Kidney Stone Removal using Lasers

Kidney Stone Removal using Lasers

URINARY STONE    

Hardened mineral deposits formed in the kidney are called kidney stones (calculi). These originate as microscopic particles and over the course of time develop into stones. Medically this condition is known as nephrolithiasis, or renal stone disease. The kidneys filter waste products from the blood and adds them to the urine. When waste materials in the urine do not dissolve completely and the kidney is unable to evacuate them, crystals and kidney stones are likely to form. Some stones may pass out of the kidney or get lodged in the ureter (tube that carries urine from the kidney to the bladder), and cause severe pain that starts from the lower back and radiates to the side or groin. A lodged stone can block the flow of urine and build a backpressure in the affected ureter and kidney. Increased pressure results in stretching and spasm, which cause severe pain.

 

CAUSES OF KIDNEY STONES

Kidney Stones are formed from chemicals found in the urine (such as uric acid, calcium, phosphorus and oxalic acid). This happens when a particular substance in the urine exceeds its solubility. They maybe grit, sand and gravel like obstructions.

Etiological factors for kidney stones are as follows.                                                             

1. Dietetic factors leading to kidney stones

A deficiency of vitamin A causes a desquamation of epithelium. The cells form a nidus around which the stone is deposited. From a study of economic conditions in districts where urinary calculi are common, it is evident that the inhabitants suffer from dietetic imbalances.

2. Altered urinary solutes and colloids causing kidney stone

In hot climate the concentration of solutes will rise.

If kidney stone is tiny, you may be able to grasp it with a wire cage -- called a stone basket -- and extract it. In many cases, however, stones trapped in the ureter are larger, and cannot be removed this way. They must be fragmented.

The answer has been provided through laser technology. Using a tiny fiberoptic fibers -- 350 microns in diameter or less -- passed through the ureteroscope (as these delicate scopes are called), laser energy is used to fragment the stone. Darth Vader, meet Marcus Welby.

There are many different types of lasers used in medicine. Different laser types and wavelengths have markedly different effects on living tissue. Some, like the CO2 laser, work best in air, and are used to vaporize skin lesions, such as warts, with very little deep tissue penetration and virtually no subsequent scarring. Others provide deep thermal energy to destroy tumors or other tissues with minimal effect on the surface. For kidney stone work, a holmium laser in direct contact with the stone is commonly used.

The laser is fired at a very rapid repeating frequency. At the tip of the fiber, which is placed in contact with the stone, the intense light energy vaporizes the water used for irrigation, creating a rapidly-expanding plasma. An intense yet short-radius shockwave results. This has the effect of drilling into the stone, which creates areas of relative weakness and fracture. As a result, the stone breaks into increasingly smaller pieces, which can be extracted or flushed out. Because of the short energy radius, the surrounding tissues are unaffected.

WHAT IS LASER LITHOTRIPSY?

Laser lithotripsy uses a laser that is mounted on the end of a fiber optic scope. The scope is inserted into the patient’s body through the urethra and bladder up to the ureter. Once the scope is advanced to the level of the stone, the laser is turned on and the stone is pulverized.

The holmium YAG laser offer advantages over previous types of lasers. Lasers for lithotripsy were first used in the late 1980's but were limited in power by the diameter of the fiber used. Larger fibers meant more power, but they were more rigid and less suited to the environment which demanded flexibility and freedom of movement. The YAG holmium also is capable of producing smaller stone fragments than previous laser treatments.

This method is rapidly replacing traditional lithotripsy for the removal of kidney stones. The advantages of laser surgery over traditional lithotripsy are that there is a higher first time rate of success with laser surgery than with traditional lithotripsy methods and the laser is more effective on complex stones. The patient can resume their daily routine within one to two days of the procedure.

REMOVAL OF KIDNEY STONE USING LASER

Kidney stones can be a very painful condition. There are several different methods used to eliminate the them. Among some of the more popular methods is herbal treatments, pain medications with a combination of increasing fluids and dietary modifications.

