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Eliminating
the Kidney Stone
Unless the kidney stone is larger than 1/4 inch (or
5mm) in diameter it will most likely pass without
medical intervention ... except for the
administration of pain killers to allow the
sufferer to endure through the episode which may
last for several days. Those between 1/4 inch and
1/2 inch in diameter are less likely to pass on
their own as they get larger.
If the kidney
stone is larger than 1/2 inch (or 10mm) in diameter
it will likely need to be either removed by surgery
or by lithrotripsy. Stones have been known to
become as large as the size of golf balls. It is
not necessary to remove a stone unless it causes
other problems. Large stones usually remain in the
kidney without symptoms, although they may damage
the kidney.
A complete
diagnosis of kidney stones should include blood
screens, 24 hour urine samples, provocative calcium
loading tests, and stone analysis to determine the
type of stone, its underlying cause, and proper
treatment, and future stoone prevention.
Lithotripsy
The kidney stone machine fragments kidney stones by
use of extracorporeal shock wave lithrotripsy
(ESWL). This roughly one to three hour long process
is known as lithrotripsy - which means stone
crushing. It uses high energy shock waves which are
focused at the exact location of the stone (located
by use of x-rays) while the semi-anesthetized
sufferer is suspended in a tank of warm water.
(PHOTO
of Lithotriptor at Midwest Stone
Institutes)
Newer lithrotriptors have eliminated the tank of
water in favor of an enclosed bag of water that is
placed in direct contact with the sufferer's body
to transfer the shockwaves without the need to
actually be immersed into the water.
During a
treatment up to 3000 lithrotripsy shock waves
vibrate the stone so that it shatters into smaller
sand-like fragments usually without injury to
surrounding tissue. Pressure is felt, but not pain.
This process is repeated until the doctors can see
on the x-rays that the stone has been crushed by
the shock waves. (DIAGRAM
of a Lithotriptor
) The
resulting stone fragments (some not so small and
most in jagged shapes) then pass out of the body
over a period of time that may be as long as three
months or more. Passing these fragments are similar
to passing small stones; and more than one sufferer
has stated that next time they will opt for some
type of physical stone removal to avoid the
prolonged painful period of these fragments being
passed.
The most common
type of stones, calcuim oxalate, is the most
difficult type to break up with shockwave
lithrotripsy due to its extreme hardness. While
some larger or complicated cases may require more
than one treatment, lithotripsy usually allows the
sufferer to return to their normal life (with the
aid of medications to reduce the pain and nausea
caused by passing the fragments) in just a few
days.
Kidney
Stone Surgery
Kidney stone removal surgery is serious. It is
resorted to in less than 5 percent of the kidney
stone cases. During surgery the doctor actually
opens up the kidney and physically takes out the
offending stones. The surgery scar can be 5 to 10
inches long. Recovery from the surgery takes four
to six weeks.
The most serious
factor against such surgery is that a kidney can
withstand being opened up by surgery only once or
twice and still remain adequately functional. It is
estimated that each time a surgeon cuts through the
meat of a kidney it will lose 20 percent of its
functionality.
Alternative
Methods of Treatment
For that reason there have been developed several
less invasive techniques for physical removal of
stones that will not pass on their own. These
include ureteroscopy: sending instruments up
through the urethra, the bladder, and into the
ureter to grab the stone and pull it
out.
Another
alternative method is the use of a laser threaded
along that same path which is then used to vaporize
the stone still inside the ureter.
A third
alternative (called PNL for short) is to enter the
kidney through a small hole made in the back and
into the kidney through which the stone can be
removed.
A new technique
is call lithoclast. It uses air pressure to vibrate
and break up the kidney stone. The the fragments
are removed with forceps or flushed with water and
then suctioned out.
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