Diagnosing Kidney Cancer

These tests confirm the presence or absence of cancer. If cancer is detected the tests also show whether it has spread to other parts of the body. These include:

Ultrasound Scans

Computerised Tomography (CT) Scan

Magnetic Resonance Imaging (MRI) Scan

Cytoscopy

Biopsy

The different Stages of Cancer

The presence of cancer, once confirmed by medical tests is given a stage. The stage identifies the extent to which the cancer is spread in the body. TNM system is used to stage kidney cancer. It consists of three numbers:

T (tumour) - It describes the size of tumour. It has a scale from 1 to 4 depending on the size of the tumour.

N (node) - It describes if cancer cells are present in the lymph nodes. It has a scale from 0 to 2 depending on whether the cancer has spread to nearby lymph glands.

M (metastases) - marked as 0 or 1 depending on whether the cancer has spread to other parts of the body or nearby organs.

Coping with the diagnosis

At aastha Kidney Hospital we understand it can be a very difficult coping if you have been diagnosed with cancer. The news may be very difficult to digest. Once the initial shock of realising you have cancer has waned, a number of emotions might take over. It is common to experience sadness, confusion, denial, guilt, anger and stress. For some they may have severe anxiety, fear about the future and depression. During such times support of family and friends makes a huge difference. Talking to a psychiatrist or other people which are going through the same can help considerably. 

The experienced doctors and trained nursing staff at Aastha Kidney Hospital specialises in dealing with all aspects of cancer. The warmth and emotional support extended by them at the hospital along with proper medical care is a great encouragement available whenever you need.

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What are the different types of Kidney Cancers and their symptoms?

Renal or kidney cancer usually affects adults in their 60s or 70s with very rare cases of people having this cancer under the age group of 50. This cancer can be cured if it is timely diagnosed at the very early stages.  However, it is not possible to cure it if it has reached a stage where it has spread beyond the kidney.

Different types of Cancer

Renal Cell Cancer

This cancer starts to grow in the lining of the tubules which filter the blood to make urine. Tubules are the smallest tubes inside the nephrons. 

Renal Cancer is of different types:

Clear cell

Papillary

Chromophobe

Other rare types of renal cancer include carcinoma of collecting ducts and renal medullary carcinoma.

Transitional Cell Cancer (TCC) of Kidney or Ureter

The transitional cells that make up the lining of the renal pelvis, ureter, bladder and urethra have a special ability to change shape and stretch when urine flows in or out through the genitourinary tract. This cancer rarely begins in the kidney or the ureter.  It most commonly occurs in the bladder.

Wilms’ Tumour

This tumour affects children. During pregnancy the kidneys develop early on and sometimes cells that were supposed to transform into mature kidney cells fail to do so, staying altogether as very immature cells. In most cases these cells mature by the time child is 3 or 4 years old. But in certain rare cases these immature cells fail to turn into mature kidney cells. These causes these cells to go out of control leading to cancer known as Wilms’ Tumour. 

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Ever thought a Kidney Stone can be removed without making even a single cut in the body?

Retrograde Intrarenal Surgery (RIRS)

RIRS is the latest technology in removal and management of kidney stones that extends the frontiers of medical sciences beyond contemplation. Progressive innovations in techniques together with recent advancements in flexible ureteroscopes with the advent of digital technology, refinements of endo-urological devices and advancement in holmium laser technology have been very impressive. Where at one point an open surgery with a very long period of recovery was the only option, research introduced minimally invasive procedures with very fast recovery phase and finally today, we stand at a point where not a single cut in the body is made for treating kidney stones. RIRS becomes a reasonable alternative to percutaneous lithotomy even for stone larger than 2 cms.

Who can perform RIRS?

RIRS is performed by an urologist (endourologist) with specialized expertise in performing this procedure.

How is RIRS performed

Not a single cut in the body is made and the problem is solved!

