ESWL

What is ESWL?
EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY Credit for the invention of LITHOTRIPSY goes to Doenier.It is a procedure wherein NO Anaesthasia is required and it is not at all an operation. The Urologist does not even touch the patient.

PROCEDURE

The patient just lies down on the Lithroscopy table, a 6 inches baloon touches the Lion and Soundwaves hit the body which feels like strong tapping on the skin. It is done on the OPD basis and the patient is called back for subsequent sittings depending upon the size and the hardness of the stone.

Advantages

  • Success rate 95%
  • No admission
  • Non Invasive
  • No Anaesthesia
  • Age no bar
  • Minimal side effects

Disadvantages

  • May require no. of Sittings
  • Stent may be required
  • Size limitations of 2.5 to 3 cm
  • Hard stones
  • Anaesthesia required in children
  • Steinstrasse, post op pain

PCNL

What is PCNL?
PERCUTANEOUS NEPHROLITHOLITHOTOMY.

PROCEDURE

A small 7 to 8 mm puncture is done in the Lion under anaesthesia , endoscope is introduced through this hole into kidney, the stone is fragmented and the fragments are removed through the same hole.

Advantages

  • Minimal Access Surgery
  • Stones of almost any size cleared
  • Hardness not a criteria
  • Minimal complication
  • Regional Anesthesia
  • Short hospital stay of 2 – 3 days
  • Minimal post op pain

Advantages (Continued...)

  • Ancilliary proceducers like Endopyelotomy can be done
  • Even staghorn stones can be cleared
  • Success rate - Total stone clearance 90%
  • Sandwitch Therapy – PCNL + ESWL

Ureteric Stones

Procedure– A small 2 to 3 mm diameter long slender endoscope is introduced through the urethra into the ureter and the stone is fragmented or removed.

Upper third stones - ESWL first choice

80% stones can be cleared with good success rate.

Ureteroscopy - Success rate 80%

  • Limitation due to Anotomical constraints, stones migrating up.
  • Miniature or flexible URS may be required
  • C-Arm guidance.

Antegrade PCNL

  • Large / Hard stones
  • Stones not accessible to URS.
  • Stone migration during URS.
  • Success rate very high
  • Push Bang ESWL
  • Ureterolithotomy, Retroperitoneo scopy, Laparo scopy etc.

Middle Third stones

  • Graveyard of radiologist
  • URS 1st choice
  • ESWL
  • Open

Lower Third Stones

  • Success rate of the URS 98%.
  • Admission less then a day.
  • No pain .
  • Intact stone can be removed.
  • Lithoclast or Laser for larger stones.
  • DJ stent may be required.
  • Meatotomy for UV junction stones.

Blader Stones

  • Almost any stone can be done Endoscopically.
  • Hospital stay less than a day.
  • No pain.
  • Small stones done on OPD basis under LOCAL NAESTHESIA A.Mauer Mayer stone punch.
  • Blader stone sheath / Nephroscope.
  • Success rate almost 100%
  • Complication rate almost 0%

Antegrade PCNL

  • Large / Hard stones
  • Stones not accessible to URS.
  • Stone migration during URS.
  • Success rate very high
  • Push Bang ESWL
  • Ureterolithotomy, Retroperitoneo scopy, Laparo scopy etc.