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Overview

Lithotripsy: Treatment, Procedure, Cost and Side Effects

What is the treatment?

Lithotripsy is a medical routine in which shock waves are used to break the kidney stones, gall bladder stones or the stones that are formed in the ureter. Lithotripsy makes sure that the hardened masses in the different organs are reduced to tiny pieces that can be easily carried by urine outside the body.

Many people develop stones in their kidneys, gall bladders and ureters. If these stones are small enough, they either get carried by urine outside the body or are cured by oral medications. However, if the stones become too big (between 4mm and 2cm in diameter), they may cause severe pain and block urine flow. Also, stones can cause kidney damage, infection in the urinary tract and fever. No medicine can cure the masses of these sizes formed in the organs. In such cases, lithotripsy is performed. Lithotripsy is a great way of removing stones from the body without operating on the patient. The procedure has mostly positive results in people having stones in their kidneys, ureters or gall bladders.

How is the treatment done?

Lithotripsy can be performed in two ways- Extracorporeal Shock Wave Lithotripsy (ESWL) and Intracorporeal Lithotripsy or Endoscopic Lithotripsy.

Extracorporeal Shock Wave Lithotripsy (ESWL) : In this process, the patient is first placed on a water-filled cushion. Then X-rays are used to detect the exact location of the stones. In some cases, an ultrasound test may also be performed to to know the correct location. High-energy shock waves are then passed through the body to break down the stones into fine particles that can pass out of the body with urine. The stones are targeted by almost 1000 to 2000 shock waves for almost an hour. After this, sometimes, the doctor places a tube through the patient's bladder or back into the kidney to drain urine carrying all the particles of the stones.

Intracorporeal Lithotripsy: This type of lithotripsy is performed in patients in whom the exact location of the stones cannot be detected. This process is performed by inserting a tube with a camera and light tied to its tip into the urethra and then gradually upwards to the point where the stones are located. Then shock waves are passed to break down the stones. Intracorporeal lithotripsy is again of four types depending on the type and source of the shock waves - laser lithotripsy, mechanical lithotripsy, electrohydraulic lithotripsy and ultrasonic lithotripsy.

Who is eligible for the treatment? (When is the treatment done?)

Kidney stones are very common and so are stones in gall bladders or ureters. Not all stones are of the same size. The stones that have diameters ranging between 4mm and 2 cmm can be treated by lithotripsy.

Who is not eligible for the treatment?

Lithotripsy is not an option for anyone who is pregnant because the X-rays and sound waves may harm the fetus. The procedure is also not suitable for people with bleeding disorders or those who are suffering from infection of kidney or urinary tract. The structure of the kidney must also be perfectly normal to be eligible for lithotripsy.

Are there any side effects?

Lithotripsy breaks down the stones in the organs into little particles so that they pass out of the body with urine. The little particles can cause great pain when passing with the urine. The fragments can also get deposited in the urinary tract sometimes thus blocking the urine flow. In such cases, a ureteroscopy has to be performed to remove the fragments from the tract. It can also lead to infection of the urinary tract and bleeding outside the kidney.

What are the post-treatment guidelines?

Patients are advised to be at complete rest for at least 2 days. They also have to carry a urine strainer that catches the stone fragments passing with urine.

How long does it take to recover?

Lithotripsy is performed as an outpatient procedure. The patient has to be recovery for 2 hours after the procedure and then he can leave. The patient needs a resting period of 2 days to get on his feet. However, the leftover fragments of the stones may keep coming out of the body even a few weeks after the procedure. But that does not hinder any normal life function.

What is the price of the treatment in India?

The cost of the lithotripsy procedure varies depending on its type. An EWSL can cost from Rs.20,000 to Rs.35,000 while a laser lithotripsy cost ranges between Rs.50,000 and Rs.80,000

Safety: Medium Effectiveness: Medium Timeliness: Medium Relative Risk: Low Side Effects: Medium Time For Recovery: Medium Price Range:

Rs.20,000-Rs.80,000

Popular Health Tips

Urinary Stones - Urolithiasis

M.Ch - Urology, MS, MBBS
Urologist, Dehradun
Urinary Stones - Urolithiasis
The development of urinary stones is most commonly related to:
Decreased urine volume
Increased excretion of stone-forming components
Inadequate urine drainage, which may lead to stasis
Decrease in urinary citrate levels leading to deposition of calcium
Deficiency of vitamins a or c - these conditions can also lead to the" hyper triad: hyperparathyroidism, hypercalcaemia, and hyperuricosuria.