A spinal or general anaesthesia is administered for ease. The surgeon then inserts a fibre optic endoscope to view the inside of a kidney, going from the urethra (urinary opening) into the bladder and from there into the ureter reaching finally inside the urine collecting part of the kidney.  Once the scope is in place, the surgeon then starts either fragmenting or evaporating the stone using 100-Watt Coherent holmium laser probe. The surgeon may also choose to remove the stones manually with small forceps even. When stone fragments appear to be less than 2 mm the procedure is considered terminated and no attempt is made to remove all debris physically however, the larger stone pieces are removed using a litho catch basket. The advantage of Holmium Laser is its ability to fragment stones of all compositions with precision. A stent is then placed if needed, which is removed after a week by flexible cystoscopy. A catheter is left in place for a day after the procedure. Patients are generally admitted on the same day of the treatment and are discharged next day, which means only 24 hours of hospitalization is required.

RIRS Indications:

•    Ureteric or kidney stones
•    Tumours of ureter and kidney
•    Stricture of urinary tract

Advantages of RIRS

•       Can be done in patients of bleeding diathesis and gross obesity
•       Can be done in any age group
•       Less chances of bleeding
•       Less invasive (Low-risk procedure)
•       Stricture and stone can be tackled at same time
•       Stich less and incision less surgery
•       Lesser pain - faster recovery - Minimum hospitalization
•       Stone clearance rates are very high
•       Both ureteric and renal stones can be tackled at same time
•       Small kidney tumors can also be tackled 

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Laparoscopic Pyeloplasty

UPJ obstruction meaning Ureteropelvic junction (UPJ) obstruction is a blockage at the point where part of the kidney attaches to one of the tubes that carry urine from the kidney to the bladder (also called ureters scientifically). This blocks the flow of urine out of the kidney.

 Causes of Ureteropelvic junction (UPJ) Obstruction

1. Congenital Condition                                                                                                                     This may be present when the baby is growing in the womb, therefore a baby may have it when its born as congenital condition. A narrowing may be seen in the renal pelvis (part of the kidney) and the ureter (the tube that carries urine from kidney to the bladder). These days however, in majority of cases this can be detected through ultrasound tests during pregnancy.
2. Abnormal blood vessel over the ureter
3. Older children and adults may have scar tissue, infection or prior treatments for a blockage or stone in the kidney.

Prognosis

An obstruction in the ureter detected early on goes a long way in preventing further damage to the kidney. However, a UPJ obstruction diagnosed before or immediately after birth might actually improve on its own.

The obstruction may lead to serious consequences and damage to kidney if diagnosed later in life. However, present treatments offer long term solutions. Laparoscopic Pyeloplasty having the best long term success.

Likely Complications

1.    Deterioration or permanent loss of kidney function (kidney failure).

2.    Kidney stones or infection may occur in the affected kidney, even after treatment.

The Treatment - Laparoscopic Pyeloplasty

This is a reconstructive surgery to correct the narrowing, blockage or scarring of the ureter at a point where it leaves the kidney. The procedure takes 3-4 hours to perform and is carried out under general anaesthesia. Following the surgery, a stent is put in place for healing and to support and protect the pyeloplasty repair.  This is removed 4-6 weeks following the surgery by the doctor. You should expect to be in the hospital for around three days depending on your recovery rate. At Aastha Kidney Hospital we have specially skilled surgeons who have performed over 50, 000 surgeries. The Hospital devotes itself to committed healthcare with rapid, accurate diagnosis and immediate, effective treatment for a wide range of urological and genital problems for both males and females.

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Laparoscopic Nephrectomy

This surgery is done to remove the diseased or cancerous kidney. As opposed to traditional open surgery involving a 15 cm incision, this is a minimally invasive procedure carried out with very tiny 1 cm cuts plus a 4-6 cm cut to remove the diseased kidney.

Why is a Nephrectomy required?

There may be several reasons why a kidney may have to be removed. A kidney may be partly working and being left in place could be a basis for infection or pain, at times the kidney may have incurred damage or there may be a cancer present the usual treatment for which is to remove the kidney. Where there is a kidney cancer present at times it becomes necessary to remove the adrenal gland as well that lies above the kidney. Also in certain cases of kidney cancer (transitional kidney cancer, TCC) there is a high risk of reoccurrence of cancer in the ureter. This might involve another surgery to remove the ureter. The doctor will discuss the reasons with you if a kidney has to be removed.
With your other kidney functioning normally you can easily manage a healthy lifestyle without major changes.

The risks and side effects

Every operative procedure carries some risk associate with it however, these are small in comparison to not carrying out the operation. Although these complications are well recognised, the majority of patients do not have problems after a procedure.

