Treatment of Kidney Stone

7/25/2019 Treatment of Kidney Stone

1/13

Treatment of kidney stones

For small stones, most people do not need any treatment other than taking pain

medicine and drinking enough fuids. The small stones can pass on its own .

There are several actors that infuence the ability to pass a stone. These includethe size o the person, prior stone passage, prostate enlargement, pregnancy,

and the size o the stone. A 4 mm stone has an !" chance o passage while a #

mm stone has a $!" chance. %tones larger than & mm to '! mm rarely pass

without speci(c treatment.

%ome medications have been used to increase the passage rates o kidney

stones. These include calcium channel blockers such as niedipine )Adalat,

*rocardia, Aeditab, +iediac and alpha blockers such as tamsulosin )Floma-.

These drugs may be prescribed to some people who have stones that do not

rapidly pass through the urinary tract.

it is the (rst time , the doctor thinks that the stone can pass on its own . the

doctor thinks the stone can pass on its own,he may suggest home treatment,

including/

0sing pain medicine. +onprescription medicine, such as nonsteroidal anti1

infammatory drugs )+%A2s, may relieve your pain. 2rinking enough fuids.

the pain is too severe and i the stones are blocking the urinary tract or i

there is an inection, the doctor will probably suggest a medical procedure, such

as lithotripsy, or surgery to deal with the stone.


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Kidney Stones - Other Treatment

3ther treatments or kidney stones are much more common than surgery. *atient

may need one o these treatments i the pain is very bad, the stone is blocking

the urinary tract, or there is an inection.The options included/

-tracorporeal shock wave lithotipsy

5 -tracorporeal shock wave lithotripsy )%67. %67 uses shock waves

that pass easily through the body but are strong enough to break up a kidney

stone. This is the most commonly used medical procedure or treating kidney

stones.

0teroscopy

5 0reteroscopy. The surgeon passes a very thin viewing tool )ureteroscope

up the urinary tract to the stone8s location, and then he or she uses tools to

remove the stone or break it up or easier removal. *atient may need a small,

hollow tube )ureteral stent placed in the ureter to keep it open or a short time

and drain urine and any stone pieces. This procedure is oten used or stones

that have moved rom the kidney to the ureter.

6hether these treatments will work or the patient will depend on the size o thestone, its location in the urinary tract, and patient overall health.


3/13

Kidney Stones - Surgery

%urgery is rarely needed to treat kidney stones. %urgery is only needed when the

kidney stone is very large, caused by an inection )staghorn calculi, blocking the

fow o urine out o the kidney, or causing other problems like severe bleeding.

*ercutaneous nephrolithotomy

5 n percutaneous nephrolithotomy or nephrolithotripsy, the surgeon makes

a small cut in your back. 9e or she then puts a hollow tube into patient:s kidney

and either removes )lithotomy or breaks up and removes )lithotripsy the stone.

This surgery may be used i other procedures do not work or i the patient have avery large stone.

5 n open surgery, the surgeon makes a cut in patient side or stomach to

reach the kidneys. 9e or she removes the stone.

the kidney stones were caused by a problem with the parathyroid gland , the

doctor may suggest surgery to remove a parathyroid gland or glands

)parathyroidectomy. This can help prevent uture kidney stones.


4/13

Component of the urinary tract

Renal pelvis

The renal pelvis or pyelum is the unnel1like dilated pro-imal part o the ureter in

the kidney.n humans, the renal pelvis is the point o convergence o two or threema;or calyces. ach renal papilla is surrounded by a branch o the renal pelvis

called a caly-.The ma;or unction o the renal pelvis is to act as a unnel or urine

fowing to the ureter.The renal pelvis is the location o several kinds o kidney

cancer.ts mucous membrane is covered with transitional epithelium, and an

underlying lamina propria o loose to dense connective tissue.

Ureters

ach o the ureters transports urine rom the renal pelvis o one kidney to

the urinary bladder . *eristaltic contractions o the muscular walls o the ureters

push urine toward the urinary bladder but hydrostatic pressure and gravity also


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contribute . The ureters are $#1

that vary in diameter rom 'mm to '!mm along their course between the renal

pelvis and the urinary bladder .