However, sometimes it is necessary to use more invasive procedures to eliminate the kidney stone in the event it is unable to be passed through other methods. Laser kidney stone removal is one of the more extreme means for assisting in the removal.

For many, just the thought of having any type of surgical procedure done causes them to cringe. However, you might not realize it, but the laser kidney removal process is definitely a lot less painful than dealing with the stomes themselves. The Uteroscopic stone removal is a fairly simple procedure that is going to require you to go under a general anesthetic.

 

The procedure consists of a surgeon using a uteroscop (small fiber optic utensil) that is inserted through the urethra into the bladder and finally it is inserted into the ureter. Usually in a fairly minimal amount of time the kidney stone is found. Once it is found there will be a shock wave that destroys the kidney stone so it can be either eliminated or passed through urine or removed by another tool during the procedure.

Typically, after the procedure has been completed a portion of the tube that was inserted is left behind. The stent it left so it can induce the body to begin the healing process. Generally, when the stent is left in the body it is because the kidney stone was likely in either the lower or middle portion of the ureter.

Laser removal is virtually painless as the small medical instrument is gently inserted. The procedure begins with the urethra and makes it way into the ureter, which is where the stone should be. You can expect to be given a local anesthetic for this procedure.

Recovery time is minimal, although you will not be able to drive after the procedure due to the anesthesia. The kidney stone is then targeted with the laser and is removed through urine after the procedure. It will either disintegrate upon contact from the laser or it will break down into smaller pieces where it will be passed in the urine.

 

 

KIDNEY STONE REMOVAL USING HOLMIUM LASER

Kidney stone removal with the Holmium laser is used to blast apart the larger kidney stones that get stuck in the ureter. During this procedure you will be given anesthesia and brought to the operating room. Initially the kidney stone is viewed with the x-ray as you are lying on the bed which shows where it is in your urinary system. Then the ureteroscope is slid into and past the urethra and bladder into the ureter; our urologists can see with either the eyepiece of the ureteroscope or up on a monitor which is provided by a camera attached to the ureteroscope. During the procedure the fluoroscopy (x-ray) is showing the movement of the instruments and the stone. Once the urologist determines that the stone cannot be removed with a basket a thin laser is slide up the ureteroscope and placed directly in front of the kidney stone and a pedal is pressed which fires the Holmium laser directly into the stone. After each blast of the laser our urologists adjust the laser and fire it again until the kidney stone is fully broken apart. A thin tube called a stent is then placed from the kidney to the bladder which allows the urine to flow out easily for the next week to a month, at which time the stent is pulled out in an office visit.

Kidney stone removal with the Holmium laser is also an out patient procedure; you will go home that day. Again you may have some “blood in urine” for a few days after the Holmium laser surgery.

Kidney stone removal that is performed when the stone is up in the kidney and cannot be broken apart with the ESWL procedure, or when the kidney stone has many branches that jut out into many parts of the kidney, such as a staghorn calculi, are removed with either the percutaneous nephrolithotomy or  nephrolithotripsy. The surgeon makes a small incision in the back to the kidney which is held open with a tube. If the stone can be pulled out of the kidney it is called a nephrolithotomy. When the stone does not come out, then it needs to be broken up and then removed, this is called a nephrolithotripsy. Both of these procedures include an over night stay.

POTENTIAL COMPLICATIONS

The holmium laser melts up to 100% of kidney stones and is useful on all kidney stone types and compositions.The laser has an excellent safety record.

Lithotripsy laser surgery is not without complications; the patient may experience bleeding for a few days after the procedure. Complication rates for any type of Intracorporeal surgery for kidney stones is approximately 3%. The incidence of major complications is approximately 1%. Other complications from the procedure can include infection, tissue scarring, and fluid overload (most common in patients with heart disease or the very young).

With its high safety rating, low rate of complications and quicker recovery time, the laser lithotripsy procedure is viewed by many as the most effective way to remove kidney stones that cannot be passed from the body.