Hello friends! I am Dr. Saurav Mishra. I am working in senior consultant in the department of Urology Moolchand MedCity Lajpat Nagar.
Friends today I am going to discuss about the stone disease. This will be more of the point of view of the general public. So coming to the topic. The Stone disease is a common disease and mostly involve the young patients. The commonest factor of the stone disease there are multiple factors in fact but dehydration has been seen as to be the most consistent factor. The risk of recurrences are as high as 50%. There are various kinds of stones but oxalate stones are the commonest one.
How are they present? Most of the stones present as a pain – pain in both the sides of the abdomen is the commonest pain. How to detect these stones. Best investigation is the CT scan. The accuracy to detect these stone of the CT is more than 99%. How to treat these stones. The treatment depends on the location and the size of the stone. The size even it may be very small but according to the location it may be a dangerous stone. For example a stone of 5mm 6mm in the ureter may be dangerous whereas a stone of 2cm versus 10mm may not be dangerous in the kidney. Because a very small stone can block a kidney completely and knock out the kidney. Even a large stone if it occupies one corner of the kidney not going to cause a problem.
Come to the treatment. The medical treatment although discussed commonly but it has a role in the ureter stone. In our practice we see approximately 60% of the small stones. They pass spontaneously under the effect of medical treatment. As such there is not a single entity or a medication which can dissolve the stone and reduce the size of the stone and cause spontaneous passage. There is no existence of such thing but it has been seen there are few drugs which relaxes the ureter and facilitate the process of passage by the tune of 10%. So if someone is claiming that I am giving a particular tablet you can get rid of stone its wrong. Its total the size of the stone which is going to decide and the passage.
If the ureter is wide enough it can allow the stone to pass off. Now if the stone does not pass then the options are the surgical intervention or procedures. In urine stone it is surgeries are almost non existent. Now almost all the procedures are minimally. Majority are done through urine passage. The commonest procedure done is the ureteroscopy. The stones which are more than 5mm in diameter the possibilities are that the urine passage is low. These are stones they need the surgical procedures for their removal. Now the commonest procedure is the ureteroscopy. And the most common ureteroscopy is the semi-rigid ureteroscopy. If the stone is lying in the kidney and a small stone, for example, less than 10mm then the flexible ureteroscope can be used and be removed the same way as the ureter stone. If the stone size is large more than 1cm in that case the capacity of RIRS is not that much. So either it will not be able to fragment that amount of stone. So the PCNL has a upper hand in such patient. PCNL is there is the hole made in the back and through that a camera incepted and the stone is broken down and the pieces are removed so for larger stone in kidney the best modality is PCNL. The stones in the ureter or even the kidney stones which are small size the best modality is the ureter uterescopy. So these procedures they carry out 80% procedures found for urolithiasis. Thank you so much.