Occasional risks

An infection may occur where the incision was made requiring further treatment. If the wounds are red or inflamed you would need to see the doctor.

Rare risks

The surgery may cause bleeding that requires blood transfusion or the surgeon may have to carry out an open surgery if visibility using keyhole technique is difficult. This occurs in five per cent cases.
During the procedure the lung cavity may be entered, but this can be repaired without any further incision.

Very rare risks

Injury to the adjacent organs may be caused causing the surgeon to move to open surgery.
Issues with anaesthetic or heart and blood vessels complications may occur requiring admission to ICU. Such complications may cause a chest infection, stroke, blood clots or a heart attack.
How long does the operation take?
Every case is different however, on an average the procedure takes about 2-3 hours.

Before the operation

A pre operative assessment is carried out to sort out any health issues that might delay the surgery.  The surgeon will review your medical history as well as any outside reports, records, and outside X-ray films (e.g. CT scan, MRI, sonogram). Also you are advised to bring along any medication you take on daily or ad-hoc basis.

After the operation

You will be in the recovery room where the nursing staff there will look after you until you are ready to return to your ward. You will be on an intravenous drip until you are in a position to drink fluids normally. Although you can have some oral fluids fairly soon after the operation, you will be able to drink normally and eat something light by the next day. While you are returned back to your ward you will have a drainage tube (catheter) put in place to drain urine from the bladder. This allows the nursing staff to have an assessment of the quantity of urine excreted within first 24 hours of the surgery. This is usually removed with two days post surgery. However, in case the ureter is also removed the catheter is left in place for a longer duration to allow for healing to take place. Post surgery it is quiet normal to experience shoulder tip pain or wind like pain in the abdomen. This is because during the surgery the surgeon uses gas to inflate the abdominal cavity so he can better see the kidney. This is easily treated with simple painkillers. The wounds have dissolvable stitches and are dressed regularly changing dressing only if they are heavily soiled and become looses. Most patients are also given injections post operatively on a daily basis to prevent blood clots. In cases where a person may be more prone to a higher risk of clots injections are continued for up to 4 weeks.

Getting out of bed

You will be encouraged to get up and about as soon as possible, usually the day of surgery. This is to prevent complications such as a chest infection, pressure sores or a deep vein thrombosis (clot in the leg veins).
By day two you should be out of bed for most part and also be able to walk short distances. Once the catheter is  removed and you are able to pass urine satisfactorily you shall be discharged.

At Home

You are advised to do light walking while refraining from lifting anything heavy or driving for at least 2-4 weeks after the operation. A healthy diet containing ample fruits and vegetables is good to keep your bowels regular. You can return to your office when you feel fit. In most cases one can return back to full physical activity with 3-4 weeks after the surgery. However, in case of an open surgery it may take up to 8-10 weeks. 

The benefits of this minimally invasive procedure

This minimally invasive approach has the advantage of improved cosmetic look, reduced pain, blood loss, shorter hospital stay and fewer post operative complications as compared to conventional open surgery with similar cure rates.

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Laparoscopic Cholecystectomy

Gall Bladder is  located in the upper right half the stomach, is a small pouch that fills up with bile (used to break down fat) produced by the liver. Before meals it is filled with bile almost the size of the pear and after meals it lays empty and flat. Gall bladder if removed in a health individual causes no significant problem, however there may be a small risk of  fat mal-absorption or diarrhea.
Cholecystectomy is the name of a fairly common procedure used to remove gall bladder stones.

Why remove the Gall Bladder? 

Sometimes substances (cholesterol and bile salts) that make up bile in the gall bladder can crystallize due to an imbalance and form stones which can be very painful. A person may not realize they have stones because the stones don't really cause any symptoms, however, very less frequently they may block the flow of bile causing irritation in the gall bladder (acute cholecystitis) or pancreas (acute pancreatitis). These conditions can make a person feel

    Sudden and intense pain in the stomach
    Feeling sick or nausea
    The skin and also the white area in the eye may become yellow 
    Abdomen may feel bloated
    Occasionally fever

 

Laparoscopic Cholecystectomy is a procedure performed under general anesthesia. Small cuts are made in the abdomen to access the stones and remove them. This is fairly comfortable and common procedure where a person recovers very quickly resuming a normal life within two weeks. Usually a person can leave the hospital the very same day or the next day The scars are also very small in comparison to an open surgery.

