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Dr. Shaw and Dr. Tsai are proud to offer the latest, most minimally invasive options for management of stones within the kidney and ureter (tube connecting the kidney and bladder).
Using the latest generation, high-definition, fiberoptic, and digital technology, we are able to locate and use small lasers and baskets to remove kidney and ureteral stones.
Once upon a time, this required major surgery or incisions. The latest technology allows us to usually perform these cases in one hour or less, and on an outpatient basis.
Some of our patients come via the Emergency Room in severe pain. Usually, these stones are lodged in the tube connecting the kidney and bladder. The resulting blockage causes dilation, or back-up of urine in the kidney, causing pain. The ureter, which is a muscular tube, has contractions, as it is trying to move the stone towards the bladder. This results in waves of pain followed by relatively pain-free episodes.
For other patients, who are a bit luckier, we are able to locate the stone before it begins its journey down the ureter. Although most patients can pass a stone less than 4mm on their own, the size of this line (—) any bigger than that, and the stone is likely to get lodged, causing trouble.
When appropriate, we will give pain medicine, including Toradol, which also relaxes the ureter, decreasing pain. We also use medications called alpha-blockers such as Uroxatral, Flomax, and Rapaflo, which can potentially dilate the ureter, allowing urine to be able to pass by the stone, reducing pain. In some lucky cases, the ureter dilates enough to pass the stone spontaneously. (No surgery!)
For others, with larger stones, complex anatomy, or other factors such as urinary infection or severe pain, ureteroscopy will be necessary to remove the stone.
No incisions! That’s the good part. Ureteroscopy is performed under general anesthesa (asleep), in the hospital, or outpatient surgery center. We use a thin, fiberoptic or digital scope which is gently introduced via the urethra into the bladder. We then guide the scope with high-definition camera up to the level of the stone.
When possible, the stone is fragmented with a laser, and stone fragments can be basketed. The remaining stone is blasted to sandy-like particles that are washed out in surgery; the remaining sandy pieces will pass in the next few days with urination.
For some people, with higher-grade obstruction, or complex situations like larger stones, urinary infection, and other situations, temporary placement of a stent is necessary. The ureter (urine tube connecting kidney and bladder) is about the dimension of a soft-drink straw. In complex ureteroscopy, the straw can swell shut after surgery, much like a swollen eye. If the ureter (temporarily) swells shut, this can result in pain, urinary infection, and failure to pass the stone fragments from surgery.
In these situations, a temporary plastic tube is placed internally, that goes from the kidney to the bladder. This stent is about as wide as coffee stirrer straw, and helps to keep the ureter from closing shut after surgery. Therefore, the stent is placed to help relieve obstruction and allow kidney stone fragments to pass, as well as making it easier to urinate. Most patients tolerate the stent just fine, although some patients may have discomfort between the kidney and bladder, or an urge to urinate frequently, because of the stent. Luckily, the stent is just temporary, usually just a few days, and is removed in a 30 second brief procedure with lidocaine (numbing) jelly in the office. Some stents may come with a string that allows the patient to remove the device right at home.
After the procedure, patients may have a variety of minor issues. Although many patients may do fine with no issues, some patients may experience minor, temporary issues such as noticing burning with urination, frequent urination, small clots, or pink/red colored urine, or occasional discomfort that radiates from the kidney to the bladder. Again, these usually tend to be minor issues and resolve within 1-2 days after the procedure.
Usually, Dr. Shaw or his staff will communicate to you a desired follow-up time frame. Please, call us the day after the procedure to verify a time to see us in the office. Usually, if there are stone fragments, we will have a stone-analysis performed. We will also want to check an X-Ray of the abdomen, to make sure all stones were removed.
Finally, Dr. Shaw prides himself on keeping his patients out of the OR, and reducing the chance of further kidney stones. This includes review of a diet to reduce kidney stones, 24-hour in-depth urine studies, and blood panels to find out the cause and source of stones. For most people, dietary and lifestyle changes will drastically reduce the chance of stones, while others may need the addition of medicines to help reduce stone formation.
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