Kidney Stone Removal Surgery in Delhi, India

Kidney stone removal surgery is a medical procedure that is done when kidney stones are too large to pass naturally through the urinary tract or when they cause severe pain, blockage of urine flow, or ongoing urinary tract infections. It may also be necessary if the stones are damaging the kidneys or causing other complications such as bleeding.

There are several types of kidney stone procedures, including:

• Extracorporeal Shock Wave Lithotripsy (ESWL): Extracorporeal Shock Wave Lithotripsy (ESWL) uses shock waves to break up the kidney stones into smaller pieces that can be passed more easily through the urinary tract.
• Ureteroscopy: In this procedure, a thin scope is inserted through the urethra and bladder to reach the stone in the ureter or kidney. The stone can then be removed or broken into smaller pieces using laser energy.
• Percutaneous Nephrolithotomy (PCNL): This surgery involves making a small incision in the back and using a scope to remove the kidney stones directly from the kidney.
• Open Surgery: In rare cases where other methods are not feasible or effective, open surgery may be performed to remove the kidney stones.
• RIRS Procedure: Retrograde intrarenal surgery (RIRS) is a procedure for doing surgery within the kidney using a flexible ureteroscope. In RIRS the scope is placed through the urethra (the urinary opening) into the bladder and then through the ureter into the urine-collecting part of the kidney.

The choice of procedure depends on factors such as the size and location of the stones, the patient's overall health, and the surgeon's expertise. The doctor will determine the most appropriate treatment plan based on the specific situation of the patient.

Preparing for Kidney Stone Removal Surgery

Preparation for kidney stone removal surgery typically involves several steps to ensure the procedure goes smoothly and the patient is adequately prepared.

• Medical Evaluation: Before surgery, the patient undergoes a thorough medical evaluation, which may include blood tests, urine tests, imaging studies (such as CT scans or ultrasound), and possibly other diagnostic tests to assess the size, location, and composition of the kidney stones.
• Medications: The doctor may prescribe medications to help manage pain and prevent infection before and after the surgery. It's important for patients to follow their doctor's instructions regarding medication usage, including any restrictions on eating or drinking before the procedure.
• Fasting: In many cases, patients are instructed to fast for a certain period before the surgery to ensure the stomach is empty, reducing the risk of complications during anaesthesia.
• Informed Consent: Before undergoing surgery, patients are asked to sign a consent form indicating that they understand the risks, benefits, and potential complications of the procedure.
• Preoperative Instructions: Patients are given specific instructions by their healthcare provider regarding what to expect before, during, and after the surgery, including any necessary preparations at home.

During Kidney Stone Removal Surgery

The specific details of the surgery vary depending on the type of procedure being performed. Here are some general aspects:

• Anaesthesia: Most kidney stone surgeries are performed under general anaesthesia to ensure patients are asleep and go through a pain-free procedure. In some cases, local or regional anaesthesia may be used instead.
• Surgical Technique: The surgeon uses the chosen surgical technique (such as ESWL, ureteroscopy, PCNL, or open surgery) to remove or break up the kidney stones. This may involve using shock waves, laser energy, specialised instruments, or making incisions as necessary.
• Monitoring: Throughout the surgery, the patient's vital signs, including heart rate, blood pressure, and oxygen levels, are closely monitored by the medical team to ensure safety and proper anaesthesia.

Post Kidney Stone Removal Surgery Care

After the surgery, patients require careful monitoring and follow-up care to ensure proper recovery and minimise the risk of complications. Here's what to expect:

• Recovery: Post surgery, patients are taken to a recovery room where they are closely monitored as they wake up from anaesthesia. Pain medication may be provided as needed.
• Hospital Stay: Depending on the type of surgery and individual circumstances, some patients may need to stay in the hospital for observation and further treatment, while others may be able to go home the same day.
• Pain Management: Patients may experience some discomfort or pain after surgery, which can usually be managed with pain medication prescribed by the doctor.
• Fluid Intake: It's important for patients to drink plenty of fluids after surgery to help flush out any remaining stone fragments and prevent dehydration. The doctor may provide specific guidelines on fluid intake.
• Activity Restrictions: Patients may need to avoid certain activities, such as heavy lifting or strenuous exercise, for a period of time after surgery to allow the body to heal properly.
• Follow-Up Appointments: Patients are required to schedule follow-up appointments with their healthcare provider to monitor recovery progress, remove any remaining stents or drains if necessary, and discuss any concerns or complications.

By following the recommended post-operative care instructions and attending follow-up appointments, patients can help ensure a smooth recovery and reduce the risk of kidney stone recurrence.

