Treatment

INTRACORPOREAL LITHOTRIPSY
I. Ureteroscopic Lithotripsy (URSL)
II. Percutaneous Nephroscopic Lithotripsy ( PCNL )

Introduction
Urinary stones are reached directly by endoscopy. Laser or pneumatic lithotripsy is applied through the endoscope. Stone fragments are removed through the endoscope by instruments or allowed to pass spontaneously. Different methods of approaching the stone are required according to the location of the stone.

I. Ureteroscopic Lithotripsy
 It is suitable for ureteric stone especially those located at distal ureter.
 
II. Percutaneous Nephrolithotomy
 It is suitable for big renal stone and upper ureteric stones.

Preparation

• Relevant blood and urine tests together with radiological examinations.
• Anticoagulants and aspirin may have to be stopped.
• Fast after midnight .
• A written consent is required

 
Procedure
I. Ureteroscopic Lithotripsy:
This is usually done under spinal or general anaesthesia. A fine semirigid or flexible fibreoptic ureteroscope is introduced into the affected ureter via the urethra and bladder. The stone is identified and broken down. The fragmented stones are removed by using either a basket or forceps depending on the size and site of the stone. A ureteric drain may be inserted according to the individual condition. No external wound is created. Most patients can be discharged a few hours after the procedure.

 
II. Percutaneous Nephroscopic Lithotripsy:
This is done under general anaesthesia. The affected kidney is punctured to allow the introduction of nephroscope into the pelvicalyceal system. The stone will then be fragmented and removed through the nephroscope. A nephrostomy tube is inserted to allow urine drainage.

 
This procedure may be performed in more than one session or in combination with other treatment like Extracorporeal shock wave lithotripsy depending on the type and the size of the stone. This is a less painful procedure compared with the traditional open surgical method and allows a rapid recovery.

 
Care and Advice
I. Ureteroscopic Lithotripsy

• Please comply with the medication regime as prescribed by your doctor.
• It is advised to drink 3-4 litres of water per day to increase the urine output to 2-3 litres a day. This will facilitate the passage of stones.
• Follow up according to schedule for removal of ureteric stent if necessary.
• Seek medical advise if persistent fever, loin pain or voiding difficulty.
• Stone formation may be prevented by a well balanced diet of high fibre, low salt, low fat and low sugar.

II. Percutaneous Nephroscopic Lithotripsy

• Please comply with the medication regime and take analgesic as prescribed by your doctor.
• It is advised to drink 3-4 litres of water per day to increase the urine output to 2-3 litres a day. This will facilitate the passage of stones.
• Urethral catheter is usually removed one day after the surgery.
• Nephrostomy tube will be removed according to the postoperative course.
• Wound will heal up about one week after removal of the nephrostomy tube.
• Stone formation may be prevented by a well balanced diet of high fibre, low salt, low fat and low sugar.

 
Potential complications
I. Ureteroscopic Lithotripsy

• Voiding difficulty and voiding of blood stained urine if an ureteric stent is inserted.
• Pain over the loin, lower abdomen for the first few days after the procedure is expected.
• Urinary tract infection.
• Perforation of ureter.

II. Percutaneous Nephroscopic Lithotripsy

• Voiding of blood stained urine.
• Pain induced by the nephrostomy.
• Urinary tract infection.
• Perforation of the renal pelvis.
• Massive bleeding due to renal vessels damage

 
Return to Accident & Emergency Department immediately if there is any suspicion of complication

Illustration by @bowlful.of.rice