Kidney stone disease is quite a painful affair, with the disease being prevalent even in individuals in their prime. The chance of being diagnosed with it over a lifetime is 7 per cent for women and 13 per cent for men, both aged above 20(1). To make matters worse, there is a fifty per cent or more chance of recurrence in the next five years and eighty per cent in the next ten years. It is no surprise that advancements have been made in urology so as to combat kidney stones effectively with methods like pyeloscopy made available to patients.
Kidney stones are formed from the minerals and salts present in urine. Most stones are removed from the body along with the urine but in certain instances, these stones are trapped in the kidney or lodged in the ureter (the tract that connects the kidney to the bladder) blocking the flow of urine and leading to hydronephrosis (swelling of the kidney). What ensues is intense pain in the back and side, burning sensation while urinating, and urine that is dark or red due to blood and/or nausea as well as vomiting.
Diagnosis and the treatment itself:
Your doctor may ask you to take an ultrasound or a CT scan so as to establish the size and the location of the stone. If the stone is relatively small in size and has/ has not caused any sort of pain, he/she may ask you to take medication and let the stone (crystallized) pass through the urine. If, on the other hand, the stone is relatively large, the recommended course of action will be surgery, so as to remove the stone. The type of treatment the urologist chooses to perform on you will be based on the size of the stone. A stone of less than 10mm will be treated with Shock Wave Lithotripsy (SWL) and involves, as the name suggests, shock waves being used to fragment the stone, sent from outside the body without any incisions, so as to allow the now fragmented stones, to pass through with the urine within a few weeks. Stones of sizes more than 20 mm are treated by Percutaneous Lithotripsy (PCNL): process where a rigid/ semi rigid tube with a telescope is inserted via an incision made in the back or side into the hollow region of the kidney where the stone is located and involves breaking the stone into little bits and sucked out via an instrument passed through the same tube. With stones between 10mm and 20mm, Ureteroscopy (URS) is preferred; thanks to its relatively lower retreatment rates (in comparison with (SWL).
URS involves using a very thin fibre-optic telescope called the ureteroscope via the bladder, through the ureter and into the kidney. A rigid telescope is used to treat stones close to the bladder and in the lower ureter sections and a flexible telescope is used for stones present in the upper sections of the ureter and in the kidneys, the process is otherwise called pyeloscopy. Through this telescope, your urologist will be able to view and ascertain the size and location of the stone. On identifying it, laser fibres are sent through to fragment the stones and micro baskets are used to collect them. Subsequently, a stent (used to relieve obstruction) may be placed in the ureter so as to allow urine to pass through freely from the kidney to the bladder. Usually, you can go home on the same day after the operation and resume normal activities in two to three days. On the other hand, if a stent has been placed, you will have to visit your urologist, four to ten days after the operation so as to remove it. It is crucial that you visit your urologist, as leaving a stent unattended may lead to complications.
Along with a high success rate and the ability to be performed as day surgery, pyeloscopy does not involve any incisions on the body, a requirement that its PCNL counterpart has. Yet, it may be considered a little more extreme given its area of entry, something SWL does not share. A general anaesthetic is used to ease the pain that the patient will experience during the process. There is also an extremely small risk of damaging the ureter.
Options to Consider:
With respect to options available to patients where they could receive a pyeloscopy, Turkey has various speciality hospitals that perform. Even Spain and Thailand are known to have excellent urology specialities, though at relatively higher prices(5).