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The aim in treating stones is to achieve the best possible results with the least side effects. There has been lots of development over the last 20 years, so open surgical methods in treating stone disease have dropped to a minimum. Flexible ureteroscopic lithotripsy using Holmium Laser is a long-known method in stone treatment. The recent technological developments in available medical instruments and the advances in lithotripsic methods have brought us into a position of cutting-edge technology in the treatment of stone disease.
This Last Generation Greenlight Laser Device has doubled both speed and efficiency. Thus, patients who were once considered inoperable with previous Greenlight Laser systems (i.e., due to prostate above 120 gr) can now easily be operated. In addition, bleeding control has become much more effective thanks to the newly developed New TruCoag technology. A special cooling system has been added to the laser fiber used for operation, so that the fiber can maintain the same level of efficiency throughout the procedure.
The kidneys that make urine and the tube system through which urine is excreted from the body is shortly referred to as urinary system. The urinary system consists of 2 kidneys left and right, ureters, the urinary bladder and the urethra. The kidneys are bean-shaped organs, each weighing about 140 to 160 grams, comprising a large number of filtering units called nephrons that make urine, which is then transmitted to the urinary bladder through ureters. The urine collected in the bladder is discharged out of the body through a channel called the urethra when the bladder is filled to a sufficient capacity.
There are several causes to which the formation of stones can be attributed. Urine contains many chemical substances. While some substances in urine increase the risk of stone formation, others inhibit it. Intake of these risky substances may be higher in some persons or our body may tend to produce these substances in larger amounts than normal. This may lead to sediments in urine, which can give rise to stone formation. It is also possible that substances inhibiting stone formation are less in some persons, which can increase the risk of stone formation.
Often times we cannot find out what caused the stone.
There is a high risk of stone formation in patients who pass excessive gravel in urine.
Risk of stone formation is higher in industrialized countries. It is believed that diet has an important effect on stone formation. Known dietary habits change as per capita income increases, i.e., there is an increase in consumption of fatty, protein and sugary food, coupled with a decrease in fibers and vegetable proteins. Foods high in sodium (salty foods) are another important factor that increases the risk of stones.
There is a proven effect of profession on stone formation. The risk of stone formation is higher in people who have reduced physical activity and work in high temperatures.
People with a history of stones in their immediate family are about 2 times more likely to develop stones in their kidney. Also, certain hereditary diseases (renal tubular acidosis, cystinuria, hypercalciuria) are associated with high stone risk.
Increases stone formation is also observed in hot climates, in summer, due to sweating and insufficient fluid intake.
Complaints and findings associated with stones may vary depending on the stone’s location. If in the kidney, there will be blunt pain in the relevant side, extending along the ureter towards the abdomen, and there will be blood in urinalysis.
If in the ureter, there will be blood in urine accompanied by sudden intense side pain. Pain may extend in different directions depending on the stone’s location. Nausea and vomiting may also be seen.
If in the bladder, there may be complaints like painful urination during and after urination, strangury, acute urinary retention and/or bleeding. Pain is usually in the lower quadrant, extending towards the penis and perineal area.
If in the urethra, there may be complaints like painful urination, dropwise urine or complete urinary obstruction.
The initial clues that make the physician suspect stone disease is the information and complaints reported by the patient. The first thing to do when suspecting stone disease in a patient is simply urine analysis, direct urinary system radiography and ultrasonography. Ultrasonography is a simple and reliable method that does not have any difficulties or side effects on the patient. Other frequently used radiological methods are intravenous pyelogram (IVP) and spiral tomography. Treatment is planned after the stone’s size, location and the kidneys’ structure is determined.
Patient follow-up without any medical treatment;
Most stones are very small in size. These small stones are expected to pass spontaneously. However, it is essential to be under doctor control while waiting for this to occur. Sometimes, even if the stone is very small, it may not pass, causing obstruction and damage to kidneys. Patients should urinate in a container and check whether the stone has passed. Once the stone is out, it should be analyzed.
It is one of the most commonly used methods in the treatment of kidney stones. ESWL is a method where shock waves are generated by an extracorporeal source and hit the stone by passing through the skin and body tissues easily. Once these shock waves hit the stone, they cause it to break into pieces by creating traumas on its surface. These pieces pass then from body during urination. ESWL is a painful procedure. Hence, most ESWL devices require anesthesia.
This procedure is performed to fracture and extract a renal stone by placing a tube, measuring 1 cm in diameter, to the kidney from a skin incision. While performing this procedure, first the area where the stone is located is accessed with a needle and a thin wire is placed to the kidney via needle under X-ray scan. The needle is withdrawn and the hole is dilated to 1 cm in diameter with dilators placed over this wire. Next, a tube, measuring 1 cm in diameter, is placed to the kidney and kidney is accessed with a device called endoscope via tube. The stones inside the kidney are fractured and extracted. A thin catheter (nephrostomy tube) is placed to the kidney from the hole though which the surgery is performed after the procedure is ended. This tube is removed after 1-2 days.
This is the treatment procedure which is performed when the stone is located inside the ureter (the canal between kidney and urinary bladder). While performing this method, the renal canal is accessed with an endoscopic device called ureteroscope via ureter, without performing any incisions. The stone is identified using camera images and fractured with assistance of a laser or pneumotic probe advanced via utereroscope. Fractured fragments are removed and the patients are generally discharged on the same day.
The purpose of treatment of renal stones is to achieve maximum benefit with minimum side effects. Various developments have been achieved in this field within the last two decades and use of open surgery methods in treatment of stone diseases is decreased to minimum level. While treatment of kidney stones using flexible ureteroscope is a method which has been known for a while, the technological developments regarding devices used in the procedure and improvements in stone fracturing methods within recent years have made this method the most advanced technology in treatment of stone diseases.
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