Laparoscopic nephrolithotomy and pyelolithotomy in Iran
Laparoscopic nephrolithotomy and pyelolithotomy in Iran | All-inclusive package at the best price | Performed by the best Iranian Urologists
Laparoscopic nephrolithotomy and pyelolithotomy in Iran :
- Duration : 8 Days
• Removing stones from the kidney
• Preventing permanent kidney damage
LAPAROSCOPIC NEPHROLITHOTOMY AND PYELOLITHOTOMY IN IRAN: ALL YOU NEED TO KNOW
Usually, small stones will pass out of the kidney with urine flow. However, larger stones should be broken into smaller pieces or get surgically removed. There are two approaches to break the stone. One is the use of high energy shockwaves from out of the body to break the stones to pieces that can be exerted by urine. This method is called Extracorporeal shockwave lithotripsy (ESWL). Another method for larger stones is called percutaneous nephrolithotomy (PCNL). In this method, a nephroscope is inserted into the kidney through a small incision in the back of the kidney and the stones are shattered using laser or ultrasound.
For larger stones that don’t respond to these methods, Laparoscopic nephrolithotomy and pyelolithotomy are recommended. Laparoscopic nephrolithotomy and pyelolithotomy are performed under general anesthesia.
In nephrolithotomy, the stone is located by ultrasound or by evidence of a bulge, or depression secondary to scarring after mobilizing the kidney. The stones are removed from calices through small incisions in the renal capsule and parenchyma using a fine optic fiber tube. The incisions may or may not be sutured. The surgeon may insert a stent running from the kidney to the bladder to maintain the shape of the ureter during the healing process. The stent will be removed several weeks after the surgery. In a pyelolithotomy, the surgeon makes an incision in the renal pelvis to access the stone. After removing the stone, the incisions are sutured with or without the stent.
The cause of nephrolithotomy and pyelolithotomy
Hard masses in the kidney known as renal stones are formed from urinal crystals. This condition is called nephrolithiasis.
There are five types of renal stones:
• Calcium oxalate (the most common type)
• Calcium phosphate
• Struvite (magnesia and ammonia)
• Uric acid (eating too much protein, red meat)
• Cysteine (mostly genetic)
The size of the stones varies from small sand grain-like stones to large stones that impair the function of more than two calyx.
Nephrolithiasis is often asymptomatic. However, you may experience pain in your abdomen, lower back, and groin and detect blood in your urine.
If nephrolithiasis is left untreated, it may cause blockage of urine flow, infection and irreversible kidney damage based on the position and size of the stone.
Your doctor may suggest laparoscopic nephrolithotomy and pyelolithotomy in these conditions:
• Large stones have extended to more than one unit of urine collection system.
• The diameter of the stones is larger than 2 centimeters.
• The ureter is blocked by large stones.
• The stones have not responded to other therapies.
Preparations for nephrolithotomy
Before the surgery, your doctor will order several tests. Urine and blood tests are done to detect signs of infection and other blood clotting disorders. A CT scan is performed before surgery to determine the location of the stones in your kidney. Your doctor will prescribe antibiotics to prevent infections after the surgery.
In addition to common risks of all the surgeries (infection, bleeding and the need for another surgery), here are the specific risks of laparoscopic nephrolithotomy:
• Laparoscopic procedures can convert to open surgery because of the complications during surgery (approximately 13% of patients)
• In about 15% of the female patients, peritoneal tear has been reported.
• Approximately 5% of patients show symptoms of urinary leakage that is defined by imaging.
What to expect from a nephrolithotomy?
The operation may take about 2 to 3 hours. The length of hospital stay is shorter in laparoscopic pyelolithotomy compared to PCNL. Most of the patients can leave the hospital after 4 to 6 days. The probability of the existence of residual stones is very low in the laparoscopic method. You can return to your daily activities and work after around 2 weeks.
LAPAROSCOPIC NEPHROLITHOTOMY AND PYELOLITHOTOMY FAQs
1-What is a kidney stone?
