Kidney Stone Treatment



Access is gained through the urethra, or urinary canal, without cutting the skin. The flexible ureteroscope is advanced to the kidney through it after being placed over a small guide wire in a "access sheet" sheath. Following camera visualization of the stone, 230 micron-thick laser wire is advanced through a flexible ureteroscope, making direct contact with the stone and fragmenting it. The stone continues to be broken up until the pieces are no larger than sand.

For generations, the most painful urologic disease has been kidney stones. Kidney stones were discovered in Egyptian mummies dating back 7000 years, according to the experts. After prostate diseases and urinary tract infections, urinary tract stones are the third disease that affects the urinary tract. Annually, millions of patients with kidney stones visit urologists or emergency room doctors. Most of the time, kidney stones can pass on their own while still hurting moderately or severely. However, depending on the size, shape, and features of the patient's canal structure, the stone may continue to grow. A stone with a diameter of 5 mm has a 50% chance of passing. As the size of the stone grows, the likelihood of passing lowers.

Before 1980, kidney stones were treated by open surgery, however recently the percentage of patients treated with this technique has dropped to 1–5% of all cases. The majority of stones are currently treated using endourological ("endoscopic closed") techniques and ESWL ("Extracorporeal shock wave lithotripsy"). In recent years, the less intrusive of these treatments, which are increasingly chosen, began to stand out.

In the past ten years, technological advancements in flexible ureterorenoscopy-related tools and equipment have elevated retrograde intrarenal surgery to a crucial position among minimally invasive procedures.

How is flexible ureteroscopy performed?

Without cutting anything, access is gained through the urethra, or urinary canal. The flexible ureteroscope is advanced to the kidney using a sheath termed a "access sheet" that is put to the ureter through a thin guide wire. The laser wire, which has a thickness of 230 microns, is moved through a flexible ureteroscope after the stone has been seen with the camera in order to make direct contact with it and fragment it. Asli gelene kadar taş krlr krlan parçalar kum tanesi.

Why is Flexible Ureteroscopic treatment superior to ESWL method?

For many years, kidney stones have been successfully treated using the ESWL procedure. However, when you consider the lengthy lengths of kidney stone treatment sessions (1-4 sessions), unsuccessful procedures, particularly when it comes to kidney stones in particular areas (success rate is 40%-60% for stones in lower section of kidneys), and undesirable side effects after ESWL like residual stone fragments, flexible ureteroscope is a more effective solution. Today, the first course of action for stones that resist ESWL fragmentation is flexible ureteroscopy. Due to the failure of ESWL, it is also the main treatment choice for stones in the lower kidneys that are less than 1.5 cm in size.

What are the fields of use of Flexible Ureteroscopy other than treatment of stones?

The procedure can be performed to investigate urinary tract hemorrhage and to diagnose patients who have upper urinary system pathology (suspected tumor in ureter or kidney). However, kidney stones are currently the most popular and productive area of application.

What are the advantages of kidney stone treatment with flexible ureteroscope?

  • The technique's high success rate is its best perk. (90-96)
  • As the kidney is reached by natural channels, there are no incision scars left in the body, in contrast to techniques like percutaneous and open surgery.
  • Studies revealed that the approach does not impair kidney tissue or function.
  • Bleeding is not brought on by it. Therefore, the procedure's accessibility to patients who tend to bleed easily and those who take anticoagulants offers a significant benefit.
  • Either the following day or the day after, the patient may be released.
  • Patients with congenital kidney anomalies including pelvic and horseshoe kidneys may benefit from it. It is one of the most practical and simple treatments for this patient population.
  • The ability to treat kidney and ureter stones simultaneously is one of the main benefits. While a ureteral stone is being treated with a ureteroscope, a kidney stone may unintentionally be discovered on the ipsilateral side. In certain situations, the kidney stone on the same side can be extracted after the ureter stone is removed, allowing the removal of all the stones.
  • Patients who need treatment for bilateral kidney stones can have both removed during the same flexible ureteroscopy procedure.
  • Patients with a large amount of body weight cannot undergo ESWL, and percutaneous ureteroscopy is a difficult technique with potential risks. The preferred choice for treating stones in such patients is hence flexible ureteroscopy.

Is it possible to treat stones in both kidneys at the same time?

This is one of the major advantages of using flexible ureteroscopy in treatment of stones. The stones in right and left kidneys can be treated within the same session if the stone load is not significantly excessive.

Can it be performed for the stones in upper sections of ureter?

The type of stones that respond best to flexible ureteroscopy are those at the upper end of the ureter. In treating these stones, ESWL has a somewhat lower success rate, and it takes time to correct the obstruction that these stones have caused. The Ho laser and flexible ureteroscopy are used to remove the stone, which is the quickest and most efficient treatment option in this case.

The potential for stone migration to the kidney is one of the main issues with using rigid ureteroscopy to treat stones in the middle, lower, or upper regions of the ureter. When flexible ureteroscopy was not used, a double-j catheter was inserted before treatments ended, and in cases where stones had moved to the kidney, treatment of the stones was delayed until it could be finished using alternative techniques. If a stone migrates to the kidney, it can be treated in one session using the flexible ureteroscopy procedure by gaining access to the kidney and fragmenting the stone.

How long is the hospitalization period?

Since there is no bleeding, no incisions are produced, and no holes are opened during the operation, patients can rapidly resume their daily activities. The day of discharge is an option for patients.

Is it possible to perform flexible ureteroscopy for patients with excessive weight?

Yes, in the majority of situations, ESWL treatment cannot be used for these patients, and percutaneous technique is difficult. For these patients, flexible ureteroscopy is a fantastic alternative. Numerous international scientific research suggest that flexible ureteroscopy should be the first line of treatment because percutaneous applications have significant complication and blood transfusion rates.