The liver still produces enough bile the same way to digest the fat, however, it doesn't get stored in the gall bladder but leaks into the stomach directly and continuously.

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Dialysis : What is it?

The procedure is used when the kidneys stop working therefore instead of sending blood to kidneys, dialysis diverts  blood to a machine that works just like the kidney and cleanses the blood by removing waste products and excess fluids from the blood.

When is there a need for dialysis?

If the kidneys are not working properly, because there may be advanced chronic kidney disease or kidney failure or they kidneys may not be able to clean the blood properly. With the kidney's not working properly this may lead to high levels of toxins in the blood. If not addressed in time this may lead to dangerous levels of unwanted substances in the blood and also be fatal. Dialysis filters these unwanted substances, before kidney failure or malfunction lead to serious consequences .

How long does a person need to be on dialysis?

This depends on the medical condition of the person. Where a kidney failure is temporary, timely dialysis can help a person recover without causing irreparable  damage to the kidney. However, in most cases a person with kidney failure would require a kidney transplant, although that may not be possible right away. So until a suitable donor kidney becomes available dialysis will be needed. Nevertheless, in situations where a major surgery is not possible because a person's current state of health may not permit a major operation like a kidney transplant, dialysis would be indispensable for the rest of their life.

What happens during Dialysis?

Haemodialysis

This is the most common type of dialysis that usually most people are aware of. The procedure takes about four hours and is carried out three times a week. A needle is inserted in the arm and thereafter the blood flows through it into a machine which purifies it and the pure blood is then sent back into the body through another tube injected in the arm. 

Peritoneal dialysis

Peritoneal dialysis filter blood by using the inner lining of the abdomen (the peritoneum) as a filter, rather than a machine. The peritoneum is similar in structure to a kidney containing thousands of tiny blood vessels making it a useful substitute to filtering blood.
At the beginning of the treatment a catheter is permanently inserted into the abdomen by making a small incision near the belly button. This is left there in place permanently.

Fluid is pumped into the peritoneal cavity through the catheter which sucks out the impurities and excess fluids from the blood while it is passing through the tiny blood vessels in the lining of the peritoneum.  The used fluid is drained and replaced with fresh fluid every few hours usually takes about 30-40 minutes, repeated around four times a day. 

How to choose which type of dialysis is suitable for me?

While on dialysis you can lead a normal life if you are fit otherwise.Whether it is swimming, driving, working or going on a holiday. Being on haemodialysis gives a person four treatment free days a week, but the sessions lasts longer and a person may have to go to the hospital each time. The procedure can cause itchy skin and muscular cramps. It is suitable in cases where a person is in a poor state of health or unable to perform peritoneal dialysis on his own due to some reason such as being visually impaired or having dementia. Peritoneal dialysis can be done at home even while you sleep and doesn't need frequent hospital visits,  however it needs to be done daily. It's usually suitable in children under 2 years of age, adults without serious heart conditions or cancer and people with limited kidney function. The procedure can put a person at the risk of developing an infection in the thin membrane that surrounds the abdomen.

Being on dialysis doesn't fully compensate for loss of kidney function because not having fully functional kidneys places a significant strain on the body.   

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Acute Kidney Failure

Kidneys balance the composition of the blood by filtering waste from blood like salts, extra fluids and other substances. They maintain a perfect balance of electrolytes like sodium, potassium  and phosphate.  A kidney also contributes in the making of hormones that facilitate regulation of blood pressure, making of red blood cells and keeping the bones strong.

Acute kidney failure leads to sudden loss of kidney function. In contrast to chronic renal failure this is temporary.

Types and Causes

Pre-Renal

This is the most common type of condition found in 60-70 per cent of cases. If the blood flow is not in proper quantities to the kidney due to maybe very low blood pressure as a result of hemorrhage, septic shock, serious illness, injury then kidneys cannot filter blood effectively. This may also be due to heart failure, liver failure or blockage to the blood vessel carrying blood to the kidney. Another important factor is dehydration due to vomiting, diarrhoea or blood loss.

