Ms Sharon Scriven
Consultant Urologist, Nottingham University Hospitals Trust
Renal stones are an often painful condition that is on the up in the western world, increasing by roughly 60% over the last 10-years alone. Not only is there a one in 13 chance of getting a stone in your lifetime, but after treatment you then have a 50% chance of recurrence.
Kidney stones, while common, can often present in a variety of different ways. From a little blood in the urine to severe pain, some can have no symptoms at all.
It means that the urological team will first have to identify where your stone, or stones, are. Then, depending on the size and location there are a number of options for the patient, including waiting for it to pass naturally.
Previously, when a large stone has been identified in the kidney and a shockwave treatment will not suffice, a small wound may need to be made for a telescope to be inserted and the stone dissipated with a laser. With traditional nephroscopy, a hole this size in the kidney could lead to bleeding and infection. The patient would potentially need to stay in hospital and be monitored.
Now, thanks to a culmination of techniques over the last 10-years or so, MIP (Minimally Invasive PCNL) means that, by working with smaller instruments from the nephroscope to the laser, the wound is much smaller.
Recovery times much improved
Ms Sharon Scriven, Consultant Urologis at Nottingham University Hospitals Trust, explains: “Since I have been working in hospitals over the last 13-years, this technique has been streamlined. Not only can we treat both adults and children, but the wound size is much smaller, less than a centimeter. This means we can close with just a single stitch or even some glue and you wouldn’t know we’d been there.”
In terms of recovery times, patients are often discharged the next day after a fluid check, sometimes even the same day.
This means that, despite a growing demand for treatment currently existing in the NHS, patient referral and treatment times are much quicker than ever before.
For 50-year old Shaun Beet from Nottingham, finding his kidney stones 18-months ago was a big surprise and only came to light after suffering a burst appendix.
He said: “It seems I might have had the stones due to other complications I’ve had from birth, but I had no symptoms. I was shocked!”
After an emergency operation for the appendix, Shaun was referred to his urology clinic where due to the location and size of his stones he was offered an MIP (Minimally Invasive PCNL).
No symptoms or pain
He said of the diagnosis and recovery, “throughout the experience I have had no pain at all, with no symptoms and no pain following the procedure either. In fact, I refused pain killers in hospital as I didn’t need them, and once my fluid output was checked I was allowed home that evening.”
Shaun added: “If anyone is in my position I would advise that they go for it.”
Instruments may get smaller still
Ms Scriven adds: “With the mini perc, or day case PCNL as they are sometimes known, the principles of kidney stone removal is still the same, it’s just our techniques that have changed. There will continue to be new advances in urology, and while the instruments may get smaller still, there is a limit due to the size of stones we may face.” This may lead to improvements in areas such as the quality of imaging or the energy used to break up the stone.
While the removal process has changed, the advice for patients recovering from kidney stones is still the same: drink plenty to dilute the urine and alter your diet to suit.
This may mean a low salt diet if a patient is living with diabetes or a need to reduce animal protein. With any treatment, patients can expect further analysis on the stone to help with tailored advice going forward.