Treatment
When a stone causes no symptoms, watchful waiting is a valid option. For symptomatic stones, pain control is usually the first measure, using medications such as nonsteroidal anti-inflammatory drugs or opioids. More severe cases may require surgical intervention. For example, some stones can be shattered into smaller fragments using extracorporeal shock wave lithotripsy. Some cases require moreinvasive forms of surgery. Examples of these are cystoscopic procedures such as laser lithotripsy or percutaneous techniques such as percutaneous nephrolithotomy. Sometimes, a tube (ureteral stent) may be placed in the ureter to bypass the obstruction and alleviate the symptoms, as well as to prevent ureteral stricture after ureteroscopic stone removal.

Prevention
Recurrence of renal stones is common and therefore patients who have had a renal stone should be advised to adapt and adopt several lifestyle measures which will help to prevent or delay recurrence:
Increase fluid intake to maintain urine output at 2-3 litres per day.
Reduce salt intake.
Reduce the amount of meat and animal protein eaten.
Reduce oxalate intake (foods rich in oxalate include chocolate, rhubarb, nuts) and urate-rich foods (eg, offal and certain fish).
Drink regular cranberry juice: increases citrate excretion and reduces oxalate and phosphate excretion.
Maintain calcium intake at normal levels (lowering intake increases excretion of calcium oxalate).
Depending on the composition of the stone, medication to prevent further stone formation is sometimes given - eg, thiazide diuretics (for calcium stones), allopurinol (for uric acid stones) and calcium citrate (for oxalate stones).

Kidney Stones: Best Way To Treat It

Interventional Nephrology, DM - Nephrology, MD - General Medicine, MBBS
Nephrologist, Bangalore
Kidney Stones: Best Way To Treat It

Kidney stones are often small enough and pass through urine without much bother. Most kidney stones are smaller than 4 mm in diameter. Having said this, even the smallest of kidney stones can be really painful until they pass through urine (learn more what Urine Says About Your Health). It typically takes a couple of days for the body to get rid of it. While medication and self-care are the foremost options, there are a range of other options as well available for treating kidney stones.

Admission to a Hospital-

You must get admitted to a hospital if the stone moves to the ureter, thereby resulting in severe pain. Typically kidney stones which are more than 6 mms in diameter need to be surgically removed through procedures such as ureteroscopy, percutaneous nephrolithotomy (PCNL), open surgery and extracorporeal shock wave lithotripsy (ESWL). A doctor takes a call on any of the above procedure if:

  1. The patient is inching towards a kidney failure.

  2. The pain doesn’t go away even after taking pain killers.

  3. If the patient is pregnant (learn more about for healthy pregnancy)

  4. If the patient is more than 60 years.

Extracorporeal Shock Wave Lithotripsy (ESWL)-

ESWL is one of the simple and most preferred stone removing procedures. It involves the usage of ultrasound shock waves to break the bigger stones into smaller ones. The latter is then passed through urine. A patient is given a few painkillers since this mode of treatment could be a little uncomfortable. A patient might need multiple ESWLs to successfully get rid of all the stones.

Ureteroscopy:

If a stone gets stuck in the ureter, a medical procedure known as the ureteroscopy is performed. In this procedure, a thin telescope is passed through the urethra and bladder to the ureter. Either a second instrument is used or the telescope itself has laser energy to break the bigger stone into smaller ones. This procedure is ideal for stones that have a diameter more than 15 mm.

Percutaneous Nephrolithotomy (PCNL)

PCNL is an alternative to ESWL for removing big stones. This procedure involves the usage of nephroscope that is routed into the kidney through a small incision made behind the back of the patient. This procedure requires general anesthesia and is effective for breaking stones that have a diameter of 20 mm or more. It has a success rate of 86%.

Open Surgery:

This is one of the older methods to eradicate kidney stones. Unless the stone size is abnormally large and other procedures cannot be performed, open surgery is generally avoided. An open surgery involves making an incision and getting access to the ureter and the kidney. The surgeon then removes the stone from the kidney. This procedure requires general anesthesia and the patient needs to be under observation for at least 24 hours, post surgery.

3164 people found this helpful

Best Ways To Treat Kidney Stones!

MBBS, MD - General Medicine, DM - Nephrology, DNB (Nephrology)
Nephrologist, Delhi
Best Ways To Treat Kidney Stones!

Kidney stones are often small enough and pass through urine without much bother. Most kidney stones are smaller than 4 mm in diameter. Having said this, even the smallest of kidney stones can be really painful until they pass through urine (learn more what Urine Says about Your Health). It typically takes a couple of days for the body to get rid of it. While medication and self-care are the foremost options, there are a range of other options as well available for treating kidney stones.

