Kidney Stones Treatment Center at HMC

Minimally invasive surgery and Shock Wave Lithotripsy have almost completely replaced the conventional surgery.                     

What are kidney stones?            

There are usually inhibitory substances that prevent urinary stone formation. Sometimes substances in the urine (such as calcium and other salts) crystallize into high concentration of small crystals which can then gradually increase until the creation of actual stones.

During the movement of the ureteral stone it may block the kidneys and cause pain and renal dysfunction. The ureter is the tube which drains the kidney into the bladder. The stone may cause an obstruction and prevent the urine from draining out of the kidney.

What is the prevalence?                         

Up to 12% of men and 7% of women may suffer pain from kidney stones during their lifetime. Kidney stones tend to repeat without prophylaxis. Following the ejection or removal of stone there is a 50% chance of a new stone formation in five years.

What are the symptoms of urinary tract stones?

In the last two decades there has been a revolution in the field of kidney stones surgery.

 

Today, with the increasing use of imaging, some of the stones are discovered by chance. However, patients usually suffer from pain in the hip that sometimes radiates towards the groin. Pain can be very intense thus it will be difficult for the patient to find a position that would ease it. Some patients suffer from nausea and vomiting. The movement of the stone may be accompanied by hematuria. During the movement of the stones in the urinary tract it can block the kidney, which will lead to a long-term kidney malfunction. Inflammation often develops as a result of contaminated urine which cannot flow as a result of the stone. This situation requires immediate treatment.

Who needs treatment of urinary tract stones?

You can follow the principle of small stones (under 5 mm) in the kidney, which do not cause problems. Approximately half of the 'quiet' stones do not cause any problems within five years after the discovery. Stones larger than 5 mm or stones causing a blockage of the kidney, urinary tract infections or unbearable pain are recommended to treat.

Treatment of urinary tract stones

In the last two decades there has been a revolution in the field of kidney stones surgery. Minimally invasive surgery Shock Wave Lithotripsy have almost completely replaced open surgery.

There are three modern approaches for the treatment of stones:

Vitro crushing stones (Shock Wave Lithotripsy)

This is a completely non-invasive treatment (no incision or insertion of a telescope). This treatment makes use of a machine which transfers shockwaves through a water-filled cushion to the patient. The procedure is performed under general anesthesia to prevent the movement of the patient. The success of the operation depends on the size of the stone, its composition and location. The overall success rate is about 70%. The larger the stones are (over 2 cm), the success rate decreases and additional steps are required.

Shock wave lithotripsy procedure is safe with a low complication rate. Possible complications include bleeding around the kidney, urinary tract infections and obstruction of the ureter by stray stone chips.

Ureteroscopy

In this action a tiny device called ureteroscope is introduced.  In fact it is a kind of "catheterization" of the urinary system. Through the ureteroscope, the urologist can detect a stone in the ureter and remove it with a small basket at the end of a wire inserted through an extra channel in the ureteroscope. The latest generation of orthoscopes (which are available in Herzliya Medical Center) are characterized by flexibility and special maneuverable devices to move within the kidney mazes. Ureteroscopy performed in the kidney is called RIRS (retrograde intrarenal surgery).

To crush stones that are too large to be crushed by lithotripsy, a powerful laser fiber is inserted through the ureteroscopy. The results of the treatment of stones by ureteroscopy is usually better than crushing vitro, but it is an invasive operation. Complications mainly include the possibility of a urinary tract infection. When the operation is done, a ureteral catheter is left for several days.

Stone removal surgery of a percutaneous approach

Percutaneous Nephrolithotomy (PCNL)

PCNL is the analysis of large kidney stones that cannot be treated effectively through crushing vitro or ureteroscopy. The operation is performed by making an incision of approximately 1 cm in diameter from the hip. The urologist chooses a suitable path to insert a hollow tube under X-ray reflection. Then the urologist enters larger fragments in order to extract the stones.

This analysis has great results but is a complex analysis; there may be a small percentage of complications. The most common complications include bleeding in the urine, urinary tract infection and the accumulation of fluid in the ventricles entrance.

After treatment:

The patient’s stones undergo a comprehensive investigation of stone composition testing. In accordance with the findings, patients receive dietary recommendations and sometimes medication to prevent the recurrence of stones. Usual hospital stay is three days. X-rays will be taken at the end of the procedure to ensure that all the bits of the stones have been removed.

This article was written by Dr. David Lipschitz, urology surgeon specialist. Consultant at Herzliya Medical Center in the Urology Department

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