Page 243 - Urological Health

How did we treat stones in the past?

Before 1980, open surgery through a large incision was used to treat stones in the urinary tract. Since
then, it has been virtually abandoned because of minimally invasive techniques that have reduced
complications and recovery time.

Currently there are three established options that can be used to treat kidney stones:
(1) extracorporeal shock wave lithotripsy (ESWL)
(2) ureteroscopy (URS)
(3) percutaneous nephrolithotomy (PCNL)

Getting emergency treatment for stones

Urgent care may be needed if a kidney is blocked and there is an infection that has gone into the blood
stream. In these situations, doctors may need to bypass the obstruction without immediately removing
the stone. The safer option is to deal with the potentially life-threatening situation first by inserting a
ureteral stent or by inserting a nephrostomy tube through the skin (for example through the skin in
the back). These tubes are left in place temporarily to relieve the blockage until a procedure to remove
the stone can be planned.
UNDER REVIEW
Once your serious situation (like draining a blocked, infected kidney) is managed, the stone can be
treated. If there is no infection or renal failure, these temporizing measures are not necessary.

Now let’s talk about the three treatments:

1. Extra-corporal shock wave lithotripsy (ESWL)

This is the least invasive treatment. It has
the unique ability to break stones from
outside the body. The first ESWL treatment
in North America was performed in 1984.

ESWL uses a machine as seen in Figure
2togenerate shock waves thatare targeted
on the offending stones by X-ray or
ultrasound. In ESWL, you lie on a machine
and the waves move from the machine
through you. The targeted stone is
repeatedly struck by multiple shock waves
and is ultimately broken into smaller
pieces (Figure 3). These smaller pieces
should pass painlessly spontaneously Figure 2. Typical ESWL setup.
through you.

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