OVERVIEW

Renal and ureteral stones are a frequent reason for consultation for urologists and emergency physicians, since they generate very annoying symptoms such as intense pain, hematuria (blood in the urine) and urinary tract infections.

Most stones in the urinary tract must be removed to relieve pain and prevent damage to the kidneys from infection and obstruction.

The indications to fragment and extract stones in the urinary tract are:

  • Kidney stones up to 2 cm
  • Kidney stones that could not be removed completely by percutaneous or laparoscopic surgery
  • Ureteral stones up to 2 cm
  • Stones in the bladder up to 3 cm

Benefits of laser fragmentation and stone removal in the urinary tract

Removing stones from the urinary tract reliefs symptoms of pain and infection and the kidney is protected from potential permanent damage.

The fragmentation of the stones with laser allows the urologist to be very precise at the time of breaking the stones, avoiding damage to important structures of the kidney.

When performed through the urethra, completely endoscopic, and without incisions, the fragmentation and removal of stones from the urinary tract helps the patient to recover quickly and with little or no pain.

Risks and complications

Possible complications that may occur when performing laser fragmentation and removal of stones in the urinary tract are the same as can occur in any surgical procedure and these are: hemorrhage, damage to nearby organs, reactions to anesthesia, etc. However, these complications occur infrequently and most of the time they can be resolved during the same surgery.

A specific risk of this procedure is the failure to ascend to the kidney in a retrograde manner (renal intrarenal surgery: RIRS), this by the narrowness of the ureter that some people have; in these cases, a JJ stent is left for a few days to passively dilate the ureter and then perform a new renal endoscopy.

Alternatives to laser fragmentation and stone removal in the urinary tract

Other options to remove stones from the urinary tract are:

  • Open surgery
  • Laparoscopic surgery
  • Percutaneous surgery
  • Medical treatment (pills) in ureteral stones (in stones that measure less than 0.4 cm and when the patient has no pain)

What to expect from laser fragmentation and stone removal in the urinary tract?

Day of surgery:

The day of the operation will arrive in the morning to the hospital in fasting

The surgery lasts approximately 1-2 hours; however, this time is variable.

Anesthesia for this procedure is a spinal block (in the back) and sedation so you will not feel pain and will be relaxed during your procedure.

The pain after laser fragmentation and removal of stones in the urinary tract is minimal and can be effectively controlled with intravenous analgesics.

Food: on the day of surgery you can eat in the afternoon, there are no food restrictions, however, a balanced diet is recommended.

Physical activity: the same day of surgery you can walk in the afternoon. It is expected to feel a bit fatigued after any surgery, this problem resolves spontaneously within a few weeks after the procedure.

Hospital stay: most patients operated of laser fragmentation and extraction of stones in the urinary tract remain hospitalized for a few hours and can go home the same day or the following day.

Catheter: after removing the stone, a JJ stent is inserted into the ureter, which remains after the surgery for 2 weeks to facilitate uniform healing of the urinary tract, this catheter is not visible because it is inside the body, however, some patients perceive mild discomforts such as burning during urination, mild pain in the back, mild hematuria (blood in the urine) and urgency (frequent urination). The removal of this stent is by endoscopy and can be performed as an outpatient procedure in an office.

Wounds: when performed endoscopically, this procedure leaves no scars on the skin.