Admission to a Hospital

You must get admitted to a hospital if the stone moves to the ureter, thereby resulting in severe pain. Typically kidney stones which are more than 6 mms in diameter need to be surgically removed through procedures such as ureteroscopy, percutaneous nephrolithotomy (PCNL), open surgery and extracorporeal shock wave lithotripsy (ESWL). A doctor takes a call on any of the above procedure if:

1. The patient is inching towards a kidney failure.

2. The pain doesn’t go away even after taking pain killers.

3. If the patient is pregnant (learn more about for healthy pregnancy)

4. If the patient is more than 60 years.

Extracorporeal Shock Wave Lithotripsy (ESWL)

ESWL is one of the simple and most preferred stone removing procedures. It involves the usage of ultrasound shock waves to break the bigger stones into smaller ones. The latter is then passed through urine. A patient is given a few painkillers since this mode of treatment could be a little uncomfortable. A patient might need multiple ESWLs to successfully get rid of all the stones.

Ureteroscopy

If a stone gets stuck in the ureter, a medical procedure known as the ureteroscopy is performed. In this procedure, a thin telescope is passed through the urethra and bladder to the ureter. Either a second instrument is used or the telescope itself has laser energy to break the bigger stone into smaller ones.

Percutaneous Nephrolithotomy (PCNL)

PCNL is an alternative to ESWL for removing big stones. This procedure involves the usage of nephroscope that is routed into the kidney through a small incision made behind the back of the patient. This procedure requires general anesthesia and is effective for breaking stones that have a diameter of 20 mm or more. It has a success rate of 86%.

Open Surgery

This is one of the older methods to eradicate kidney stones. Unless the stone size is abnormally large and other procedures cannot be performed, open surgery is generally avoided. An open surgery involves making an incision and getting access to the ureter and the kidney. The surgeon then removes the stone from the kidney. This procedure requires general anesthesia. If you wish to discuss about any specific problem, you can consult a nephrologist.

1833 people found this helpful

Surgical Management of Kidney Stones

MBBS, MS - Urology, DNB
Urologist, Guwahati
Surgical Management of Kidney Stones

Kidney stones are not exactly stones, but hard deposits that are composed of minerals such as calcium or uric acid. These deposits start accumulating and over time enlarge to form obstructions within the urinary tract. Most kidney stones pass out on their own with little or no medication required, but in some cases, they have to be taken out through surgery. Let us now look at the surgery options available for the removal of kidney stones and why they are needed.

Need for surgery:
You might have to opt for a surgical procedure if you are in a lot of pain and if the stone is very large and cannot pass out on its own. Surgery will also be advised if the stone blocks the urinary tract hampering the free flow of urine. There are four types of surgical procedures that can be done for kidney stones.

  1. Shockwave lithotripsy
  2. Ureteroscopy
  3. Percutaneous nephrolithotomy
  4. Open surgery

Shock Wave Lithotripsy
This is the most common procedure that is performed for the removal of a kidney stone. It works best for small or medium stones. It is noninvasive - there are no cuts or scars made in your skin. In this procedure, the doctor after identifying the exact location of the stone sends out shock waves aimed at your kidneys. This dislodges the stone and breaks it into small pieces. This is a painless procedure, and no hospitalization is needed. You might have blood in the urine for a few days after the procedure, but it is considered normal and heals on its own. Check with your doctor in case you experience any complications

Ureteroscopy
This procedure is recommended to treat stones in the kidneys and ureters. A thin, flexible scope is used to find and remove the stones. There are no cuts made, and you will be under anesthesia throughout the procedure. A thin scope is passed through your bladder and ureter to reach the kidney. Once the exact location of the stone is reached, the doctor uses a small basket to scoop out the stone. In case the stone is big, a laser is used to break the stones. This is procedure too does not require a hospital stay. Recovery time is short and you can get back to normal activities soon.

Percutaneous Nephrolithotomy or Percutaneous Nephrolithotripsy
This procedure is done when you have a large size stone and the other methods do not work. In this procedure, a small cut is made in the back, and a thin tube is inserted to reach the stone. Once it reaches the stone, high-frequency sound waves are used to break the stone. You will be under anesthesia throughout the procedure. This can be considered as the most successful types of procedure and is routinely used to remove large stones. Recovery time is short but a short stay in hospital of about a day will be required.

Open surgery
This procedure is rarely done nowadays as it involves the traditional method of surgery. However in some rare cases, when your stone is very large, and the other methods are not an option this approach is used. Hospitalization is required for this procedure and the recovery period usually takes between 4 to 6 weeks. In case you have a concern or query you can always consult an expert & get answers to your questions!

2773 people found this helpful

How To Treat Kidney Stones?

