Lithotripsy (ESWL) & Lithotomy (PCNL) Producedures

Kidney stones are primarily an aggregation of crystals development by deposition of different chemicals. An article by Dr. N. Subramanian indicates that this usually happens in patients who are susceptible to stone formation. Kidney stones are amongst the most common emergency conditions in urology occurring more frequently in adults. Affecting around 3-5% of the world population, it is seen more in men. Various inhibitors in the urine ususally prevent the formation of these stones, but in some people, this protective mechanism fails or is overwhelmed by other stone forming chemicals. The most common stone is calcium in combination with oxalates and phosphates. It usually happens in patients who are susceptible to stone formation. Contrary to popular perception, dietary intake of calcium does not increase the risk of stone formation unless there is a family history or conditions like Gout and increased activity of parathyroid gland. In some cases they damage the kidney. The most common symptoms are: pain, urinary infection, fever, blood in urine, urinary frequency and burning.

Diagnosis: An Ultrasound Scan, X-Ray. A CT scan: A most accurate method, Blood and Urine Tests and Stone analysis.
Non-Surgical treatment: Stones that are 4mm or smaller pass through the urine and will not require treatment other than pain relievers.Medicines such as Tamsulosin help in passing the stones through the Ureter. Potassium Citrate helps in reducing recurrences. Those having high uric acid will benefit from Allopurinol.
Surgical treatment: Extra Corporeal Shock Wave Lithotripsy (ESWL) is the non evasive option for breaking kidney stones using shock waves delivered externally with precise mechanisms to focus the energy on the tones without damaging the surrounding structures. This is an OPD procedure and does not need anesthesia or hospitalisation.
Percrutaneous Nethro Lithotomy (PCNL) involves removal of the stones from the kidney through an endoscope introduced via small puncture hole at the back, called keyhole surgery.
Extracorporeal shock wave lithotripsy (ESWL) has replaced percutaneous nephrolithotomy (PCNL) much as the latter replaced open surgery, but a place exists in clinical practice this day for PCNL as well as open procedure and it is important for surgeons and urologists to be familiar with this technique of PCNL. Indications for PCNL. Renal calculi greater than 3 cms in diameter. Stone with composition inappropriate for ESWL.

Complete or partial staghorn calculus. Renal malformations like infundibular stenosis, pelvi - ureteric Junction obstruction. Cystine calculi greater than 1.5 cm. Failure of ESWL. Body habitus unsuitable for ESWL.
An ideal patient for PCNL is one who has two functioning kidneys and 2 cm stone in one of the kidneys with extrarenal pelvis with mild to moderate hydronephrosis. PCNL procedure has advantage of short hospital stay, small stab wound scar and negligible pain in the post operative period. Even today in good centres doing large stone work 10% to 15% require PCNL either by itself or together with ESWL. The patient needs to undergo pre operative workup as required in open operation and urine infection if present to be covered by prior antibiotics, the PCNL procedure is done with help of imaging facility like "C" Arm or fluoroscopy and under general anaesthesia. The kidney and upper ureter can also be entered through a small incision in the back through which a telescope, called a nephroscope is introduced. This operation is called percutaneous nephroscopy. Again, lasers, and grasping instruments can be introduced through these video-nephroscopes to allow for the treatment of large kidney stones or the incision of scar tissue that obstructs the outflow of urine from the kidney.
Laparoscopy is the newest and most sophisticated technique of minimally invasive surgery. This technique uses small cylindrical tubes called trocars to enter the abdominal cavity. The trocars allow entry of a video-telescope, called a laparoscope, to view the entire abdominal cavity and its contents from inside the patient. Accessory small trocars allow the introduction of fine instruments necessary to perform surgery. In laparoscopy several small keyhole incisions (usually 1 to 2 centimeters in size) are used in place of a significantly larger and more painful incision. The patient undergoes a similar operation by laparoscopy as by open incision. The advantages of laparoscopy include less pain, a more rapid recovery, a decreased hospital stay, and a quicker return to normal activities.

