Kidney stone surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
=== | The following surgeries are used for the management of nephrolithiasis:<ref name="pmid17332586">{{cite journal |vauthors=Miller NL, Lingeman JE |title=Management of kidney stones |journal=BMJ |volume=334 |issue=7591 |pages=468–72 |date=March 2007 |pmid=17332586 |pmc=1808123 |doi=10.1136/bmj.39113.480185.80 |url=}}</ref> | ||
====Extracorporeal Shock wave Lithotripsy (ESWL)==== | |||
n most of these cases, non-invasive [[Lithotriptor|Extracorporeal Shock Wave Lithotripsy]] or (ESWL) will be used. Otherwise some form of invasive procedure is required; with approaches including ureteroscopic fragmentation (or simple basket extraction if feasible) using [[laser]], [[ultrasonic]] or mechanical (pneumatic, shock-wave) forms of energy to fragment the larger stones. [[Percutaneous]] [[lithotomy|nephrolithotomy]] or rarely open [[surgery]] may ultimately be necessary for large or complicated stones or stones which fail other less invasive attempts at treatment. | |||
A single retrospective study in the [[United States|USA]], at the [[Mayo Clinic]], has suggested that lithotripsy may increase subsequent incidence of diabetes and hypertension,<!-- | A single retrospective study in the [[United States|USA]], at the [[Mayo Clinic]], has suggested that lithotripsy may increase subsequent incidence of diabetes and hypertension,<!-- | ||
Revision as of 22:01, 18 June 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Surgical intervention is not recommended for the management of [disease name].
OR
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
OR
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
OR
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
OR
Surgery is the mainstay of treatment for [disease or malignancy].
Indications
- The mainstay of treatment for nephrolithiasis is medical therapy. Surgery is usually reserved for patients with either:
- Persistent and severe pain
- Renal failure
- Kidney infection.
- Stone fails to pass or move after 30 days.
Surgery
The following surgeries are used for the management of nephrolithiasis:[1]
Extracorporeal Shock wave Lithotripsy (ESWL)
n most of these cases, non-invasive Extracorporeal Shock Wave Lithotripsy or (ESWL) will be used. Otherwise some form of invasive procedure is required; with approaches including ureteroscopic fragmentation (or simple basket extraction if feasible) using laser, ultrasonic or mechanical (pneumatic, shock-wave) forms of energy to fragment the larger stones. Percutaneous nephrolithotomy or rarely open surgery may ultimately be necessary for large or complicated stones or stones which fail other less invasive attempts at treatment.
A single retrospective study in the USA, at the Mayo Clinic, has suggested that lithotripsy may increase subsequent incidence of diabetes and hypertension,[2] but it has not been felt warranted to change clinical practice at the clinic.[3] The study reflects early experience with the original lithotripsy machine which had a very large blast path, much larger than what is used on modern machines. Further study is believed necessary to determine how much risk this treatment actually has using modern machines and treatment regimens.
More common complications related to ESWL are bleeding, pain related to passage of stone fragments, failure to fragment the stone, and the possible requirement for additional or alternative interventions.
Ureteral (Double-J) Stents
One modern medical technique uses a ureteral stent (a small tube between the bladder and the inside of the kidney) to provide immediate relief of a blocked kidney. This is especially useful in saving a failing kidney due to swelling and infection from the stone. Ureteral stents vary in length and width but most have the same shape usually called a "double-J or double pigtail". They are designed to allow urine to drain around any stone or obstruction. They can be retained for some length of time as infections recede and as stones are dissolved or fragmented with ESWL or other treatment. The stents will gently dilate or stretch the ureters which can facilitate instrumentation and they will also provide a clear landmark to help surgeons see the stones on x-ray. Most stents can be removed easily during a final office visit. Discomfort levels from stents typically range from minimal associated pain to moderate discomfort.
References
- ↑ Miller NL, Lingeman JE (March 2007). "Management of kidney stones". BMJ. 334 (7591): 468–72. doi:10.1136/bmj.39113.480185.80. PMC 1808123. PMID 17332586.
- ↑ Krambeck AE, Gettman MT, Rohlinger AL, Lohse CM, Patterson DE, Segura JW (2006). "Diabetes mellitus and hypertension associated with shock wave lithotripsy of renal and proximal ureteral stones at 19 years of followup". J Urol. 175 (5): 1742–7. PMID 16600747.
- ↑ Ed Edelson (2006). "Kidney Stone Shock Wave Treatment Boosts Diabetes, Hypertension Risk - Study suggests link, but doctors say it's too early to abandon this therapy". HealthFinder. National Health Information Center.