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Stone Fragmentation
What is
Stone Fragmentation?
Ureteral stone disease is among the most painful
and prevalent of urologic disorders. Stone
fragmentation involves treatment of ureteral
stones.
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Effects
of Stone Fragmentation
Stone
fragmentation is effective in the removal of
ureteral stones.
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Candidates for Stone Fragmentation
Stone fragmentation is ideal for those who have
been diagnosed with ureteral stones.
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Your Consultation
Sometimes "silent" stones - those that cause no
symptoms - are found on X-rays taken during a
general health exam. These stones would likely
pass unnoticed. If they are large, then
treatment should be offered. More often,
ureteral stones are found on a X-ray or sonogram
taken on someone who complains of blood in the
urine or sudden pain. These diagnostic images
give the doctor valuable information about the
stone's size and location. Blood and urine tests
also help detect any abnormal substance that
might promote stone formation.
If your doctor suspects a stone but is unable to
make a diagnosis from a simple X-ray, he/she may
scan the urinary system with intravenous
pyelography (IVP). It is an imaging technique
that utilizes radiopaque injections of dye
followed, during excretion by the kidneys, by
abdominal X-rays. A kidney obstructed by a stone
will not be able to excrete the dye as quickly
and may also appear enlarged when compared to
the normal organ. Since this technique requires
preparation, it has been replaced in many
hospitals by an abdominal/pelvic CT scan, an
extremely accurate diagnostic tool that can
detect almost all types of ureteral stones
painlessly.
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The
Stone Fragmentation Procedure
Extracorporeal shock wave lithotripsy (ESWL®).
Shock wave treatment that uses a machine called
a lithotripter. Lithotripsy fragments a stone
into pieces small enough to pass out with
urination. "Extracorporeal" means the shock
waves come from outside the body. For treatment
with ESWL®, the patient is placed in a tub of
water or against a water-filled cushion or
mattress. A lithotripter makes shock waves, and
the doctor, using ultrasound or X-rays, focuses
the waves exactly on the ureteral stone inside
the patient's body. They travel easily through
both the water and the patient's soft body
tissues, until they hit the stone. The impact
causes stress on the stone. Repeated shock waves
cause more stress, until the stone eventually
crumbles into small pieces. Because of possible
discomfort during the procedure, the patient may
need general, regional or local anesthesia or
some form of sedation. Also, a plastic tube,
called a stent, may be temporarily inserted
through the urethra and bladder and into the
ureter. The stent may assist in locating the
stone or in helping the fragments pass following
treatment. ESWL® is the least invasive of the
four active treatments and has a short recovery
time. Most patients can resume normal activities
in a few days. However, one ESWL® session by
itself may not free the ureter of all stone
material. A repeat ESWL® session may be
necessary. ESWL® is not the ideal treatment
choice for all patients. Patients who are
pregnant or have abdominal aortic aneurysms,
urinary tract infections or uncorrected bleeding
disorders should not have ESWL®. In addition,
certain factors such as stone size, location and
composition may require other alternatives for
stone removal.
Ureteroscopy (URS). Ureteroscopy involves the
use of ureteroscopes, small flexible or
semi-rigid telescopes that can be inserted up
the urethra, through the bladder and into the
ureter without an incision. These instruments
allow the doctor to view a ureteral stone
directly. They also have small working channels
through which various devices can be passed to
remove or fragment the stone. Anesthesia is
generally used, and a stent is left in the
ureter for a few days after treatment while
healing takes place. Ureteroscopy was developed
in the 1970s and came into wide use during the
1980s. Before then, a type of treatment called
"blind basketing" was often used. A basket-like
device was passed - blindly, with no viewing
instrument - through the urethra and bladder and
into the ureter to pull out the stone.
Percutaneous nephrolithotomy (PNL). This
procedure is the treatment of choice for
patients with ureteral stones that are larger
are in a location that does not allow effective
use of SWL or cause a blockage so severe that
they cannot be bypassed using stent. In this
procedure, the surgeon makes a tiny cut in the
flank area and then uses an instrument called a
nephroscope to locate and remove the stone. For
larger stones, a type of energy probe
(ultrasonic, electrohydraulic or hydraulic) may
be needed to break the stone into small pieces.
All of this is done while the patient is sedated
or under anesthesia.
One
advantage of this procedure over SWL is that the
surgeon removes the stone fragments instead of
relying on their natural passage from the
ureters. Generally, patients stay in the
hospital two to three days and may have a small
catheter in the kidney.
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Recovery
Although stone recurrence rates differ with
individuals, in general you have a 50 percent
chance of redeveloping stones within the next
five years. So prevention is essential. Your
urologist may follow-up with several tests to
determine which factors - e.g., medication or
diet - should be changed to reduce your further
risk.
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Risks
While shock wave
lithotripsy is considered safe and effective, it
can still cause complications. Most patients
have blood in their urine for a few days after
treatment. Bruising and minor discomfort in the
back or abdomen from the shock waves are also
common. To reduce the risk of complications,
urologists usually tell their patients to avoid
aspirin and other drugs that affect blood
clotting for several weeks before treatment.
Another complication may occur if the shattered
stone particles cause discomfort as they pass
through the urinary tract. In some cases, the
urologist will insert a small tube called a
stent through the bladder into the ureter to
help the fragments pass.
This type of
"blind" treatment risks injury to the ureter and
is less effective than other methods used today.
In particular, as ureteroscopy has advanced with
continual instrument improvements, blind
basketing is no longer a satisfactory treatment
choice. The risks of ureteroscopy include
perforation or stricture (scar tissue),
especially if the stone has been impacted or
embedded within the wall of the ureter for
longer than two months. The majority of
ureteroscopic procedures can be performed as day
surgery and most individuals can return to work
within one to two days following the procedure.
Frequently Asked Questions
Q:
What is a ureteral stone?
A:
A ureteral stone is a kidney stone that has
moved down into the
ureter.
The stone begins as a tiny grain of undissolved
material located where urine collects in the
kidney.
Q:
What are the signs of a problem?
A:
Occasionally, stones do not produce any
symptoms. But while they may be "silent," they
can be growing, even threatening irreversible
damage to kidney function. More commonly,
however, if a stone is not large enough to
prompt major symptoms, it still can trigger a
dull ache that is often confused with muscle or
intestinal pain.
If the stone is too large to pass easily, pain
continues as the muscles in the wall of the tiny
ureter try to squeeze the stone along into the
bladder. One may feel the need to urinate more
often or feel a burning sensation during
urination. In a man, pain may move down to the
tip of the penis. If the stone is close to the
lower end of the ureter at the opening into the
bladder, a person will frequently feel like they
have not fully completed urination.
Q:
How can I prevent ureteral stones?
A:
A good first step for prevention is to drink
more liquids - water is the best. If you tend to
form stones, you should try to drink enough
liquids throughout the day to produce at least
two quarts of urine in every 24-hour period.
People who form calcium stones used to be told
to avoid dairy products and other foods with
high calcium content. However, recent studies
have shown that foods high in calcium, including
dairy foods, help prevent calcium stones. Taking
calcium in pill form, however, may increase the
risk of developing stones. Women taking vitamin
D and calcium pills in the post-menopausal
period to prevent osteoporosis, especially with
family history of stones, need to be careful. If
you are at risk for developing stones, your
doctor may perform certain blood and urine tests
to determine which factors can best be altered
to reduce the risk. Some people will need
medicines to prevent stones from forming.
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The following list of Urology procedures are
performed at Beverly Hills Medical Group -
please click the links to find out more:
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