Most kidney stones tend to pass spontaneously. About 80 of all urinary tract stones go away with drug treatment. The most important factor affecting the falling of the stone is the size of the stone. While it is expected that the stone below 4 mm will fall, intervention is required for stones over 6 mm. In addition, the shape of the stones and their location in the urinary tract are important factors affecting the fall.
Removing the stone spontaneously or with the help of medication
ESWL (breaking stones with shock wave)
Minimally invasive interventions (Percutaneous Nephrolithotomy, Ureterolithotripsy)
Classic open surgery method
Which of these approaches will be applied depends on the location of the stone, its size, the damage it causes or may cause to the urinary tract, and the type of stone. Today, as a result of the development of minimally invasive techniques, classical open surgery has remained the least used and preferred method.
ESWL (Extra-body stone breaking with shock waves)
Shock waves emanating from a focus are directed onto the stone and the stone is broken. There are ESWL devices that focus with X-ray and ultrasound. Broken stone pieces are excreted from the body through urine. ESWL cannot be successful in all stones. Success depends on the type, hardness, size and location of the stone in the urinary tract. While there may be stones that can be broken in a single session, repetitive sessions may be needed.
There may be discomfort and pain during the ESWL session. For this reason, pain relievers are used before treatment. After the procedure, there is usually no need to stay in the hospital.
Minimally invasive interventions
The aim of these interventions is to get rid of the stones that threaten the urinary system and to ensure that the patient returns to daily life as soon as possible. Percutaneous nephrolithotomy and ureterolithotripsy are interventions in this group. Intervention is necessary if the stone does not pass despite the treatment, if it is in sizes that will not fall, if it forms a complete block to prevent the flow of urine in the urinary tract, if it causes recurrent urinary tract infection, if it has caused damage to the kidneys.
Previously, open surgery was performed for stones, but today there is a new approach called minimally invasive interventions. The aim of these interventions is to eliminate the disease as soon as possible and to ensure that the patient returns to his daily life as soon as possible. In minimally invasive procedures, the patient returns to his normal life in the early period.
Percutaneous nephrolithotomy (PCNL)
In endoscopic kidney stone surgery, an incision of 0.5 – 1 cm is made at the level of the kidney in the back area. Under X-ray control, a thin tube with two open ends is inserted into the kidney. With the help of an optical device placed through this tube, the stone is seen on the monitor with the video system and is removed with the help of special tools. The most important advantage of percutaneous surgery is the preservation of the normal structure of body tissues. As a result, the healing process is fast. Patients spend the postoperative period much more comfortably than open surgery. Our patients are usually discharged in 2-3 days and quickly regain their daily activities. This is quite a short time compared to open kidney stone surgery.
Especially in stones located in the lower pools of the kidney and in large stones, the success of ESWL decreases significantly. In these cases, PCNL surgery is a minimally invasive procedure with high success. Pneumatic lithotripsy and laser lithotripsy are used to clear the stone during the surgical procedure. With the help of these technologies, even the hardest stones are easily broken. With this technique, the stones that cover the whole pastry and are called coraliform stones can also be intervened.
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