Urine is a combination of water and various dissolved wastes. When the concentration of wastes gets higher, crystals begin to form. If the kidney can’t pass out the stone with the urine, the crystal grain attracts other elements like phosphate, urate, oxalate, cysteine, and xanthine to itself and gets larger.
Large stones may stay in the kidney or get stuck in the ureter. Passing a stone can be painful. Also, if the stone doesn’t move from the kidney, the urine backflows in the kidney, ureter, bladder, and urethra. This backflow causes pain in the abdomen and back.
2-Why do the stones develop?
There are several reasons for the formation of stones. Dehydration, too much or too little exercise, obesity, salt or sugar-rich diets, surgery for weight loss (alteration of digestive tract causes a higher concentration of oxalate), genetic factors (in about 25% of stones) and infection are amongst these reasons. Eating too much corn syrup and table sugar (fructose that may be metabolized to oxalate), diabetes, osteoporosis, hypertension, and chronic diarrhea may increase the risk of stone formation.
3-How much is the chance of developing kidney stones?
Each year 500,000 people in the USA. It is estimated that one in every ten people will have a kidney stone in their lives. In the last 3 decades, the number of people with kidney stones has increased. The people from 20 to 50 are more susceptible to kidney stone formation and the likelihood of stone development is higher in men compared to women.
4-What are the signs of a kidney stone?
Small stones with the size of a grain of sand are passed out of the urinary tract with manageable pains. The size of the stone can be as large as a golf ball. The larger the stone, the more significant the symptoms.
You may experience these symptoms:
1. Pain in the sides of the lower back
2. Persistent vague pain in the stomach
3. Cloudy urine with a bad smell
5-What are the tests for diagnosing the stones?
In your first session, the doctor performs a physical examination and reviews your medical history. Then the doctor orders some tests to determine the exact size, location, and shape of the stones. CT scan from the kidneys to the bladder, intravenous pyelogram with is X-ray of the urinary system with the use of contrast dyes and KUB x-ray for assessment before and after the surgery by the surgeon, are the most common tests.
6-Why is it necessary for the doctor to know the composition of the stone?
Examining the stone composition can help the doctor to determine what has caused the stone formation and how you can prevent the formation of further stones.
7-Is there any way to treat it without operations?
If your stone is small, your doctor may ask you to drink a lot of water to pass the stone without surgery. But if it is large you need to undergo one of the noninvasive or invasive operations.
8-What happens if I don’t get treatment?
Kidney stones increase the risk of kidney diseases. you are 50% more at the risk of developing kidney stones in the nest 5 to 7 days if you already had one.
9-What can I do to prevent stone formation?
Make sure to stay hydrated and drink a lot of fluid to decrease your urine concentration. The darker your urine, the more concentrated it is. The best fluid is water. Citrus fruits like orange have natural citrate, which blocks the formation of stones. Therefore, your second choice is citrus fruit juice. If you exercise, you should drink more water than usual. Consider omitting kolas from your diet (kola contains phosphate) and limit your alcohol consumption because it causes dehydration.
It is recommended to limit your salt, sugar, fructose and corn syrup consumption to small quantities. Maintain a balanced diet containing 50 grams of proteins per day. High protein diets increase the risk of uric acid stones formation. Include calcium from foods (milk, yogurt, cheese) in your diet especially if you are eating too much of oxalate-rich foods (tea, chocolate, nuts, spinach). However, don’t take calcium supplements since they have been proved to increase the risk of stone formation. Eat plenty of food rich in vitamin D and get enough sunlight. If you are over-weight, consider losing weight.
10-Do children develop kidney stones?
Children as young as 5 years old may develop kidney stones. It is mainly because of the dehydration, eating salty snacks such as potato chips and, child obesity. Children may not realize that they are thirsty. So, don’t wait for them to ask you for water. Make sure your child has access to water in sports activities and trips.
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