Kidney stone surgery is a surgical procedure performed to remove stones that are in the kidneys and urinary tract and bladder. This surgical procedure can be performed with minimal incision surgical techniques or conventional surgery, depending on the size of the stone, the severity, and the general condition of the patient.
Kidney stones can occur along the urinary tract, from the kidneys, ureters, bladder, to the urinary tract or urethra. Kidney stones also need to be treated immediately if they have caused certain symptoms, such as lower back and waist pain, pain when urinating, reduced amount of urine, and red or brown urine.
When is Kidney Stone Surgery Necessary?
Small kidney stones can generally be treated independently at home, for example by drinking more water. The goal is that the stone can be passed through the urine.
However, large kidney stones can cause blockages in the flow of urine so they need to be removed with drugs or kidney stone surgery. Surgery is also needed when kidney stones are severe and at risk of causing complications in the patient.
One of the procedures that doctors can do to destroy kidney stones is: extracorporeal shock wave lithotripsy or ESWL. Kidney stone crushing therapy with shock waves is effective for crushing stones with a diameter of less than 2 cm.
Meanwhile, to remove or remove kidney stones that are more than 2 cm in size, the doctor may suggest kidney stone surgery. Kidney stone surgery generally needs to be done in the following conditions:
- Has a very large size and is difficult to overcome with drugs or ESWL tindakan
- Blocks the flow of urine and causes hydronephrosis
- Causes severe symptoms such as severe pain and bleeding
- Causes urinary tract infection
Types of Kidney Stone Surgery
The following are some types or techniques of kidney stone surgery that can be done to treat kidney stone disease:
1. Cystoscopy
Cystoscopy aims to remove stones in the urethra and bladder. Before undergoing a cystoscopy, the patient will be given anesthesia or anesthesia first.
After the anesthetic has worked, the doctor will insert a cystoscope (a special tube-like instrument equipped with a camera at the end) through the urinary tract into the urinary tract or urethra to the bladder.
Stones in the urethra or bladder are then removed using an instrument that is attached to the cystoscope. After the stone is successfully removed, the patient is usually allowed to go home and carry out activities as usual.
However, if the patient undergoes a cystocopy under general anaesthesia, it is likely to be hospitalized for one day.
2. Ureteroscopy
Ureteroscopy aims to remove stones in the kidneys and ureters using a ureteroscope, which is an instrument in the form of a camera tube. The method used by the doctor is the same as that of a cystoscopy, namely:
- Administer anesthesia to the patient
- Inserting the ureteroscope into the urinary opening to look for stones then crushing and removing them
- Using a laser or ESWL to break up the stone if it is too large and the stone can be excreted with urine
- Install stent or a special tube made of metal in the urinary tract to facilitate the flow of urine so that the remnants of small kidney stones can come out
After the ureteroscopy is complete, the patient is usually allowed to go home, but is not allowed to drive his own vehicle. If the ureteroscopy is performed under general anesthesia, the doctor will ask the patient to stay in the recovery room until the anesthetic wears off.
The stent that was placed during kidney stone surgery with ureteroscopy may be removed within a few days or weeks.
3. Percutaneous nephrolithotomy or nephrolithotripsy (PCNL)
PCNL is kidney stone surgery with small incisions to remove kidney stones that are more than 2 cm in size or cannot be treated by the ESWL method as well as cystoscopy and ureteroscopy.
This procedure is also performed if kidney stones have caused an infection in the kidneys or severe pain that cannot be treated with medication.
PCNL uses an instrument called a nephroscope, which is an instrument in the form of a tube with a camera on the end. This device is inserted directly into the kidney through a small incision made by the doctor on the patient's back.
The PCNL procedure can be performed in two ways, namely:
- Nephrolithotomy, namely lifting and removing stones in intact condition.
- Nephrolithotripsy, which is breaking the stone using a laser or sound waves, then the kidney stone is pushed out using a machine.
After surgery, patients need to stay in the hospital for at least 1-2 days.
4. Open operation
Surgery or open surgery is a kidney stone surgery technique that is now quite rarely done. However, kidney stone surgery may be performed on large kidney stones and the following conditions:
- Kidney stones are not successfully removed or removed by other methods of kidney stone surgery
- Kidney stones block the ureters or the channels that carry urine from the kidneys to the bladder
- Kidney stones block the flow of urine so that urine cannot be excreted smoothly
- Bleeding or infection occurs
- Severe pain due to kidney stones (renal colic)
Open surgery begins with general anesthesia. Next, the doctor will make an incision in the patient's back as a way to remove kidney stones.
Compared to other procedures, open surgery requires a longer recovery and hospital stay compared to other kidney stone surgery techniques. Patients may only be able to fully recover in about 4-6 weeks after undergoing open surgery.
In addition to the 4 types of kidney stone surgery above, there are other procedures that can be performed to treat kidney stones based on the cause.
For example, hyperparathyroidism can make calcium in the blood increase and cause kidney stones to form. This condition needs to be treated with hyperparathyroid medication, including hyperparathyroid gland surgery if needed.
Treatment of kidney stones through ESWL or kidney stone surgery is generally relatively safe to do. However, just like other surgical procedures, kidney stone surgery still has postoperative risks, such as urinary tract infections, bleeding, narrowing of the ureters or urinary tract due to surgical wounds, to side effects of anesthesia.
Before kidney stone surgery is performed, the doctor will provide information to the patient about the preparation, benefits, and side effects of the kidney stone surgery that will be undertaken.
If you suffer from kidney stones and are advised by a doctor to undergo kidney stone surgery, be sure to understand what the doctor explains and don't hesitate to ask if there is anything you don't understand.