Pictures above show in a 5-year child a large stone in the right kidney removed through a key hole in the back with Holmium laser Percutaneous Nephrolithotomy (PCNL). Pictures below show stones in the kidney and ureter treated by flexible ureteroscope retrograde intrarenal surgery (RIRS) and Holmium Laser.
There are different methods available for urinary stone breaking like pneumatic, ultrasonic, electro-hydraulic etc. However, Holmium laser is a versatile laser in stone treatment; stones of any size in the kidney, ureter or urinary bladder are best managed, irrespective of the nature and hardness of stones, with least complication and best results.
Various setting options in the 100-watt laser help in the fragmentation and dusting of the stones, with superior stone clearance rate and shorter time than those of shock-wave lithotripsy (a procedure that uses shock waves to break up stones). Also, Holmium laser is quite effective in patients who are unhealthily obese, or pregnant, or on blood thinners, whereas shock-wave lithotripsy is not medically advisable.
Patients with urinary stone disease must reduce salt intake, increase fluid intake and cut down on red meat. Medication and periodic check-up with an Ultrasound Sonography Test (USG) or an x-ray would help plan appropriate treatment and avoid recurrence of the disease.
Further metabolic evaluation is needed in cases of frequent stone formation, single functioning kidney, anatomical defects in the urinary system, chronic diarrhea with stone disease, infected stones and strong family history of stone disease.
There are certain popular beliefs which are not medically true. For example, the common belief is that reduced sodium intake helps prevent urinary stone formation. But, in fact, reduced calcium intake beyond normal requirement is not advisable. Reduction of the daily required calcium in our diet usually results in increased absorption of oxalate from the gut, which in turn increases the oxalate in urine leading to stone formation.
There isn't enough scientific evidence to support the belief that restriction of a particular fruit, nut or vegetable helps in preventing stone disease. However, it really helps to eat all the vegetables and fruits, in moderation. There is no relationship between stone formation and hardness of water.
Carbonated water and beer tend to increase urinary excretion of oxalate leading to stone formation. Eating leafy vegetables after cooking is safer than taking uncooked fresh ones as in salads: boiling prevents absorption of oxalate. Yet another myth is that once a patient has had a procedure, recurrence of the illness is a certainty, which is simply not true. A careful reevaluation has to be done at the time of completion of treatment through confirmatory tests.
The most important thing in urinary stone disease management is its early identification and timely expert advice on treatment. Taking home remedies, following the advice of quacks and neglecting proper treatment may lead to increased stone size, kidney dysfunction, and infection and in some rare cases, life-threatening sepsis.
Healthy life style, eating any food in moderation with low salt, avoiding red meat, drinking plenty of oral fluids and more importantly, periodic check-ups will surely prevent stone formation and its recurrence.
Article by Dr. Jeevagan, Senior Consultant Urologist, Kauvery Hospital