Kidney Stone Laser Treatment

Kidney Stone Treatment Based on Stone Size

4 methods for Kidney Stone Removal

There are 4 methods for kidney stone removal surgery depending on the size, number, and location of the stone. These treatment methods are recommended when the mediations are ineffective against kidney stones. Different surgical methods for kidney stone removal surgery include the following –

• ESWL ( Extracorporeal Shock Wave Lithotripsy )

The doctor administers spinal anesthesia to the patient before the procedure. The procedure can be done without anesthesia also, depending on the preference of the patient. The patient is made to lie on a water-bed cushion. The fluid prevents damage to the surrounding organs by acting as a medium between the lithotripter machine and the tissues. After determining the location of the stone, the surgeon releases a series of precise high-energy shock waves that break the renal stones into smaller fragments.

The stone pieces are flushed out of the body through urine. There are no cuts or stitches involved during the shockwave lithotripsy and therefore, results in faster recovery. ESWL is usually not recommended for large kidney stones as it may require multiple sessions to completely break them. The surgeon may also choose to insert a ureteral stent in case of a large stone to reduce the pain during the stone expulsion.

• URSL ( Ureteroscopic Lithotripsy )

The procedure begins after the patient is given spinal or general anesthesia. The surgeon inserts a thin, long fiber-optic ureteroscope into the ureteral passage through the urethra. The stones are located precisely using external x-rays and imaging tests.

Once the stone is located, it is either broken into smaller pieces with the laser or removed in its intact form. The stone fragments are collected in the stone basket and removed from the body. The remaining stone fragments are then flushed out through urine. The surgeon may use ureteral stents to help flush out the stones from the body. The stent expands the passage of the ureter, which makes it easier for the stone fragments to travel through the ureter and out of the body.

• RIRS ( Retrograde Intrarenal Surgery )

Before the procedure, the patient is administered spinal or general anesthesia. After the patient is sedated, the surgeon uses a long, thin flexible endoscope and inserts it into the urethral passage to reach the urine-collecting part of the kidneys.

Since precision is a key factor during RIRS surgery and so, the surgeon leverages x-rays and image screening to generate live images of the kidneys on an external screen. The endoscope is moved up in a retrograde manner towards the kidneys where the stone is present. Once the scope reaches the desired location, the surgeon uses an advanced holmium laser to target stubborn stones and break them into smaller fragments without damaging the surrounding organs. The stone fragments are then collected in the stone basket which is subsequently removed. Alternatively, the stones are also removed in their intact form using small forceps.

The surgeon may insert stents to expand the ureteral passage. Stents are flexible, hollow tubes that run from the kidneys to the ureter. They enlarge the ureteral passage to help flush out stone fragments from the body smoothly. Ureteral stents are removed once the stones are completely flushed out of the body. Usually, it takes 10 to 14 days under normal circumstances. Furthermore, the viability of the RIRS procedure has been upgraded by the advancements in medical tools and equipment like wires, ureteral access sheath, and stone containers.

• PCNL ( Percutaneous Nephrolithonomy )

After the anesthesia is given, the surgeon makes a tiny incision in the flank area (lower back). A thin, flexible nephroscope is inserted through the incision under x-ray guidance to visualize the stones and determine their precise location. Next, a thin needle may be used to access the urine collecting system of the kidney to carefully dilate the route. This is achieved using a guidewire that allows the nephroscope to safely access the part of the kidneys.

Once the stones are located, the surgeon may choose to either break the stone into smaller pieces or remove it in its intact form using microforceps. In some cases, DJ stenting may be required that allows the stone pieces to flush out through urine. Ureteral stents are thin, hollow tubes that are inserted through the urethral opening to reach the kidneys. They may be kept for about 10-14 days, depending on how long it may take for stones to completely flush out of the body.

Kidney Stone Laser Surgery - Step-by-Step Procedure

• Before the surgery, the patient is usually given either general anesthesia.
• The patient may be asked to lie on their back or stomach.
• A thin, flexible tube with a camera on the end, called a ureteroscope, is gently inserted into the urinary tract through the urethra.
• The ureteroscope is passed through the bladder to reach the ureter and kidney where the stones are located.
• Using the ureteroscope, the surgeon locates the kidney stones within the kidney or ureter.
• Once the stones are located, a laser fiber is inserted through the working channel of the ureteroscope.
• The laser emits high-energy pulses that are directed at the kidney stones, breaking those into smaller pieces. 
• After the stones have been fragmented into smaller pieces, the surgeon removes the stone fragments from the kidney or ureter. 
• The ureteroscope is then removed and the patient is shifted to a recovery ward where the vitals are monitored. 

What To Expect After Laser Surgery for Kidney Stones

• After the laser treatment for kidney stones, the patient is taken to the recovery room where the doctor monitors the vitals and checks any sign of complication.
• The patient will be under the effect of anesthesia and may take time to regain consciousness completely.
• A catheter is usually placed for a day or two in the urethra to minimize the pain and discomfort while urinating.
• If the doctor does not suspect any possible signs of complications, you may be allowed to go home.
• In case of any abnormality, you may be asked to stay in the hospital for observation purposes.

Benefits of Kidney Stone Laser Surgery

• Minimally Invasive – Laser surgery for kidney stones is minimally invasive, meaning it involves small incisions or no incisions at all. This results in less trauma to the body compared to traditional open surgery.
• Precision – The laser technology used in this procedure allows for precise targeting of kidney stones, minimizing damage to surrounding healthy tissue.
• Shorter Recovery Time – Patients typically experience a shorter recovery time with laser surgery compared to traditional open surgery methods. They can return to their normal activities sooner.
• Reduced Pain and Discomfort – Patients experience less pain and discomfort both during and after the procedure compared to open surgery.
• Lower Risk of Complications – Laser lithotripsy carries a lower risk of complications such as infection, bleeding, and damage to surrounding organs.
• Outpatient Procedure – Laser surgery for kidney stones can be performed on an outpatient basis, meaning patients can go home the same day as the procedure, further reducing inconvenience and hospital stays.
• Minimal Scarring – Because laser surgery involves small incisions or no incisions at all, it typically results in minimal scarring compared to traditional open surgery.

Recovery After Kidney Stone Laser Treatment

• Drink plenty of water throughout the day to help flush out remaining stone fragments and to prevent dehydration.
• Follow a balanced diet rich in fruits, vegetables, and whole grains, and low in salt, sugar, and processed foods to support kidney health.
• Limit consumption of foods high in oxalates and animal proteins, which can contribute to kidney stone formation.
• Engage in regular physical activity to promote overall health and well-being, but avoid heavy lifting or strenuous exercise during the initial recovery period.
• Follow any specific postoperative instructions provided by your healthcare provider regarding medication, dietary changes, and activity restrictions.

Cost and Insurance Coverage of Laser Treatment for Kidney Stone

The cost of laser treatment for kidney stones may vary from individual to individual depending on multiple factors. Typically, the factors that can influence the cost of your laser kidney stone surgery cost are:

• Surgeon’s fees
• Fee of the facility where surgery is done 
• Anesthesia fees
• Preoperative and postoperative care
• Medical supplies and equipment
• Experience and expertise of the urologist
• Technology of the surgical equipment used
• Additional tests and diagnostic procedures

Insurance coverage for laser treatment for kidney stones can vary depending on the patient’s insurance plan and provider. Generally, private health insurance plans may offer coverage for laser lithotripsy as a medical necessity. 

Medicare, the federal health insurance program for individuals aged 65 and older, may also provide coverage for eligible beneficiaries, typically covering a significant portion of the costs associated with the procedure.