Urologist
What are the treatment alternatives for kidney stones?
There are three treatment options:
The choice of treatment depends on the size of the stone, its location within the kidney, the condition of the kidney, the patient's body structure, and the patient's preference. (Click here to learn which treatments are available for you.)
It is preferred for stones smaller than 2 cm located in the upper and middle parts of the kidney.
ESWL can be used for stones smaller than 2 cm. For stones larger than 2 cm, ESWL typically requires more than 3 sessions to break the stones into sizes that can pass through the 3-4 mm ureter. This can be dangerous for the kidney. Even if the stones are fully fragmented in three sessions, the stone load may be too much, causing the fragments to accumulate and block the ureter.
For stones located in the lower part of the kidney, even if they are fragmented, gravity makes it difficult for the fragments to pass out with urine. Therefore, ESWL is not preferred for stones in the lower part of the kidney.
In which cases is ESWL preferred?
In which cases cannot ESWL be performed?
1. In the presence of an active urinary tract infection
2. Use of blood-thinning medications
3. Pregnancy
4. In very hard stones such as cystine or whewellite (Although the stone type cannot be determined before treatment, the stone's density can be measured in a CT scan. If the stone density is greater than 1000 HU, the likelihood of it being fragmented by ESWL is low).
What problems can occur after ESWL?
After ESWL, the fragmented stones may pass from the kidney and accumulate in the ureter, potentially blocking it and causing severe pain. In such cases, either ESWL is performed on the lowest stone or the stones are cleared with URS (Ureteroscopy).
Blood may be visible in the urine; if it is not prolonged or severe, and there are no abnormalities in the blood count, no additional treatment is needed other than rest.
Bleeding around the kidney may occur. In this case, bed rest, blood count monitoring, and imaging to assess the amount of bleeding are required.
What is RIRS?
RIRS (Retrograde Intrarenal Surgery) with a flexible camera: This method involves inserting a thin, flexible camera through the urinary tract to reach the kidney, where stones are broken using a laser. Due to the thin nature of the device, it is very difficult to remove stones larger than 2 cm in a single session. Therefore, RIRS is not preferred for kidney stones larger than 2 cm, and multiple sessions may be required.
What problems can occur after RIRS?
The most common issue is the remaining stone in the kidney or ureter. Stones left behind can be cleared with a second session of RIRS. A few days after the surgery, there may be slight blood in the urine, which typically resolves without the need for intervention.
What is PNL?
For stones larger than 2 cm, RIRS is not preferred as it takes too long to break the stones. In such cases, PNL (Percutaneous Nephrolithotomy) is the preferred method. PNL involves breaking kidney stones through a small incision in the flank (2-3 cm), with a camera inserted into the kidney. A catheter (JJ catheter) or a nephrostomy tube may be placed to connect the kidney to the bladder or exit the body directly, depending on the surgical situation. After a few days, the tube or catheter is removed.
What problems can occur after PNL?
The most common problem is bleeding, which rarely reaches a serious level. It usually occurs at the point where the camera enters the kidney. In such cases, bed rest, blood count monitoring, and imaging techniques to assess the amount of bleeding are necessary. Typically, bleeding stops with rest, and intervention is rarely required. If intervention is needed, it is done by identifying and closing the bleeding vessel using angiographic techniques.