Here's a list of benefits that kidney stone removal surgery offers in addressing the complications caused by kidney stones:

• Pain Relief: The primary benefit is significant pain relief. Kidney stones can cause excruciating pain, and surgery effectively removes the source of that pain, allowing for a return to normal activities.
• Prevent Blockage and Damage: Stones can block the flow of urine, leading to kidney damage and infection. Surgery removes the blockage, restoring normal urine flow and preventing further complications.
• Improved Kidney Function: Blocked or damaged kidneys can lose function. Surgery can help preserve and potentially restore kidney function by removing the stones and preventing further damage.
• Reduced Risk of Infection: Stones can increase the risk of urinary tract infections. Removing the stones reduces this risk.
• Improved Quality of Life: The constant threat of pain and complications from stones can significantly impact quality of life. Surgery can help people regain a sense of normalcy and control over their health.

While kidney stone removal surgery can be highly effective, it also carries certain risks and potential complications, which vary depending on the type of procedure performed and individual factors. Some common risks include:

• Bleeding: Surgery may cause bleeding, both during the procedure and afterwards. In some cases, additional interventions may be needed to control bleeding.
• Infection: Any surgical procedure carries a risk of infection, which can occur at the surgical site or elsewhere in the body. This risk is higher in patients with pre-existing urinary tract infections or other medical conditions.
• Damage to Surrounding Tissues: In some cases, surgery may inadvertently damage surrounding tissues, organs, or blood vessels, leading to complications such as perforation or injury.
• Anaesthesia Risks: General anaesthesia carries inherent risks, including allergic reactions, respiratory problems, and adverse reactions to medications.
• Stone Fragmentation: During procedures such as lithotripsy, the fragmentation of kidney stones can sometimes lead to the formation of smaller stone fragments that may require additional interventions for complete removal.
• Urinary Tract Injuries: Certain surgical techniques, particularly those involving the insertion of instruments into the urinary tract, carry a risk of injury to the ureter, bladder, or other structures.
• Recurrence: Despite surgical intervention, there is always a possibility of recurrent kidney stones in the future, especially if underlying risk factors are not addressed.

It's important for patients to discuss the potential risks and benefits of kidney stone removal surgery with their healthcare provider and weigh them against their individual circumstances and preferences before making a decision. Additionally, proper preoperative preparation and postoperative care can help minimise the risk of complications and optimise outcomes.

What preventive measures can one take to reduce the risk of developing kidney stones?

Preventive measures include staying hydrated by drinking plenty of water, reducing salt intake, maintaining a healthy weight, limiting consumption of foods high in oxalates and purines, and ensuring an adequate intake of calcium through dietary sources.

What dietary guidelines are recommended for individuals diagnosed with kidney stones?

Dietary recommendations for kidney stone patients typically involve reducing intake of oxalate-rich foods such as spinach, rhubarb, nuts, and chocolate, moderating consumption of animal proteins, limiting salt intake, and ensuring adequate calcium intake through dietary sources.

Is surgical removal considered a major procedure for kidney stones?

Yes, surgical removal of kidney stones can be considered a major procedure, especially for larger or more complicated stones that cannot be passed naturally.

What are the most effective procedures available for the removal of kidney stones?

Common procedures for kidney stone removal include shock wave lithotripsy (SWL), ureteroscopy with laser lithotripsy, and percutaneous nephrolithotomy (PCNL), each with its own advantages and considerations depending on the size and location of the stone.

What is the typical recovery period following surgical removal of kidney stones?

The recovery period can vary depending on the type of procedure performed, but generally, patients can expect to resume normal activities within a few days to weeks after the surgery, with full recovery taking several weeks.

How painful is the process of kidney stone removal?

The level of pain experienced during kidney stone removal can vary depending on the procedure used and individual pain tolerance. Measures such as anaesthesia or sedation are typically used to minimise discomfort during the process.

Which foods are known to contribute to the formation of kidney stones?

Foods high in oxalates, such as spinach, rhubarb, nuts, and chocolate, as well as those high in purines, like certain meats and seafood, are known to increase the risk of kidney stone formation.

At what size are kidney stones typically considered for surgical intervention?

The decision to intervene surgically depends on various factors, including the size, type, and location of the stone, as well as symptoms and potential complications. Stones larger than a certain size may require surgical removal if they do not pass spontaneously.

What are some fast-acting methods to alleviate the pain associated with kidney stones?

Pain relief medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids may be prescribed to manage the intense pain associated with kidney stones. Additionally, applying heat to the affected area or taking hot baths may provide some relief.

Reviewed By Dr. Vimal Dassi Director - Urology, Uro-oncology, Kidney Transplant, Robotic Surgery on 12 June 2024.