 year old diabetic lady from Indore presented with high fever and right-sided abdominal pain since the last 2 weeks. She was found to have large stones in both her kidneys with severe infection in the right kidney.
Case 3: Muskaan, a 6 years old girl from Shajapur was brought to the hospital with severe swelling all over the body and difficulty in breathing. She had not passed urine since last 2 days. Both her kidneys had large stones that were not allowing urine to be formed.
Ankit and Zubedabee, both underwent primary endoscopic surgery for their kidney stones (PCNL). Muskan due to her kidney failure status had to undergo initial dialysis. Tubes were then placed in both the kidneys. Both her kidneys recovered. She then underwent successful stone removal operations of both the kidneys endoscopically.
All these 3 cases also show the impact and efficiency of endoscopic laser treatment for kidney and urinary stones.
Urinary stones are highly prevalent in our and neighbouring states like Gujarat and Rajasthan due to the hot and humid climate, poor water intake and urinary infections. Patients routinely get pain in the flanks, vomiting, burning while passing urine. Occasionally they also get fever and blood in the urine. Two very important facts to be noted are:
1. 20% of urinary stone patients do not have any complaints and hence are not diagnosed early.
2. 3% of patients with kidney stones present with kidney failure.
Sonography is the best and the most routine test performed to detect urinary stones. Blood and urine tests along with X-ray test are also required.
What is the best treatment for urinary stones?
Stones up to 6mm generally pass out spontaneously by drinking excessive fluids. Medicines do not dissolve the stones but help in their passage. Up to 98% of small stones (less than 5 millimeters in diameter) may pass spontaneously through urination within four weeks of the onset of symptoms.
Large stones especially larger than 1 cm require treatment in the form of endoscopic surgery.
Endoscopy treatment is the most efficient and successful treatment available all over the world. All type of stones irrespective of the age, size and hardness can be removed. Also the complication rate is the lowest and very minimal. Endoscopic surgery is of 2 types.
1. PCNL: A small 7mm cut is made in the flank and the endoscope is passed. There are no stitches. This is the best treatment for stones bigger than 1.5cm.
2. RIRS (Ureteroscopy): Endoscope is passed through the hole from where we normally pass urine. This is the best treatment for stones less than 1.5cm.
In both these types, after inserting the endoscope, the stones are broken using Holmium Laser and all the pieces are removed immediately. When the patient comes out from the endoscopy operation room, all his stones are already out.
Stay away from myths and know important truths!
1. Increasing your fluid intake is the best way to prevent urinary stone formation. You should pass 1.5 to 2 liters of urine per day.
2. There is no scientific evidence of dietary restriction in stone formation. The only 2 recommendations are:
a. Increase intake of citrate foods such as lemon and orange.
b. Avoid extra salt and excessive salty products.
Milk intake in any form up to 200cc is absolutely essential for the body and does not increase the chances of stone formation.
1. No medicine can dissolve stones. Small stones pass out by increasing fluid intake.
2. Surgery if required should always be endoscopic.