Three layer o tissue orm the wall o the ureters . The deepest coat , the

mucosa , is a mucous membrane with transitional epithelium and an underlyinglamina propria o areolar connective tissue with considerable collagen , elastic

(bres and lymphatic tissue . Throughout most o the length o ureters , the

intermediate coat the muscularis , is composed o inner longitudinal and outer

circular layer o smooth muscle (bres. The muscularis o the distal third o the

ureters also contain an outer layer o longitudinal muscle (bre . Thus , the

muscularis in the distal third o the ureter is inner longitudinal , middle circular

and outer longitudinal . *eristalsis is the ma;or unction o the muscularis .

The super(cial coat o the ureters is adventitia , a layer o areolar

connective tissue containing blood vessels , lymphatic vessels , and nerves that

serve the muscularis and mucosa . The adventitia blends in with surrounding

connective tissue and anchors the ureters in place .

Urinary bladder

The urinary bladder is a hollow , distensible organ situated in the pelvic

cavity posterior to the pubic symphysis . n males it is directly anterior to the

rectum = in emales it is anterior to the vagina and inerior to the uterus . Folds o

the peritoneum hold the urinary bladder in position . 6hen slightly distended due

to the accumulation o urine , the urinary bladder is spherical. 6hen it is empty ,

it collapses . As urine volume increases , it become pear1 shapped and rises into

the abdominal cavity.

n the foor o the urinary bladder is a small triangular area called the

tigone . The two posterior corners o the trigone contain the two ureteral

openings = the opening into the urethra , the internal urethral ori(ce , lies in the

anterior corner . >ecause its mucosa is (rmly bound to the muscularis , thetrigone has a smooth appearance .


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Three coat make up the wall o the urinary bladder . The deepest is the

mucosa , a mucous membrane composed o transitional epithelium and an

underlying lamina propria similar to that o the ureters . ?ugae are also present

to permit e-pansion o the urinary bladder . %urrounding the mucosa is the

intermediate muscularis , also called detrusor muscle , which consist o three

layers o smooth muscle (bers = the inner longitudinal , middle circular , and

outer longitudinal layers . Around the opening to the urethra the circular (bers

orm an internal urethral sphincter = inerior to it is the e-ternal urethral sphincter

, which is composed o skeletal muscle and is a modi(cation o the deep muscle

o the perineum. The most super(cial coat o the urinary bladder on the posterior

and inerior surace is the adventitia , a layer o areolar connective tissue that is

continuous with that o the ureters. 3ver the superior surace o the urinary

bladder is the serosa , a layer o visceral peritoneum .

Urethra

The urethra is a small tube leading rom the internal urethral ori(ce in the

foor o the urinary bladder to the e-terior o the body . n both males and

emales , the urethra is the terminal portion o the urinary system and the

passageway or discharging urine rom the body . n males , it discharge semen

as well.

n emales , the urethra lies directly posterior to the pubic symphysis = is

directed obli@uely , ineriorly , and anteriorly = and has a urethra to the e-terior ,

the e-ternal urethral ori(ce , is located between the clitoris and the vaginal

opening . The wall o the emale urethra consist o a deep mucosa and a

super(cial muscularis . The mucosa is a mucous membrane composed o


7/13

epithelium and lamina propria . The muscularis consist o circularly arranged

smooth muscle (bers and is continuous with that o the urinary bladder. +ear the

urinary bladder, the mucosa contains transitional epithelium that is continuous

with that o the urinary bladder = near the e-ternal urethral ori(ce , the

epithelium is nonkeratinized strati(ed s@uamous epithelium . >etween these

areas , the mucosa contains strati(ed columnar or pseudostrati(ed columnar

epithelium .

n males , the urethra also e-tends rom the internal urethral ori(ce to the

e-terior , but its length and passage through the body are considerably dierent

than in emales . The male urethra (rst passes through the prostate , then

through the deep muscle o the perineum and (nally through the penis .