Post Renal

This failure may occur once the urine is produced and there is obstruction in its flow from the kidney. Most common reason may be cancer in the urinary tract , prostate in men, abdomen or pelvis that push on the ureter.  

Renal Failure

This is caused when there is damage to the kidney. It may be in the units (glomeruli) or the tubules leading from the glomeruli. The damage may be caused by an auto immune disease, infection, cancer and some medications or nephrotoxins. Kidney diseases (glomerulonephritis and nephrotic diseases, such as membranous nephropathy) can also cause this as well as well as chronic renal failure.

The causes: The Signs and Symptoms

You may experience swelling in lower half of your body - legs, ankles and feet

Shortness of breath

Drowsiness

Fatigue

Confusion

Decreased urine output although occasionally urine output remains normal

Chest Pain or Pressure

Nausea

Seizures or coma in severe cases

Treatment at Aastha Kidney Hospital

Timely treatment of the above symptoms is very important to restore normal working of the kidney. Some causes of kidney failure are treatable and the kidney function may return to normal. Unfortunately, kidney failure may be progressive in other situations and may be irreversible. Aastha Kidney Hospital, Ludhiana is renowned for having the latest equipment, lasers and treatment technology in the world in its department of Urology and Nephrology.

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Kidney Stone Diagnosis

Kidney stones can be ready diagnosed from the symptoms one is experiencing and the medical history.

Some of the initial tests that a general physician might suggest would include

URINE TEST

This will check if you are having any infection or presence of pieces of stones in the urine.

STONE ANALYSIS

Any stones that you may pass in your urine  can be collected (by urinating through a gauze) and  is then sent for a medical examination to verify its type and constitution. This is very helpful in determining the right course of treatment most beneficial to your condition.

BLOOD TEST

This is to check if your kidneys are working properly and also to determine the levels of certain substances that may lead to stone formation (e.g. calcium)
However,  in  case you  are having fever and your pain is very severe which  does not subside with pain killers you will be referred to a urologist (Specialist in treating urinary problems).

Visiting a Urologist

A urologist may suggest an imaging test. These can be of various types and are used to confirm whether a kidney stone is present or to pin point its exact location.

 

Computerized Tomography (CT Scan or CAT Scan)

This scan uses a series of x-rays taken at different angles to produce horizontal, or axial, images (often called slices) of the body which are then  put together by a computer. This scan being 2D is more detailed than a normal X-ray. 

Kidney, Ureter, Bladder X-ray (KUB X- Ray)
X-ray used a beam of high-energy radiation which is aimed at the body is used to create an image highlight the abnormalities in body tissue. KUB results may show the presence of kidney stones or gallstones. Although it may also highlight others reason for abdominal pain like injuries to the stomach or intestines, fluid in your abdominal cavity, or a blockage of your intestines, the test is sometimes a preliminary step towards further diagnosis. It is important that you mention if you might be pregnant or have an intrauterine device (IUD) or have had a contrast X-ray done.

Ultrasound Scan
Ultrasound Scan uses high-frequency sound waves to create images of the insides of the body. Because sound waves are used instead of radiation, ultrasound scans are safe. 

Intravenous Urogram (IVU) or Intravenous Pyelogram (IVP)
The test is used to look at the whole of the urinary system - the kidney, ureter and bladder. A intravenous die is injected and an X- ray image is generated which pin points any blockages if present as the kidney filters the dye out of the blood into the urine.  The test reveals the internal structure of kidney and may be used to roughly assess how well the kidney are working.

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How are Kidney Stones Formed?

Kidney filters waste products from our blood and releases them in the form of urine. However, accumulation or excess of certain salts, minerals and crystal forming substances in the body lead to accumulation of these substances over a period of time in the kidney eventually forming stones. It maybe that the urine lack substances that prevent these crystal forming substances from coagulating
Depending on the type of chemical which is accumulated either due to dietary reasons, medication or not drinking enough fluids to flush your system the stone types may vary.

Usually the following chemicals are the main culprits:

Are you having kidney stone repeatedly?

