In general, stones in the entire urinary system can be called kidney stones among the people. Known as one of the 'most painful diseases', kidney stone pain causes serious discomfort and loss of labor in individuals.
Since its incidence is increasing gradually in the society, it is seen at rates of up to 15-20%, so its treatment is important. Therefore, kidney stone surgeries are also on the agenda for urinary system stones that cannot be removed spontaneously.
The medical name for kidney stone pain is renal colic. Kidney stone pain is severe intermittent pain that hits the flank where the stone is. It is not continuous and does not increase with movement and fatigue. The pain is more severe, especially in stones that fall into the ureter. Stones that settle in the chambers in the kidney and do not obstruct may cause mild pain or sometimes insidious and not painful.
Kidney stone pain is felt on the flank on the side of the stone. Stones descending into the ureter (the tubes of kidney) and getting stuck there are also accompanied by severe side pain as well as pain hitting the groin.
The most important factor for the passing of kidney stones is the size of the stone. While the passing rate of stones 5 mm and below is high, the rate of stones larger than 1 cm is very low. Adjunctive medicines (expulsive therapy) are also prescribed when needed to remove kidney stones without surgery. Kidney Stent ▶
May affect kidney functions by obstructing the urinary system; Kidney stone surgery is necessary in the presence of stones that will impair the quality of life such as pain, nausea, vomiting and infection. This is also true for ureteral stones and bladder stones. However, it can be followed for stones smaller than 5-6 mm due to the possibility of spontaneous passing within a few weeks. For patients with solitary kidney, it may be pointless to wait.
Urgent kidney stone removal may be required for kidney stones that are unresponsive to painkillers, impair kidney function, cause sever kidney obstruction and infection. Sometimes, laser kidney stone surgery is required for social reasons other than medical conditions. For example, a ship captain or a pilot flying overseas can not be expected to pass the stone. Or, if people who have serious problems in their business life due to stone pain are not small in size, it is unnecessary to kidney stones removal.
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With the technique called ESWL (Extracorporeal shock wave lithotripsy),it is applied over the skin based on the vibration of sound waves. No intervention is required. However, there are some limitations. Especially in large and hard stones, the failure rate is high. In patients with severe pain, the long duration of treatment, the presence of sessions and the existence of session intervals reduce compliance with treatment. Its advantages are that it can be applied without anesthesia and that it is not invasive like surgical methods such as percutaneous nephrolithotomy.
Kidney stone surgeries are generally divided into three types.
Kidney stone removal with laser, which is done endoscopically, varies according to the size and location of the stone. In general, it varies between 30 minutes and 90 minutes. Percutaneous nephrolithotomy and laparoscopic kidney stone surgeries take between 1-3 hours.
After the stone is found by entering the ureterorenoscope and through the urinary canal, the process of breaking the stone into pieces is carried out with the laser sent through it. It is the standard treatment method applied for the ureteral Stones.
It is the most widely used surgical method in the world, where the safest and best stone-free rates are provided for stones located in the kidney and with a long diameter of less than 2-2.5 cm. Thanks to the flexible URS that enables imaging, the kidney stone can be reached without any incision by advancing through the bladder and ureter. Then the stone is broken into pieces by laser. In appropriate and necessary patients, a sample for the stone is also removed.
The kidney is reached by entering a 1-2 cm hole in the dorsal region. A tube is placed in the kidney and the stones are broken into pieces with pneumatic or ultrasonic stone crushers inside the kidney and taken out with the help of stone holders. The most important advantage is that it has a high stone-free rate even in large kidney stones and provides faster recovery than open surgery. However, it is still more invasive and more likely to have side effects than retrograde intrarenal surgery (Flexible URS) and ESWL. In these surgeries, double (DJ) stent requirement is less and a catheter (Re-entry) placed in the hole opened from the back may be needed and it is removed in 1-3 days on average.
It provides high success in experienced hands, especially in large kidney stones located in the renal pelvis (main pool) or present in the ureter. The advantages of not puncturing the renal parenchyma, such as percutaneous nephrolithotomy, are that there is no loss of nephrons, that kidney function is preserved very well, and that the probability of bleeding is very low. However, if there are stones extending to the minor calyces (small pools) of the kidney, this creates a limiting factor for the operation. Again, in laparoscopic kidney stone surgery, DJ stent is usually placed and removed after 4-6 weeks.
Laser kidney stone removal prices are also frequently sought in search engines. Kidney stone removal cost also vary according to the location of the stone, its size, the equipment to be used, the hospital, the factors of the patient and the surgeon. Costs range 1500 to 4000 USD
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The difficulty of kidney stone surgery depends on the location of the stone, the size of the stone, the anatomical and functional factors of the patient, the technical structure of the operating center, and the experience and ability of the surgeon. But they are not major surgeries in general (especially ureteroscopy and retrograde intrarenal surgery).
Discharge occurs within 12-24 hours in laser kidney stone breaking surgeries. After percutaneous nephrolithotomy and laparoscopic stone surgery, an average of 2 days of inpatient treatment is performed in the hospital.
After ureterorenoscopy (URS) and retrograde intrarenal surgery (RIRS, Flexible URS),which are endoscopic surgeries performed with laser, patients can return to their normal lives quickly (within 1-2 days). The average time to return to normal life after percutaneous nephrolithotomy and laparoscopic stone surgery is 5-7 days.
First of all, there is no surgical procedure without risk. However, the risk is less in kidney stone surgeries, especially in endoscopic surgeries performed with laser. Surgical risk is minimized in experienced hands, especially with the methods applied to prevent infection and sometimes the operations performed step by step.
After kidney stone surgeries, it may be necessary to insert a catheter in order to monitor urine output and to provide urine output in bed in cases where the patient cannot be mobilized after surgery. However, this is not always essential, and the surgery can be terminated without a probe, as patients have reservations and if there is no complete need. In cases where a catheter is inserted, the catheter residence time is a few hours after laser stone removal.
In endoscopic kidney stone surgeries (especially in ureteroscopy and RIRS),stent placement and removal after a few weeks may be required for strictures in the ureter, edema, rapid relief and rapid healing of the obstruction in the kidney, rapid drainage of purulent urine caused by stone-related infections.
After the laser kidney stone removal, there is no throbbing pain caused by the stone before. Only mild pain due to minimal mucosal damage during the operation and, if a stent was placed, symptoms such as mild flank pain, urination, and frequent urination may occur. Patients whose kidney stones are completely cleared do not have any complaints within a few days.
Before or immediately after kidney stone surgery, patients with DJ stent inserted or removed do not have any sexual restrictions. It is wrong to think that sexual intercourse can damage the stent.
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