Kidney Procedures

Kidney problems can be extremely serious, and patients should seek a thorough diagnosis as soon as they begin to experience problems. It is the job of the kidneys to filter waste products from the body, and if they cannot perform this operation, the risk of kidney infection and kidney failure becomes significant. In cases of severe kidney problems, open kidney surgery may be pursued to provide relief. These surgeries include the removal of a kidney or part of it, open removal of a kidney stone, kidney biopsy or kidney transplant procedure.

Nephrectomy for Malignancy, Non-functional Kidneys & Severe Infections

Nephrectomy refers to a procedure in which the kidney or parts of the kidney are removed. A complete nephrectomy, also known as radical nephrectomy, involves the removal of the entire kidney, as well as nearby structures such as the ureter, lymph nodes or adrenal gland. A partial nephrectomy involves the removal of the diseased areas of the kidney only.

Dr Choonara may recommend a nephrectomy if you have been diagnosed with a kidney tumour. He may also remove parts of the kidney in cases where injury, disease or infection have caused severe damage and affected the proper functioning of the organ.

Percutaneous nephrolithotomy for Stone Disease

Percutaneous nephrolithotomy (PCNL) is one of the most innovative surgical treatments for patients who have large kidney stones (larger than two cm in diameter) that cannot be treated successfully using SWL (shock wave therapy) or ureteroscopy. PCNL has become the standard surgical treatment for large kidney stones, including staghorn stones (stones that fill the kidney). Percutaneous refers to a minimally invasive surgical technique performed via a very small incision through the skin, rather than an open, more invasive procedure.

Before treating your large kidney stone(s), Dr Choonara will determine whether you are an appropriate candidate for this surgery. The procedure may be performed in the hospital and you may need to stay in the hospital for at least three days.

Shock Wave Lithotripsy for Stone Disease

Shock Wave Lithotripsy (SWL) is a non-invasive option if you have smaller kidney stones that are too large to pass on their own. While SWL is not indicated for very large kidney stones, the treatment is typically prescribed for smaller stones that are not dense or very hard, and which are not located in the lower pole of the kidney.

During the treatment, X-ray is utilised to locate the stone(s) within the kidney. High energy shock waves are then delivered through the body to the stone. These shock waves break up the stone(s) into very small particles that can then be passed through the urinary system. SWL is an outpatient procedure that takes approximately one hour to perform. You may receive local anaesthesia or a sedative for your comfort during the procedure.

In cases where the stone is blocking the ureter, you may have a stent placed to open the urinary tract to allow for the stone fragments and urine to pass through following SWL. Dr Choonara will determine if a stent is necessary after viewing the X-ray images.

Ureteroscopy & Lithotripsy for Stone Disease

Ureteroscopy is a minimally invasive procedure. No incision is made and it is usually performed as an outpatient procedure, during which a small scope is passed into the urinary tract to locate and remove stones. With the use of a tiny scope, Dr Choonara is able to see the kidney stone, and a special laser breaks up the stone into tiny pieces that can be easily passed through the urinary system. This is sometimes referred to as “stone dusting” or breaking the stone into minute fragments that resemble grains of sand. Stone dusting requires training and a special laser.

In some cases, Choonara will use a tiny wire “basket” that is passed via the scope through the bladder and into the ureter and/or kidney to grab and clear any remaining stone fragments. Ureteroscopy is appropriate for nearly all stones, but larger stones may require repeat procedures to completely clear the stone from the body.

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