Certain people have a repeated tendency to develop kidney stones and among other people who may be more likely like the ones who:
    have had kidney stone before, especially if it was before the age of 25
    have a family history of kidney stones
    eat  a high protein diet and very little fibre.
    have had a number of kidney and urine infections
    have only one properly working kidney
    sedentary lifestyle or bed ridden
    have had intestinal bypass or Crohn's disease.
    Are on medications like asprin, antacids, certain antiretroviral medication (used to treat HIV), certain anti-epileptic medication, diuretics (used to reduce fluid build-up), certain antibiotics.

Types of kidney stones

Reason behind formation of each type or kidney stone

Calcium stones

Majority of people develop calcium stones which are the most common type of kidney stone, usually formed because of the presence of large amount of calcium in the urine. This may happen because of say an inherited condition like hypercalcuria which increases the levels of calcium in the urine, abnormal function in parathyroid gland (the parathyroid glands essentially maintains the quantity of calcium in the  body), kidney disease, some cancers or maybe a rare condition called sarcoidosis.

Appearance

Large and smooth or rough and spiky.

Struvite stones

These type of stones are commonly cause by infections. One of the major cause for their occurrence can be a urinary tract infection which has lasted a long time. Women are more likely to have them in comparison to men.

Uric acid stones

The presence of large amounts of acid in the urine can trigger the formation of uric acid stones. Eating a high protein diet especially meat, health condition like gout (an inflammatory arthritis which prevents break down of certain chemicals in the body), hereditary illness that heightens acid levels in the body and chemotherapy.    

Cystine stones

These stones affect a very small number of people and are rather rare in occurrence. An inherited condition like cystinuria which affects acid levels in the urine may cause them.

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Kidney Stones Treatment

Kidneys filter waste from blood and produce urine that is passes out of the body. However, sometime stone forming substances like (salt and minerals) may join together to form small stones which over time build and grow in size to form hard stone-like lump. The situation is more probable in case a person is dehydrated or is consuming less fluids. Certain medications also increase the levels of stone forming substances in the urine therefore it is important to keep the urine diluted and clear. Once a stone is present the body tries to pass it out when you urinate. Very smalls stones painlessly pass through the urine however if a stone is 5mm in size the changes of it passing on its own in the urine come down to 50 per cent. The small stones can be also be very painful sometimes but the pain disappears once the stone passes through the urine. 

What can help in such cases:

Medication

In case the pain is unbearable you might be given an injection for alleviate your pain. You might be administered a second dose again after half an hour depending upon the severity of your pain.

Lifestyle

If you are having a kidney stones then it is important that you drink a lot of water. In case it has passed in the urine you can collect it and send it for analysis. The doctor will check what type of changes you need to make in your diet and medication depending upon the constitution of the stone.

Clinical Procedures to treat Kidney Stone

"The latest treatment in the world to remove Kidney Stones is RIRS where NOT A SINGLE CUT IS MADE IN THE BODY to remove the kidney stones." - Department of Urology, Aastha Kidney Hospital. 

The very large stones (6-7 mm) pose problem as they try to pass through the ureter naturally from the kidney into the bladder causing very severe flank pain that extends to the groin. This is because the tube (ureter) connecting the kidney to the bladder is narrow and a large stone is not able to pass through easily. 

Extracorporeal Shock Wave Lithotripsy (ESWL)

For a Stone 4 mm to 2 cm in size and in the kidney or part of the ureter close to the kidney causing pain or blocking urine flow.  

This procedure takes about an hour. You will be made to lie down comfortably on a water filled cushion. A sedative or a local anesthesia may be administered. Following this an  X-ray or ultrasound test is carried out to locate the exact position of the stone in the body. Extracorporeal shock wave lithotripsy (ESWL) uses high energy sound waves to crack open and disintegrate the stones into smaller fragments. These high energy sound waves pass through the body without injuring it. The smaller fragments pass through the urine.

In case of a large stone a stent may be placed to keep the ureter open so that smaller stone fragments may pass easily without blocking the ureter.  

After the procedure

There is no need to stay in the hospital overnight. In fact you may go home the same day. Small pieces of stone which have disintegrated will pass out through the urine causing mild pain. This may happen for a few days. However, in case of a very large stone  the procedure may have to be repeated again or other treatments carried out.