Types of Kidney Stones

Yes your right. It is a Kidney Stone

I chose to write on the topic of Kidney Stones since my Spouse has suffered immensely from Kidney stones over the past few months. An article written by Dr. Ajit Saxena in the Times of India

gave me the idea to start this Blog. The reason being many people out there are ignorant of this fact, which proves a growing menace to many in the world today. It is only when one suffers that people begin to realise "I should have taken care". Moving forward.Types of Kidney Stones: Sometimes a smooth large stone may pass through with little pain whereas a small one with spicules may get stuck any where in the kidney or urinary canal and cause excruciating pain. A kidney stone is a solid piece of material that forms in a kidney out of the substances in the urine. A stone may stay in the kidney or break loose and travel down the urinary tract. A small stone may pass out of the body without much pain, a larger stone could get lodged in the ureter,l causing much more pain. The shape of the stone, interestingly determines the amount of pain. Sometimes a smooth large stone may pass through with hardly much pain whereas a small one with spicules may get stuck along the way and cause tremendous pain.To get to the point of types of Stones. We know that Calcium is an important part of our diet. It is required for healthy bones and muscles. However, the calcium that is not used in the body is flushed out by the kidney with urine. In some people it joins other wastes to form a stone. A stone called Struvite may form after an infection in the urinary system. It contains minerals, magnesium and waste products like ammonia. Next there are the Uric Acid Stones. These form when the urine contains too much acid. In such cases one should cut down on the amount of meat intake. Yet another called Cistine stones help in the formation of muscles, nerves and other parts of the body. Cystine can build up in the urine to form a stone. Formation of these stones are generally genetic. Any stones that pass spontaneously should be saved for analysis. In order to Expel Stones: (a) Take fluids in abundance as this helps in flushing out the stones. It increases the movement of a stone through the urinary tract. (b) Pass urine forcibly and speedily when the bladder gets full so that the stones in the pathway comes out faster. Chemical Analysis of calculus or (stone) passed in the urine or removed surgically is very helpful in identifying the underlying causes and helps prevent recurrence.

The Kidney & its Functions

Most people feel the kidney is just another body organ. Few actually know or have read about how vital they really are and the numerous functions they play a role in. A general overview of these vital bean shaped organs and their functions will help better understand the importance of these organs and their primary role in maintaining the homeostatic balance of bodily fluids by filtering and secreting metabolites (such as urea) and minerals from the blood and excreting them, along with water, as urine thus eliminating impurities in the human body. The kidneys are poised to sense plasma concentrations of ions such as sodium, potassium, hydrogen, oxygen, and compounds such as amino acids, creatinine, bicarbonate, and glucose, they are important regulators of blood pressure, glucose metabolism, and erythropoiesis (the process by which red blood cells (erythrocytes) are produced). In medical terminology kidneys and diseases of the kidney is called nephrology. There are two, one on each side of the spine; the right kidney sits just below the diaphragm and posterior to the liver, the left below the diaphragm and posterior to the spleen. The kidneys are about 9 to 13 cm in diameter, the left being slightly larger that the right. The kidneys receive unfiltered blood directly from the heart through the abdominal aorta which then branches to the left and right renal arteries. Filtered blood then returns by the left and right renal veins to the inferior vena cava and then the heart. Renal blood flow accounts for up to a third of the cardiac output. The kidneys excrete a variety of waste products produced by metabolism, including the nitrogenous wastes: urea (from protein catabolism) and uric acid (from nucleic acid metabolism) and water

Nephritis

Nephritis or disease of the Kidney. Inflamation of one or both kidneys can be caused by many different conditions. This terrible disease can unfortunately appear in children and adults. The symptons for adults and children are different.

Chronic glomerulonephritis - Is the advanced stage of a group of kidney disorders, resulting in inflammation and slowly worsening destruction of internal kidney structures called glomeruli. Chronic glomerulonephritis occurs when there is slow, progressive destruction of the glomeruli of the kidney, with progressive loss of kidney function.

One should take note of symptoms like high blood pressure (hypertension) and chronic kidney failure. Blood in the urine (dark, rust-colored, or brown urine)
Foamy urine, Decreased alertness,Drowsiness, somnolence, lethargy,Confusion, delirium, Decreased sensation in the hands, feet, or other areas, Decreased urine output, Easy bruising or bleeding, Fatigue, Frequent hiccups, General ill feeling (malaise), Generalized itching, Headache, Increased skin pigmentation -- skin may appear yellow or brown, Muscle cramps, Muscle twitching, Nausea and vomiting
Need to urinate at night, Seizures,Unintentional weight loss, Blood in the vomit or stools, Excessive urination, High blood pressure, and Nosebleed.

Tests that should be conducted:-

Chest x-ray
Kidney or abdominal CT scan
Kidney or abdominal ultrasound
IVP
Urinalysis

Treatment :

Treatment varies depending on the cause of the disorder, and the type and severity of symptoms. The primary treatment goal is control of symptoms. High blood pressure may be difficult to control, and it is generally the most important aspect of treatment. Various medications may be used to attempt to control high blood pressure.