The male urethra , which also consist o deep mucosa and a super(cial

muscularis , is subdivide into three anatomical regions / )' The prostatic

urethra , passes through the prostate )$ The membranous )intermediate

urethra , the shortest portion passes through the deep muscle o the perineum

)


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UreteroscopyFor this procedure the surgeon, often a urologist,doesn't make any incisions (cuts in

the body). He or she first inserts a thin viewing instrument (ureteroscope) into

the urethra(the tube that leads from the outside of the body to the bladder). hen the

doctor passes the ureteroscope through the bladderand the ureter, to get to wherethekidney stoneis located.

!ee a picture of ureteroscopy .

he urologist removes the kidney stonewith forcepsor by using an instrument

with a "basket" that grabs the stone.

!maller stones can be removed all in one piece. #arger stones may need to

be broken up before they can be removed.

!everal types of instruments are available to break up stones. $ut most

urologists prefer to use a laser.

he urologist can also use the ureteroscope to reach a kidney stonethat is stuck in

the ureter %ust after it leaves the kidney.He or she may then try to push the stone

back up into the kidney. &fter the stone is back in the kidney, the stone may be

broken up using lithotripsy .

hat o pect &fter reatment

*ost people are able to go home the same day of the procedure. $ut you may need

to stay in the hospital. +f you do, the stay is usually no more than - to - hours.

For several hours after the procedure you may have a burning feeling when you

urinate. his feeling should go away within a day. /rinking a lot of water can help

reduce the burning. 0our doctor also may recommend you take medicine to numb

the burning.

0ou may have some blood in your urinefor or 1 days.
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/uring ureteroscopy, the doctor passes a thin viewing instrument (ureteroscope)

through your urethra and bladderinto your ureter. he doctor moves the scope

through your ureter until it reaches the location of the kidney stone. 2o cuts are

made in the body.

0our doctor can take out the kidney stoneusing a small "basket" that comes out of

the end of the ureteroscope. !mall stones can be removed all in one piece. #arger

stones may need to be broken up before the doctor can remove them.

tracorporeal !hock ave #ithotripsy

(!#) for 3idney !tonestracorporeal shock wave lithotripsy (!#) uses shock waves to break a kidney

stoneinto small pieces that can more easily travel through the urinary tract and

pass from the body.

!ee a picture of !# .

0ou lie on a water4filled cushion, and the surgeon uses 54rays

orultrasoundtests to precisely locate the stone. High4energy sound waves pass

through your body without in%uring it and break the stone into small pieces. hesesmall pieces move through the urinary tract and out of the body more easily than a

large stone.

he process takes about an hour.

0ou may receive sedativesor local anesthesia.

0our surgeon may use a stentif you have a large stone. & stentis a small,

short tube of fleible plastic mesh that holds the ureteropen. his helps the small

stone pieces to pass without blocking the ureter.


!# is usually an outpatient procedure. 0ou go home after the treatment and do

not have to spend a night in the hospital.

&fter !#, stone fragments usually pass in the urine for a few days and cause mild

pain. +f you have a larger stone, you may need more !# or other treatments.

hy +t +s /one
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10/13

!# may be used on a person who has a kidney stone that is causing pain or

blocking the urine flow. !tones that are between - mm (6.78 in.)and cm (6. in.) in

diameter are most likely to be treated with !#.

!# may work best for kidney stonesin the kidneyor in the part of the uretercloseto the kidney. 0our surgeon may try to push the stone back into the kidney with a

small instrument (ureteroscope) and then use !#.

!# is usually not used if you9

&re pregnant. he sound waves and 54rays may be harmful to thefetus.

Have a bleeding disorder.

Have a kidney infection, urinary tract infection, or kidney cancer.

Have kidneyswith abnormal structure or function.

3idney !tones9 !hould + Have #ithotripsy to $reak Up the !tone:

How ell +t orks

!# works for most people who have small kidney stones4either in the kidney or in

the ureter.

;isks


11/13

tracorporeal shock wave lithotripsy (!#) uses shock waves to break a kidney

stoneinto small pieces. hese pieces can more easily move through the urinary tract

and pass from the body.