RISKS

    Pain caused by passage of stone fragments.
    Stone fragments might get stuck in the urinary tract. These will have to be removed with a ureteroscope.
     UTI (Urinary tract infection)
    Bleeding around the outer side of the kidney

Ureteroscopy

If a stone is stuck in the ureter close to the bladder (in the lower third or ureter)

A Thin Tube (Ureteroscope ) is passed from the outside of the body into the urethera, making its way up to the bladder and from there into the ureter (i.e the pipe which carries urine from kidney to the bladder) to the point where the stone is located.  The kidney stone is removed with the forceps. Smaller stones can be removed in one piece but larger stones are broken down into smaller pieces before they are removed, most common technique being laser.  While carrying out ureterocopy no cuts or incisions are made in the body.

After the treatment

Although in most cases a person can go home the same day of the procedure. However, in case there is  a requirement for you to stay in the hospital it will only be for a day or two. After the treatment a person may experience a burning sensation while urinating which goes away in a day.  The burning can be reduced by drinking plenty of water. A doctor may also recommend a painkiller. Some blood may also come in the urine maybe for 2-3 days. 

RISKS

These usually are likely if the stone is close to the upper third of the ureter.
    Bleeding
    UTI (Urinary tract Infection)
    Injury to Ureter
    Abdominal pain

Percutaneous Nephrolithotomy (PCNL) /Nephrolithotripsy

If the Kidney stone is irregular, larger than 2 cm diameter within the kidney 

The operation takes about 20 -45 minutes. During the procedure a general anesthesia is administered the person is made to lie on the stomach.  A keyhole surgery is performed by a 1 cm incision at the back in the skin above the kidney. An X ray image is used as a guide to decide the entry point of 1cm tube into the kidney. Once the surgeon is inside the kidney a nephroscope (minature fibre optic camera) and other instruments are threaded in through the hole that are able to see, fragment and remove stones.  A drainage catheter which leaves through the skin is left in the kidney at the end of the procedure. The whole idea is to remove all the stones leaving no fragments behind that may pass through the ureter. 

After the procedure

A short hospitalization (2-3 days) may be needed. You may be off work for a week taking it easy. There should only be minimal discomfort from the wound. Oral antibiotics are given to prevent further infection. Occasionally a stent is left to ensure that urine drains correctly in the bladder which will be removed later. In case a person is feeling unwell with fever, chills or is having heavy bleeding in the urine is it important to contact your doctor.

Advantages

Most effective procedure that ensure a patient is stone free.

Risks

    Infection
    Bleeding
    Operations on the abdomen carry a small risk of injury to other nearby organs, such as the bowel, the ureter, the liver or the bladder.

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Kidney Stones Types and Symptoms

How are Kidney Stones formed?

Kidney Stones medically referred to as Nephrolithiasis are formed when there is reduction in the urine flow volume as well as because of the presence of stone forming substances (salt and minerals) in the urine which are retained inside the kidney because of not being eliminated by the kidney completely due to their excessive or concentrated presence as a result of medication, dehydration or drinking less fluids. So, these substances eventually stick together to form small kidney stones. Kidney stones can cause severe pain if it blocks the ureter (tube that carries urine from the kidney to the bladder) or the urethra (tube that leads urine out of the body) Dehydration is one the major causes leading to the formation of kidney stones, the pain caused by kidney stones can be very severe. A stone once formed tries to leave the kidney making its way to ureter, then into the bladder finally passing out of the body on its own.  

Other causes leading to the formation of kidney stones can be being overweight or obese, consuming a high-protein or glucose diet, gastric bypass surgery, disease in the bowel like inflammation that increases calcium absorption, taking medications such as diuretics, anti-seizure drugs, and calcium-based antacids.

Kidney Stone Types:

Not every person has the same type of kidney stones. The may be different in their constituency and type varying from person to person.

Major Kidney Stone Symptoms

• Flank Pain or persistent pain in the lower back which may extend up to the groin and last for a few minutes or hours.

• Hematuria (Blood in the urine)

• Pain while urinating (Dysuria)

• Nausea or feeling sick

• Feeling restless and unable to lie still

• Feeling like urinating more frequently than the normal 

In case there is an infection along with kidney stone

KIDNEY STONES - If they cause kidney infection then a person will experience additional other symptoms like:

• High fever (103.1 F or 39.5 Degree Celsius)

• Loss of appetite

• Chills and shivering

• Diarrhoea

• Fatigue

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