Dr Jitendra Kumar Sakhrani

Kidney Stones Treatment OptionsKidney stone treatment depends on the size, location, type, and symptoms of the stone. Treatment ranges from conservative management (fluids, pain relief) to minimally invasive and surgical procedures for larger or obstructive stones.1. Conservative (Non-Surgical) Management✅ Indications: Small stones (<5 mm), mild symptoms, no infection✅ Methods:Hydration: Drink 2.5–3 liters/day to help pass the stone.Pain relief: NSAIDs (e.g., ibuprofen, diclofenac) or opioids for severe pain.Medical Expulsive Therapy (MET):Tamsulosin (alpha-blocker) relaxes ureter muscles to ease stone passage.Effective for stones 5–10 mm in the ureter.Dietary Changes: Reduce sodium, animal protein, and oxalate-rich foods (e.g., spinach, nuts).⏳ Passage Time: 1–4 weeks, depending on size/location2. Minimally Invasive Procedures✅ Indications: Stones >5–10 mm, severe pain, blockage, recurrent UTIsA. Extracorporeal Shock Wave Lithotripsy (ESWL)Uses sound waves to break stones into small fragments.Non-invasive (no incision).Best for stones <2 cm in the kidney or upper ureter.Limitations: May require multiple sessions, less effective for dense or large stones.⏳ Recovery: 1–2 daysB. Ureteroscopy (URS) with Laser LithotripsyEndoscope inserted via urethra → ureter → kidney.Laser breaks stone into fragments, which are removed or left to pass.Best for stones in the ureter or kidney, <2 cm.Can treat hard stones (e.g., cystine stones).⏳ Recovery: 2–5 daysC. Percutaneous Nephrolithotomy (PCNL) – For Large StonesSmall incision in the back, stone removed with a nephroscope.Best for:Large kidney stones (>2 cm)Staghorn stones (branched, filling kidney)Failed ESWL/URSMost effective treatment for large stones (80–90% success).⏳ Recovery: 1–2 weeks, hospital stay: 1–3 days3. Open / Laparoscopic Surgery (Rarely Needed)✅ Indications: Very large, complex stones or failed minimally invasive treatments✅ Types:Laparoscopic stone removal (keyhole surgery).Open surgery (last resort, rare).⏳ Recovery: 2–4 weeks

Laser ProstatectomyLaser prostatectomy is a minimally invasive surgical procedure used to treat benign prostatic hyperplasia (BPH) by removing excess prostate tissue using laser energy. It is an alternative to TURP (Transurethral Resection of the Prostate) and is preferred for patients on blood thinners, those with large prostates, or those wanting a faster recovery.Types of Laser ProstatectomyHolmium Laser Enucleation of the Prostate (HoLEP)Uses a holmium laser to cut and remove large portions of the prostate.Provides long-lasting relief and is ideal for very large prostates (>80–100g).GreenLight Laser Vaporization (PVP - Photoselective Vaporization of the Prostate)Uses a high-energy green laser to vaporize excess prostate tissue.Suitable for small to moderately enlarged prostates.Thulium Laser Enucleation of the Prostate (ThuLEP)Similar to HoLEP but uses a thulium laser for more precise cutting.Indications for Laser ProstatectomyModerate to severe BPH symptoms, such as:Weak urine streamFrequent urination (especially at night)Urinary retentionIncomplete bladder emptyingRecurrent urinary tract infections (UTIs)Patients at higher risk for bleeding (e.g., those on blood thinners).Large prostates where TURP may not be effective.Procedure OverviewAnesthesia: General or spinal anesthesia.Endoscopic Approach:A laser fiber is inserted through the urethra via a cystoscope.The laser either vaporizes (PVP) or enucleates (HoLEP) the enlarged prostate tissue.Tissue Removal: In HoLEP, the enucleated tissue is pushed into the bladder and then removed using a morcellator.Catheter Placement: A Foley catheter may be placed for 24–48 hours post-surgery.Surgery Duration: 30–90 minutes, depending on prostate sizeHospital Stay: Usually same-day discharge or 1-night stayPost-Operative CareHydration: Helps flush out debris.Urinary catheter: Removed within 1–2 days.Avoid heavy lifting for 2–4 weeks.Temporary urinary urgency or mild discomfort may occur.Sexual activity: Usually resumed after 2–4 weeks.Potential ComplicationsTemporary burning sensation while urinatingUrinary urgency or frequency (usually resolves within weeks)Retrograde ejaculation (semen flows into the bladder instead of out)UTIs or mild bleeding (short-term)Rare risk of stricture formation (scar tissue narrowing the urethra)

Transurethral Resection of Bladder Tumor (TURBT)TURBT is a minimally invasive surgical procedure used to diagnose, stage, and remove bladder tumors. It is the primary treatment for non-muscle-invasive bladder cancer (NMIBC) and is performed using a cystoscope inserted through the urethra.Indications for TURBTSuspected bladder cancer (blood in urine, abnormal imaging, or urinary symptoms)Confirmed bladder tumor requiring removalStaging and grading of bladder cancerRecurrent bladder tumorsProcedure OverviewAnesthesia: General or spinal anesthesia is used.Cystoscope Insertion: A thin camera (resectoscope) is passed through the urethra into the bladder.Tumor Removal:A wire loop is used to shave off the tumor.Deep muscle sampling may be done to check if the tumor has invaded deeper layers.Cauterization: The area is sealed with electric current or laser to prevent bleeding.Catheter Placement: A Foley catheter may be inserted for urine drainage and bladder irrigation.Duration: 15–60 minutes, depending on tumor size and numberHospital Stay: Usually same-day discharge or 1-night stayPost-Operative CareBlood in urine (common for a few days)Hydration to flush out clotsAvoid strenuous activities for 2–4 weeksCatheter care (if placed)Bladder instillation therapy (e.g., BCG or Mitomycin C) for cancer preventionPotential ComplicationsBleeding (usually self-limiting)Urinary tract infection (UTI)Bladder perforation (rare but requires intervention)Recurrence of bladder tumors (common, requiring repeat TURBT)Follow-Up and Additional TreatmentRepeat TURBT (4-6 weeks later) if:Tumor was large or high-gradeMuscle invasion was uncertain