Corticosteroids, immunosuppressives, or other medications may be used to treat some of the causes of chronic glomerulonephritis. Dietary restrictions on salt, fluids, protein, and other substances may be recommended to help control of high blood pressure or kidney failure. Dialysis or kidney transplantation may be necessary to control symptoms of kidney failure and to sustain life.

If you feel you are facing any of the above problems call your health care provider if disorders associated with increased risk of chronic glomerulonephritis are present, or if symptoms indicating glomerulonephritis develop.

Prevention:

There is no specific prevention for most cases of chronic glomerulonephritis. Some cases may be prevented by avoiding or limiting exposure to organic solvents, mercury, and nonsteroidal anti-inflammatory analgesics.

Take a General Medical Check periodically or at least once a year to keep yourself fit from ailments.

Ayurvedic Solutions & Treatment for Kidney Problems

Alternative Medicine or Ayurvedic Treatment - Care N Cure capsules have been recommended for preventing Nephropathy induced by Diabetes, Hypertension and Alcohol.

The Kidneys have various funcitons in the body.

1. Purification of blood by removing toxins through urine
2. Blood pressure control
3. Red Blood Cell Production
4. Bone formation control
5. Water, salt Acid base balance (i.e. Sodium /Potassium)

If the kidneys do not function the following will result.

1. There will be an increase in blood urea and serum creatinine,
2. Decreased appetite,
3. Nausea, itching, lethargy.
4. One will experience headaches, anxiety and decreased vision.
5. Bone aches and consequently bone fractures will result from neglect.
6. Swelling of body, decrease in urine output, breathlessness, weakness and heart failure.

A simple Urine test for Albumin and a Blood test for Serum Creatinine. The increased level of Albumin and Serum Creatinine will tell if the kidneys are getting effected. Other symptoms which show kidney problems are: High Blood Pressure, Decreased Hoemoglobin and High Blood Urea.

The last resort of Dialysis only partially replaces the excretory functions but do nothing for metabolic and endocrinal functions. This is not a complete treatment and eventually results in losing one's life.

Preventing Kidney Stones

Kidney Stones are solid mineral deposits that accumulate inside the kidney or in other parts of the urinary tract. These deposits can cause acute pain. Symptoms are severe back or abdominal pain, nausea and vomiting along with excessive sweating. If there is fever one should immediately consult a doctor. Drinking more liquids, pure water is best. Drink at least two quarts of water every twenty four hours. This will prevent dehydration and reduces the risk of forming stones. Additional water should be taken while performing strenous work or exercise. In case one notices the urine to be yellow in colour,which is a sign of less water in the body, it is advised that more water be taken. Eating tender coconut daily prevents stones.

Kidney stones risk can also be reduced by consuming juniper berries or adding lemon juice to your water. Lemon juice helps prevent crystallization in the kidneys. Teas such as thyme tea and knotgrass tea are good for dissolving mineral build-up in the kidneys as well.

It is very important to drink plenty of liquid through out the day to help prevent stones. By drinking at least two quarts of liquid each day of purified water, juice or tea, your body will be able to flush your bladder more effectively eliminating those dreaded kidney stones. Eat a low fat diet rich in proteins Recently, vitamin A deficiency has been linked to kidney stones as well, by eating lots of fruits and
vegetables such as carrots, yams, peaches, and cantaloupe or supplement with vitamin A in the form of Retinyl Palmitate or beta carotene can help reduce the risk or kidney stones. Several manufactures of Natural vitamin supplements offer kidney stone formulas you might look into as well to help ease existing pain or prevent future stones.

If you are taking calcium stones avoid consuming animal protein from meat and other dairy products. Discontinue consumption of calcium supplements and food rich in calcium like icecreams chocolates, tea etc.

On the other hand people suffering from oxalate stones should avoid eating green vegetables, black pepper, almonds and peanuts. Salt intake should be restricted.

People sufferning from uric acid stones must avoid citrus fruits. Most stones pass out of the body without a doctor's help. If you do pass out stones try to collect them with a strainer and show it to your doctor and have them analysed.

If you have a family history of kidney stones, your family doctor can perform blood tests to see if you are at risk and help you determine what factors to change in your diet to reduce your risk. Stop into your local health food store or shop online for supplements like magnesium and kidney cleansers.

This posting is collection of news articles in newspapers and magazines for Readers to learn more about preventing Kidney Stones.