MBBS, MS - General Surgery, M.Ch - Urology
Urologist, Bangalore
How To Treat Kidney Stones?

Our kidneys are an important organ in the body and are responsible for the filtration of blood and creation of urine. Sometimes, during this process salt and other chemicals get stuck together to form small crystals also known as kidney stones. The size of a kidney stone can range from the size of a sugar crystal to the size of a ping pong ball. However, it is noticed only if it is large enough to cause a blockage. Smaller stones may pass out of the body without you realizing it.

Kidney stones can be a very painful experience. Some of the symptoms exhibited by patients suffering from kidney stones are:

1. Severe back pain
2. Pain in the belly or groin
3. Painful urination
4. Frequent urination
5. Nausea and vomiting
6. Blood in the urine

Excruciating pain is usually the symptom that makes a patient consult a doctor in cases of kidney stone problems. A confirmed diagnosis can then be made by using a series of tests that include an X-ray, ultrasound, CT scan and urine analysis. A blood test may also be conducted to check the mineral levels in the body.

Kidney stones are a common condition faced by many people, but some people are at a higher risk of suffering from this than others. Some of these factors are:

1. Family history of kidney stones
2. High uric acid levels in the blood
3. Being between 20-50 years of age
4. A previous kidney stone
5. Chronic diseases such as diabetes and high blood pressure
6. Some medication such as diuretics and antacids with calcium
7. Inadequate fluid intake

Between men and women, the former are at a higher risk of suffering from kidney stones. Asians and Caucasians also suffer from this condition more than people from other races. Hormone changes during pregnancy can also trigger the formation of kidney stones.

The first thing to do if you suffer from a kidney stone is to increase your water intake. This can help dissolve some of the minerals in the stone and make it a small enough to pass through the urethra. Injectable anti-inflammatory drugs and pain relievers may be used to ease the pain caused by kidney stones.

If the kidney stone does not pass on its own, a process known as lithotripsy may also be used. This involves the administration of shock waves that can break a large stone into smaller pieces. In extreme cases, surgical techniques may also be used. However, Lithotripsy in only one of the ways of treatment and given in only selected cases nowadays. Better ways of treatment are: 

  1. Ureteroscopy- seeing the stone through a long telescope through the urine passage and removing it.
  2. PCNL- removing kidney stone by a small puncture into the kidney through the skin.
  3. RIRS- visualising the stone in the kidney with a bendable telescope and breaking the stone using laser.

    If you wish to discuss about any specific problem, you can consult an urologist.

Popular Questions & Answers

I hv 1.1 cm stone in pipe I mean came down from kidney n nw its paining so doc said to do lithotripsy so is there any side effect if I do lithotripsy and is it painful and after this van I do any kind work and right after lithotripsy can I travel please reply me soon plz.

Bachelor of Ayurveda, Medicine and Surgery (BAMS), DYA (DIPLOMA IN YOG & AYURVED), D.I.H.M (DIPLOMA IN INDUSTRIAL HEALTH MANAGEMENT)
Ayurveda, Nashik
1) Avoid hard water to drink, drink sufficient boiled water or purified water only. 2) Avoid fruits containing small seeds like tomato, guava, vegetables like brinjal, 3) Duration to cure kidney stone is depends upon size, number of stone, position (kidney? urethra?). 4) Do skipping exercise daily so that stone can come down to bladder. 5) Drink sugar-cane juice without ice empty stomach or as possible. 6)Take 4 crushed Elaichi (cardamom) add 2 cup of water boiled to become half filter it, add 2 spoons of cow ghee take on empty stomach. 7) Give feedback in 6 days .do consult privately for perfect treatment.

Is lithotripsy good enough to cure all stones from kidney or one should go for micro surgery?

Bachelor of Ayurveda, Medicine and Surgery (BAMS), DYA (DIPLOMA IN YOG & AYURVED), D.I.H.M (DIPLOMA IN INDUSTRIAL HEALTH MANAGEMENT)
Ayurveda, Nashik
it depends on size & position of stone . attach reports for better answer. if size less that 10 MM .then ok go for litho.
1 person found this helpful

What is the best treatment for kidney stones. Is the lithotripsy is safe treatment for 17 yrs. Of age. Please help me out, I am thankful to you.

CCAH, BHMS
Homeopath, Palakkad
Size of the kidney stone is important to do whether lithotripsy or not. If the size is below 9 mm, HOMOEOPATHIC MEDICINES can definitely break the stones and helps to drain out through urine. No side effects in HOMOEOPATHIC MEDICINES. Once lithotripsy done the chance for further formation of kidney stones also more. Homoeopathic medicine can prevent further recurrence. Feel free to contact me for further details. Thank you.
2 people found this helpful

Hi, I was having a 13mm stone in right kidney which is now removed through lithotripsy treatment. I just want ask how I can prevent from recurrence of stone?