For this procedure you lie on a water4filled cushion. 54rays orultrasoundtests are

used to locate the stone. High4energy sound waves pass through your body without

in%uring it and break the stone into small pieces.

=ercutaneous 2ephrolithotomy or

2ephrolithotripsy for 3idney !tones+n percutaneous nephrolithotomy or nephrolithotripsy, the surgeon makes a small

incision in your back to remove kidney stones. He or she then puts a hollow tube into

your kidneyand a probe through the tube. +n nephrolithotomy, the surgeon removesthe stone through the tube. +n nephrolithotripsy, he or she breaks the stone up and

then removes the fragments of the stone through the tube.

!ee a picture of nephrolithotomy .

0ou need either general anesthesiaor regional or spinal anesthesiaduring this

procedure. & small tube (catheter) may be inserted into thekidneyto drain urine until

the kidney heals.


0ou will be in the hospital for at least to 1 days. *ost people are able to return to

work within a few weeks.

hy +t +s /one

his procedure may be used to treat kidney stonesthat are9

#arger than cm (6. in.) in diameter.

#arge and caused by an infection (staghorn calculi). $locking the flow of urine out of the kidney.

2ot broken up by etracorporeal shock wave lithotripsy (!#).2+2U ;&/+2? $#>

How ell +t orks

hese procedures work for most people with stones in the kidney orureter.

;isks

;isks of this procedure include9
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$leeding.

Holes (perforation) in the kidney. hey usually heal without further treatment.

+n%ury to other abdominal organs, such as the bladderor colon.

/amage that affects normal kidney function.

hat o hink &bout

& stone that has left the kidney may need to be pushed back into the kidney with a

small tool (ureteroscope) before the surgeon can do the procedure.

hese procedures are used more fre@uently than etracorporeal shock wave

lithotripsy (!#) to remove larger stones, such as staghorn calculi. very fragment

of a staghorn calculus must be removed to prevent the stone from returning.

=ercutaneous 2ephrolithotomy

=ercutaneous nephrolithotomy or nephrolithotripsy uses a small incision in the

person's back to remove kidney stones.he surgeon puts a hollow tube into

the kidneyand a probe through the tube. +n nephrolithotomy, the surgeon removes

the stone through the tube. +n nephrolithotripsy, he or she breaks the stone up and

then removes the fragments of the stone through the tube.

>pen !urgery for 3idney !tones+n open surgery to remove kidney stones, the surgeon uses an incision in the

person's abdomenor side to reach the kidneyand remove the stones. He or she

then puts a small tube (catheter) near the kidneyto drain urine until the kidney heals.

hat o pect &fter !urgery

0ou will be in the hospital for 8 to A days. 0ou are usually able to resume your normal

activities within - to 8 weeks.

hy +t +s /one

>pen surgery is rarely needed to remove kidney stones. 0ou may need it if9

0ou have large stones caused by an infection (staghorn calculi).

0ou were born with an abnormality in your urinary system that affects

urine flow in the kidneys, ureters, or bladder.

>ther treatment methods have failed to remove or dissolve the stone.
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How ell +t orks

/epending on the location of the kidney stone, open surgery usually can completely

remove the stone.

;isks

he risks of open surgery to remove a kidney stone include9

!evere bleeding.

+nfection.

;isks linked with anesthesia.

&n increased risk of getting a herniawhere the cut was made for surgery.

here also is the risk that the kidney may be severely damaged by the open surgery

and may have to be removed.

hat o hink &bout

/uring recovery at home, call your surgeon immediatelyif you have9

!udden pain.

Fever.

2auseaor vomiting.

!igns of infection, such as swelling or redness around the incision.

he use of etracorporeal shock wave lithotripsy (!#), percutaneous

nephrolithotripsy, and ureteroscopy to remove kidney stones has nearly eliminated

the need for open surgery to remove stones.

he recovery time following open surgery is much longer than the recovery time for

the treatments listed above
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Documents

Treatment of Kidney Stone