KIDNEY STONES AND PILOTS
A small kidney stone in most of the people can be observed for spontaneous passage and may not warrant surgical removal. However there is a set of professionals where even a small asymptomatic stone may become a professional hazard as in aviation industry and Navy.
A stone in kidney may suddenly dislodge and slip into the tube draining urine from the kidney to the bladder(Ureter) and cause sudden excruciating pain with or without nausea and vomiting.
Some departments in Aviation and Naval profession may require their professionals to be stone free for obvious health concerns involved.
How can these small stones be removed with least intervention?
Medicines generally don’t help in passage of stones located inside the kidney. However they may help in passage of small stones which have slipped to the ureters.
There are two procedures by which stones can be removed without making any cut or opening on the body:
1. ESWL( Extra corporeal Shock Wave Lithotripsy):
A beam of powerful X rays focused on the stone to fragment it into smaller pieces and then waiting for them to pass spontaneously.
Limitations of ESWL:
- Stone clearance dependent on spontaneous clearance by the body. Stone might break but not necessarily pass out, thereby defeating the purpose of procedure, i.e., making the individual stone free.
- May require more than one sitting to break stone.
- Not all stones can be removed by this procedure. Stones must be visible on X Ray for it to be focused by the ESWL machine.
2. RIRS(Retrograde Intra Renal Surgery)
- A thin scope (Flexible Ureteroscope) is passed through the urinary passage (under anesthesia) and negotiated inside the kidney. A laser beam is used to dust the stone and fragments removed using a specialized basket passed through the endoscope. A thin tube called Double J stent is left in place for healing and the residual dust to pass through, which is removed generally after one to two weeks through the urinary passage. There is almost no blood loss, there is no external cut or opening and recovery is very fast.
- In last nine years I have treated many individuals from aviation industry, including pilots and cabin crew, and naval profession using RIRS successfully.