MBBS, MS - General Surgery, DNB (Urology)
Urologist, Ghaziabad
you should take 3-4 l water daily avoid taking vegetables containing seeds like brinjals, tomatoes, palak and please confirm that no other stone is present in kidney at present.
3 people found this helpful

I had a urethral lithotripsy 3 weeks ago. The stent has not been removed yet. After how long can I indulge in coitus?

MBBS
General Physician, Fatehabad
Hi lybrate-user, It is advisable to wait for atleast 1-2 weeks after stent removal before having intercourse. Stent removal should not interfere with ejaculation and if you are having any such problem then you should get it checked from your urologist.
1 person found this helpful

Table of Content

What is the treatment?
How is the treatment done?
Who is eligible for the treatment? (When is the treatment done?)
Who is not eligible for the treatment?
Are there any side effects?
What are the post-treatment guidelines?
How long does it take to recover?
What is the price of the treatment in India?
Play video
Is It Dangerous For Kidney To Hold Your Pee?
Hello friends,

I am Doctor Anirudh Kaushik and senior consultant Urologist at Holy Family hospital and my clinic is complete family Clinic and program.

Today I will talk about stone disease especially the kidney stone disease. In Kidney Disease wants her very prevalent in North India and this part of Delhi Haryana and Rajasthan. The incidence of kidney stones is very high or simply because of hot weather kidney stones can be of many times it can be a renal stone which is a kidney stone and lying on one side not obstructing then it required only medical management system can be a kidney stone which is blocking the urinary passage most likely require surgery.

And many times when the patient comes with the stone is stuck in the ureters the urinary stones are the most troublesome because the cause severe policy the prevention of kidney stone why North India has so much prevalence of kidney stone is one should drink at least four to five litres of water in summer season or 3 to 4 litres of water in winters if you give yourself well hydrated anyone if you have a tendency to take excret certain salts in your urine those salts will remain hydrated has been detected and will not give rise to formation of Crystal and one thing very important to understand here is if you have been really very religiously taking care of your hydration but if even for 5 minutes if urine is concentrated then a crystal formation offering can precipitate formation of a stone because crystal forms that are the foundation stone laid of a stone in the future.

However stones can again be treated with swl which is extracorporeal shock wave Lithotripsy but the stone sem enable for this modality of treatment are the one which is not very obstru ctive in nature and now we don't treat big stones with this because this modality the advantage meaning that the shock wave is given from outside no surgery of any kind is performed but it only brake system and the passage of all those broken down fragments is on the person so bigger the stone more the fragments more fragments will have to fast way we are seeing all these treatments main give you problem so that is why is wl is not so popular as we thought it would be the most commonly used mortality for treatment of kidney stone is PCNL in which a punctured is down to the skin write into the kidney and a guide wire is passed into the kidney and all that died by v dilator track and have access to the kidney through a tube through that you will pass a telescope in break the stone with laser and all the broken down fragments are immediately removed through that tube which has access from the skin to the kidney and at the end a stand double standard space inside and this is about the kidney stones the other states which are very commonly found unitrix stone for that the modality is like you refer scopic Lithotripsy or RIRS same principal telescope is passed into the ureter stone is seen and broken down with the laser and Statistics it so it requires only one or two days of hospitalization and one is free of the disease

Thanks you.

Play video
Know More About Kidney Stones!
Hi, I am Dr Sarwar Eqbal. I am Urologist and I hav done MBBS in the year 1999, MS in General surgeon in 2002. Later I have done snior residency in Urology from reputed Insitute of Delhi. Then I have done the urology in kidney transplant in Sir Gangaram Hospital, Delhi, in the year of 2008. I am working as a consultant urologist from last 8 years. And I would have attached to reputed hospitals in the Delhi NCR region.

Today I am going to talk about the major problem which people are facing in Delhi, that is, Urolithiasis or Kidney stones. The kidney stone issue has become very commonin the Delhi-NCR region. Out of 8-10 cases of OPD, we a can see 5-6 cases of kidney stone, and it is more common in male. The most common cause we see is an inadequate hydrateion body because of which there occur crystallization of urine which sediments in kidney and become stones later on. So , you have to be more carefull about your health. This kind of problem is very common in summers because of the sweating, there is a lack of water in the body which gets precipitated in the kidney and takes the shape of a stone.

Stone is one of the common cause of destruction or damage of the kidney world wide. So, what we do in case of the kidney stone?

