Urology

Advancements in Kidney Stone Treatment for 2cm and 4cm kidney stone

Dr. Mohan Keshavamurthy Jun 26, 2024

Introduction

Today, we're diving into an exciting area of development: the integration of technology to revolutionize kidney stone treatment. Gone are the days of invasive procedures; instead, we now embrace minimally invasive techniques tailored to individual patient needs.

Q: Let's kick things off by discussing the evaluation and treatment approach for a patient with bilateral 2cm kidney stones.how would you approach this scenario?

A: Traditionally, PCNL (percutaneous nephrolithotomy) would have been the go-to option. However, with advancements in minimally invasive endoscopic technology and the introduction of RARS (retrograde intrarenal surgery), our approach has evolved. For stones up to 2cm, we now offer patients the choice between RARS and PCNL after discussing the pros and cons. Many patients prefer RARS due to its non-invasive nature and the absence of incisions.

Q: That’s fascinating. When considering simultaneous treatment for both kidneys, what factors come into play?

A: The hardness of the stone, as indicated by Hornsfield units, is crucial. If we can complete stone removal on one side within a reasonable timeframe without subjecting the renal pelvis to prolonged pressure, we may opt for simultaneous treatment. However, if the procedure is prolonged or the patient has underlying comorbidities, we prioritize patient safety and opt for sequential treatment.

In the realm of urology, advancements in technology have paved the way for more effective stone removal procedures. The introduction of smaller nephroscopes and the transition from prone to supine PCNL (percutaneous nephrolithotomy) has expanded the options available to urologists, particularly in tackling challenging cases.

Q: Consider this scenario: a patient presents with a staggering 4cm kidney stone burden and uncontrolled diabetes. This poses a significant challenge, but with the evolution of PCNL techniques, there are viable solutions.

A: Despite the daunting stone burden and the patient's medical history, our first choice would still be PCNL. Over the years, PCNL techniques have undergone significant transformation, particularly with the adoption of supine positioning. This approach offers numerous advantages, including simplified anaesthesia management and enhanced procedural ease."

"By opting for supine PCNL, we can effectively address the stone burden in a single setting, mitigating the need for multiple procedures and minimizing patient discomfort."

The utilization of supine PCNL represents a ground-breaking advancement in kidney stone treatment, particularly for high-risk patients with comorbidities such as uncontrolled diabetes. As technology continues to evolve, urologists at Fortis Hospitals, Bannerghatta Rd, remain at the forefront of innovation, ensuring optimal outcomes for patients with complex urological conditions.