Keyhole Surgery to Remove Kidney Stones as Big as the Kidney itself!

June - 29 - 2021
Stones are the most common kidney problems seen by specialists in this country. There are multiple contributing factors. This includes hot weather conditions or the patient lifestyle with less attention to health & decreased water intake. As summer approaches, number of pts visiting hospital for stone related problems increase as patient own susceptibility to form stones & availability of frozen food with high salt content are to equally share the blame.
Ms. Elisita was a regular Philipina lady, working as a house help with no previous major hospital visits. She first went to the hospital with sudden pain in flanks, pain in urine. She was taken to the hospital & evaluated. There she was told that she has a small stone on Lt Side but a very large stone on the RT side, which was causing the kidney to be swollen & filled with infected urine, with risk of losing the kidney due to stones & resultant infection.
Dr Vipul Agrawal, Consultant Urologist, Medeor Hospital, Al Ain who treated her for the stones, explained her course of treatment. He tells – when she came to the hospital first, she was having significant urine infection with the stone occupying the entire RT kidney (a Staghorn Calculus). The calculus was reaching all the corners of the kidney & blocking the urine being produced by the kidney. As a result, the kidney had swollen & was full of infected urine. The primary aim was to control the infection & then plan for removal of the stone.
After detailed evaluation, her infection was controlled (with medications & stenting) she was planned for removal of the stones. Dr Vipul mentioned, it was not an easy surgery to perform, with need for proper patient counselling, experienced surgeon & high-end equipment. It was essentially a complicated surgery, not being routinely done as the pts usually came to hospital when the stones are small. The classic option for treatment was open surgery, but that would lead to a large scar & prolonged recovery. The endoscopic keyhole surgery (PCNL) was a better option, but it has its limitations with need for staged surgery, requiring 2 or even 3 surgeries. After careful planning & discussion with the patient, the team went for endoscopic keyhole surgery. The difference between PCNL & laparoscopic surgery is that while the former is a single hole of 6-8mm, the later requires 3-4 cuts for the surgery.
The surgery went safely & we were able to remove all the stones, from all corners of the kidney with a single minor cut (PCNL). The patient was even discharged the same day. She was fit enough to resume her work, next day itself. At 1 week after surgery, she was beaming with happiness as her pain was gone & she was doing her full regular duties. Due to the small size of the incision, that she should be worried about a barely visible/noticeable scar. She thanked the doctor & the hospital for a safe & quick recovery from a major illness.
Dr Vipul told, this is one of the largest & most complicated kidney stone that he has removed, recently. The surgery needed careful planning with help from anesthesia & radiology departments. With the patient. Recovering fully & able to resume her duties from next day itself, he feels the efforts of the entire team paid off.
Dr Vipul further mentions kidney stones are the most common problems for which the patient come to his clinic. He explains that most of the patient. Come to the hospital with pain or infection because of the stone. However, he stresses that it is the silent stones, which are most dangerous to patient. Health & kidney. Like in this patient, she did not have any problems at all, until the stone grew to a large size risking the kidney function.
He also explains that not all stones need surgery & many can be safely treated with medicines. Also, the important thing is to keep regular check-ups in case you had a stone. Patient should go for proper evaluation & regular screening & never ignore any symptoms, even if they are minor or momentarily present. Many stones are painless, & still dangerous, hence “No pain does not mean No stone”.
He also tells that people often ask of ways to get rid of the stone problem, once for all. However, this is not possible as stone formation is multifactorial with no single cause or reason. The doctors can evaluate a patient & guide in lifestyle & dietary changes to prevent problems. However, proper diet & fluid intake can reduce the formation of stones as well as reduce their complications. Also, a healthy lifestyle & proper diet will decrease the need for surgery for treatment of stones. Even if the surgeries are required, with the latest technologies available, all the stone surgeries are daycare surgeries, where the patient. Resume their normal life immediately without any problem or loss of work.