The first thing is the awareness. They should know the cause of kidney stones, or how it can be checked or prevented. So, keep yourself hydrated throughout the summer. You are supposed to have that much amount of water which can make you produce atleast 2 litres of urine pe day.

In certain cases, it is very common amongst the family. May be in the family, or may be related to some kind of food which is very common, specially the non veg which may cause urinary stones.

Now, let us come to the different kind of stones which is vry common all around India;

Oxalate stone
Ureteral stones and the other stone
Now, what does these Kidney stones cause?

These types of stones are formed in the kidney and they grow with time and they can take the size of the stone, ehrein they are called size of the kidney. So they start forming in the kidney. If proper precautions are not taken , they can take the shape of the kidney and can enlarge to the kidney size. This is called staghorn calculus, which can cause complete destruction of kidney and leads to kidney failure. When the stone size is small, they can cause obstruction of the kidney at certain point, like the pigeon of the kidney is the common cause of obstruction, which leads to swelling in the kidney, pain, infection. If it is not treated on time, it can cause complete damage to kidney permanently. They can trickle down to uretor. Uretor is a line that connects kidney and the urinary bladder. So, they can obstruct the uretor at any point of kidney upto the bladder level. This can cause urinary chronic which is a severe pain associated with Nausea, vomiting, burning sensations and also sometimes can cause blood in the urine. If it is not treated on time, it can lead to complete destruction of kidney.

Sometimes these stones enetrs the urinary bladder and can choke the urethera. Due to this, patients may have some problem in passing urine, which is called obstruction of the retention of urine for which we may require catheterization and later the removal of the stone.

What are the modality in the treatment of kidney stones?

The modalities depends on the size of the kidney stones as well as the location of the stones. The other parameters like the diabetes, hypertension, CADS related conditions with the patients.

The size and position of the stone.

The management depends on the stone size and the location. If the size of the stone is < 1 cm and lies anywhere inside the kidney. Then the treatment procedure is very simple, which is known as ESWL lithotripsy. It requires some small waves targeting the stones which makes the stone pulverised (sand like) and expelled out through the urine itself. But if the stone size is big, like more than 1 cm or 1.5 cm, then the choice of treatment will be miniperc. And if the size of the stone is < 1.5 cm and the patient is not ready for ESWL. Because ESWL requires some staging, then the other great option is RIRS, which is known as the Retrograde Intrarenal Surgery.

In RIRS, we put the endocscope through urinary passage and break the stone through laser. The fragments are taken out from the kidney itself. The patient does not require any kind of incision, not even the button hole incision. When the stone is inside the ureter, then the treatment of choice is URS, which is called Ureteroscopy. If the stone is inside the bladder, then the treatment procedure will be Laser lithotipsy. In this process, we pass the endoscope through the bladder and pulverise the stone and take out the fragments through it.

If you have any such problem. Like stones in the kidney or ureter or bladder, you can contact me through Lybrate.

Thank you.

Play video
How Do Kidney Stones Form?
Hi!

I m Dr. Tanuj Paul Bhatia, senior consultant of urology at Sarvodya hospital, Faridabad.

So I will discuss what is urology? And mainly about kidney stones today. Urology is a branch of medicine which deals with male and female urinary tract and male reproductive organs. Basically in this we deal with the kidneys, where it is formed and then it comes to ureter and through the ureter it comes to the bladder and then it does empties through urethra and comes out of the body. So this is our entire urinary system and the diseases of this entire system is dealt by urologist i.e. us. So when we come to kidney stones we know that kidney stone is a very common disease, it is highly prevalent in almost whole of entire north India and states like Punjab, Haryana, Delhi and Rajasthan. They form part of stone built of India and stone built of the world. That is mainly because in this regions the temperatures are very high mainly due to summers and water consumption is not enough and most of the people tend to be dehydrated which is also occurring in the formation of kidney stones. Now if we come to etiology of kidney stone that is why our kidneys stones formed? In some people it is because the condition is genetic, they have parents or grandparents who were the stone former so the genes are passed on and they have the tendency of formation of stones. Sometimes there are patients who have other diseases which can lead to stone formation or sometimes during treatment e.g. some forms of bilateral surgery or excessive dieting can also lead to the formation of kidney stones most of the patients, however, do not have a specific reason of stone formation and they are etiologic stone formers. When it comes to symptoms of kidney stones, most common symptoms of kidney stone is pain and the pain is very typical, patients usually typically complain of back pain which rotates either from back to front or lower part of abdomen or from lower part of abdomen to the back. And sometimes male can experience pain in the scrotum and females can experience pain in the vulva region as well because of the kidney stone when they are obstructing. Having said that it is rather ironical sometimes bigger stones can actually be asymptomatic and detect on investigations done on the other purposes. So when it comes to diagnosis of kidney stones most useful entity to us for diagnosis is ultrasound.

Ultrasound is a non-invasive test and it offers them as a screening test. For urologist it is a examination of a clinical examination, it is the extension of the clinical examination. So most of the times stones are identified on ultrasound and when required we do the CT scan to further confirm the size and location of kidney stone as well as the density i.e. how hard is that stone. And these tool examination mainly form are basic outcomes. So when it comes to treatment of kidney stones the treatment of kidney stones depends on the size of the kidney stones, the location of the kidney stones and whether it is causing any complications. So when we talk about size it has been seen in most of the studies that stones that are lesser than 6mm have good chance of passing out by itself. So we always try conservative approach for these patients and we keep them on medications. Most of the patients that is about 80-90% of the patients who develop the pain due to stones have small stones and they do not require any surgery and they will pass out the stones with themselves with some additional medicines which will keep them pain free and their ureter to relax and in turn helps the stone to pass out themselves. When the stones is bigger than 6mm the chances of passing out spontaneously decrease. As the sizes increases further the chances decreases further. Similarly if the stone is tuck in the upper part of the urinary tract the chances of passing out spontaneously are less however if the stone is tuck in the lower part of urinary tract the chances of passing spontaneously is good. So third thing is complications, so whenever there is stone and it is causing recurrent urinary tract infection or it is causing fever or it is cause disengagement of the renal functions then it requires urgent treatment and it has to be removed. When we talk about surgeries of kidney stone there are different types of surgeries. So when the stone is in the kidney itself basically we can do 3 types of surgeries. One is ESWL or lithotripsy. In ESWL the patient is made to lie on a bed and some shock waves are applied to this part of the abdomen and they help the stones to break. However disadvantages of ESWL is that the success rate is relatively poor when compared to other modalities and they usually requires repetition.

So then came the era of PCNL. PCNL is the procedure which is called as percutaneous nephrolithotomy. In this the hole is made at the back and into the kidney and endoscope is passed into the kidney and stone is broken and removed. So it is a very good techniques but nowadays it is prefer only for very large stones and the latest technique in treatment of kidney stones is RIRS which is retrograde intrarenal surgery. In RIRS we basically go through a normal urinary tract and that is we go through the urethra up into the bladder and through the ureter we go into the kidney. And with this flexible urethroscope we break the stone there and there in the kidney itself, we make it into a very fine dust like substance and then we put it in a stand and come out. So most of the time this dust clears has ureter dilates because of the strand. However it has its own limitations specially when there is a very large stone e.g. stones larger than 2cm you may require multiple sitting of RIRS but for stones less than 2cm RIRS is now the preferred procedure. It is also preferred when the kidney is located in the abnormal position like in the pelvis or it is the malrotated kidney because when the kidney becomes difficult to approach via other modalities and but flexible endoscopy or RIRS we can reach it and we can break the stone then and there. When it comes to stone in ureter there are 2 modalities that are used to treat.1 is ureteroscopy which is a straight reject stereoscope and it is used to access the ureter and the stone is broken and removed. When the stone is in the upper part of kidney again there is a high chance of reproduction. Retrobuction is passing out the stone back into the kidney so if it is going back into the kidney the advantages of RIRS comes in, we can pass the flexible ureteroscope through the same route going into the kidney and break the stone which is retro pass back into the kidney. When it comes to bladder stones there are 3 procedures which are done one is cystolitholapaxy, then cystolithotripsy, and percutaneous cystolithotripsy. It depends on the size of the stone that which procedure will be done. If the stone is not very big it can be crush using a special forceps which is called as cystolitholapaxy. If the stone is between 1-5 cm then it can be broken through the normal urinary tract to transvaginal cystolithotripsy. If the stone is very big a small tract is made in the upper pelvic area and the stone is fragmented and removed.

Thank you!
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I am Dr Waheed Zaman principal consultant neurology and renal transplant Max Shalimar Bagh and Max Pitampura. I have got clinic in Rohini Sector 13 that is Care Multispeciality Clinic and we are dealing complete urology specially pertaining to all urology problems specially stone disease, prostate problem then genitals urinary tract, cancers we are dealing, then infertility and about the importance and male infertility specially we are doing in our centres and my main topic of interest is renal transplant.

I have got experience of more than 1000 transplant and I am very much interested and I helped in people, I have given many lectures for cadaveric transplant and we try to promote it. But today I am discussing on different topics that is stone disease, this is very common in India, especially in North India. We get large number of kidney stone patient they usually present with the brain in emergency with a flying plane, radiating down, blood in urine and majority of the times in emergency severe colic pain. So immediately we give pain Killers, we settle this patient and we ask for ultrasound, urine test and kidney function test. On Ultrasound majority of the stones can be detected or indirect evidences maybe there are life dilatation of the kidney, kidney me sujan ho sakta hai or yadi doubt ho toh definitely hum log CT-SCAN karate hain, plain CT-SCAN se 99% stone detect kiya Ja sakta hai. Ek bar stone detect hua phir uske size pe cocern hota hai, jaise general public mein thinking hoti hai ki sab stone nikal jate hain dawai se ya pani se, yeh sahi nahi hai yadi aap dekhenge ki char millimeter se kam size ke jo stone hote hain almost 80 to 90% nikal sakte hain medicine pani se, mainly pani se aap nariyal pani le, pani piye kafi aur nimbu pani, shikanji yeh 3 apne indian drinks jo hain woh best drinks maane jaate hain, wo chote stone ko aaram se flush kar deta hai. 4 se 7 millimeter ke jo stone hote hain almost 50-50 chance hota hai nikalne ka, 7 millimeter se 10 millimeter ka jo stone hota hai around 10 to 20% chance hai or 8 centimetres se jayada 10 percemt se bhi kum chance hota hai ki nikale, par hamare log jayadatar yehi galat dharna bani rehti hai ki nai medicine se sab nikal jayega even ek-daid centimetre ka stone nikal jayega, yeh commonly hamhe OPD main kuch log puchte bhi hain log, sir aap toh medicine do bade se bade stone mein aur galado usko. Aise stone bahut kum hai jo medicine se galte hain specific uric acid stone wagairah hote hain, jo aur excess pani peene se chhote stone to niklenge hee, definitely. Ab ek baar yadi diagnosis ho gaya ki stone kis level pe hai kidney mein kya changes ho rahi hai yadi back pressure changes jyada hai kidney even phat jati hai itna back pressure rehta hai, infection ho jata hai, bleeding hoti hai, toh aise condition bukhar rehta hai infection ki wajah se, toh hum patient ko salah dete hain ki better hai aap operation ki ke liye jaiye aur wait mat kariye. Kyunki yadi do hafte se jyada yadi kidney block rehti hai stone ki wajah se toh reversible kidney damage start ho jata hai. So we have to be very careful, very judicious, listen to your doctor and there are many myths associated with the kidney stone disease, so try to be more judicious. Kidney stone nikalne ki kai padhatian aajkal adhunik lithotripsy ho sakti hai par ab utni popular nahi rahi hai, uske alawa ureteroscopy hai jisse ureter ke stone nikale ja sakta hain. Kidney stone hum log keyhole surgery se karte hain PCNL, mini PCNL techniques hain, aur aaj kal jo latest aagaya RIRS, that is Retrograde Internal Surgery, aaram se hum log peshab ke raste se hi bahut hi patle sukshm yantra aagye hain jisko flexible urteroscope bolte hain, woh peshab ke raste se bladder hote huye ureter or wahan se kidney per pahunchte hain, aur aise even ded-do centimetre ke stone hum log laser se tod sakte hain, aur ekdum dhul ke kann jaise ho jate hain aur woh peshab ke sath nikal jate hain. Bade kann hum log retreat karte hain, uska stone analysis karte hain aur based on that hum log ye plan karte hain ki aage kya treatment diya jaye. So iska follow-up bahut zaroori hai ek baar kisi ko stone banna hai to 70% chance hai ki dubara banega apna lifestyle change kijiye, salt kam le, fast food kam kare, pepsi wagera bilkul minimum karde, it is full of obsolete chai kam kare, coffee kam kare, chocolate band kare aur pani jyada piyen din mein barah se pandrah glass pani peena chahiye, shkanji piye, ek nimbu daily piye, shikanji uska istemal kare uske alawah anaras hai, kele hain inka sevan kare, karele ki sabji zaroor le isse kidney swasth rehti hai, kuch fruits hain jaise especially maine bataya banana and pineapple yeh kafi useful hota hai, jo sabjiya kam leni hai umne bhindi hai, baingun hai, gobhi, palak inka kam kare istemal band nahi karna hai. Sabse badi dawa pani hai, pani piye one lemon day keeps the stone away , aur iska sahi upchar kare otherwise kidney stone may lead to kidney failure even. So aap bade sachet rahey issme, doctor ki sune mein baar baar request karta hoon, hum log daily yrh a problem face karte hain hum log sahi salah denge aapko koi misguide nahi karta hai, yddi kidney damage ho raha hai toh definitely intervene hona chahiye otherwise medical management bhi possible hai chote stone ke liye.

Dhanyavad.
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