Kidney+Scoping

**Term**: Kidney Scoping

**Description:** This is a surgery which is formally known as retrograde intrarenal surgery (RIRS). This procedure is done using a fiberoptic scope (an endoscope) to view the kidneys. The way that the procedure works is that first the scope is inserted into the urethra and into the bladder. The scope then moves up the urinary tract to the kidney. This procedure is often used to remove a stone. You are able to see the kidney stone through the scope and it also can be crushed by an ultrasound. Because of the immediate pain of the procedure, its usually done under anesthesia. Water flows through the cystoscope so the surgeon can see the bladder, urethra and the insertion of the ureters into the bladder. X-rays may be done along with cystoscopy to look for different problems with the ureter or kidney. It is done under general anesthesia so you/your child will feel no pain. **Purpose of Kidney Scoping:** Kidney scoping looks for complications that deal with bleeding or pain. It's used to examine obstruction of the urinary tract or to look for kidney stones. It can also detect problems with the lining of the bladder. **What is a kidney stone?** Kidney stones is the collection of small crystals that separate from the urine and build into mass in the urinary tract. Usually, urine contains special chemicals that prevent the crystals from forming. However, if the crystals remain tiny enough, they will travel through the urinary tract and pass out of the body in the urine without being noticed. **Measures to pass the stone: ** Medical expulsive therapy in which the medication aids in getting the stone through the ureter and out of your body. Hydration is key to moving the stone down the ureter and into the bladder. Anti-nausea and pain control medications may also aid in the process of passing a stone. **Advantages of Kidney Scoping:** There is a quicker solution to the issue and it's more popular than open surgery. There are fewer complications after surgery and the recovery is very fast. Open surgery compared to Kidney scoping is very timely and the pain lingers after the surgery. **After the Cystoscopy:** Urine may be blood-tinged for 1-2 days after the procedure. There may also be some pain and burning during urination for the first 24 hours afterwards. Encouraging fluid intake, in particular water and non-citrus juices and non-carbonated fluids will help. You may also give acetaminophen (tylenol) as directed and sit in a tub of warm water to urinate. **Diet and Activity After the Procedure:** Avoid substances that can irritate the bladder. These include soda, citrus juices and fruits, caffeine-containing drinks and chocolate. Generally, return to school or work can occur the next day. **New Technological Advances: **

__Extracorporeal shockwave lithotripsy (ESWL): __ This procedure uses shock waves to crush stones into small pieces. When they are already small enough, they can easily pass through your urinary system without causing infections and other complications. ESWL uses high-voltage discharges to crush the stones in the kidney. Stones that are between 4 mm (0.16 in.) and 2 cm (0.8 in.) in diameter are most likely to be treated with ESWL. High-energy waves are transmitted through water by positioning water cushions between the patient and the instrument used for transmitting shock waves. The process takes about an hour and you may receive sedatives or local anesthesia.This kidney stones removal method has continued to earn the approval of medical institutions because of its low-risk nature. Benefits: Disadvantages:
 * Performed under sedation
 * Outpatient procedure
 * Minimal pain
 * Minimally invasive
 * Small risk of bleeding around the kidney
 * Stone fragments still have to pass and may get stuck along the ureter
 * Stone may not adequately break apart, resulting in multiple procedures
 * Only one stone may be shocked per session

What to expect after the procedure: Since it is outpatient, you do not have to spend a night at the hospital. Stone fragments usually pass in the urine for a few days and cause mild pain. If you have a larger stone, then you may need another session or have a different procedure done.

ESWL is usually NOT used when you:
 * are pregnant (sound waves and X-rays may be harmful to the fetus
 * have a bleeding disorder
 * have a kidney infection, urinary tract infection, or kidney cancer
 * have kidneys with abnormal structure or function

ESWL Success? ESWL gets rid of all of the stone or leaves only small fragments that do not cause any symptoms for 9 out of 10 patients who have kidney stones smaller than 10 mm (0.4 in.) either in the kidney or in the ureter.

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__Laser Lithotripsy:__ Laser lithotripsy utilizes a laser to pulverize uric acid stones. Its laser is usually mounted on a fiber optic scope that is inserted through the urethra. As soon as the scope reaches the stones, the laser is activated to crush down the mineral deposits in your kidney. This is a non evasive procedure, that is more cost efficient and quicker to perform. media type="youtube" key="7jjf98VtIBU" height="315" width="560"

__ Ureteroscopic Surgery: __ Small flexible telescopes are used to access the urethra, bladder, and ureter. The scope is carefully guided into the ureter and the surgeon is able to see the kidney stone. No cuts are made in the body. The surgeon may be able to take out small stones using a "basket" that comes out of the end of the ureteroscope. Larger stones usually need to be broken up before being taken out of the body using this procedure. A soft, plastic stent is left in place to allow for the ureter to heal and minimize swelling. The stent is later removed by an in-office procedure. Advantages:
 * no need to pass stone fragments
 * can treat multiple stones per session
 * minimal chance of requiring follow-up procedures

Disadvantages:
 * risk of injury to ureter
 * requires temporary stenting
 * more invasive than SWL
 * usually requires general anesthesia
 * small chance the ureter will be too tight for the scope



** For stones larger than 2 cm: ** __Percutaneous Nephrolithotomy (PCNL):__ Larger telescopes and instruments are placed directly through the back and into the kidney. The stone is broken up and then the pieces are sucked out. After the procedure, the patient has 2 catheters coming out of their back. One is usually removed the day after surgery and the larger tube is removed a few days after in the office. Typically, this procedure requires an overnight stay in the hospital. Advantages:
 * most effective/efficient method in removing large kidney stones
 * replaces open stone surgery that requires a large incision and 3-4 day hospitalization
 * short hospital stay
 * minimally invasive

Risks: ** Links: **
 * bleeding and hematoma around kidney
 * requires a temporary tube coming out of the back to drain kidney
 * rare risk of injury to adjacent organs
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 * http://www.wakemedphysicians.com/kidneystonesurgery
 * http://www.webmd.com/kidney-stones/extracorporeal-shock-wave-lithotripsy-eswl-for-kidney-stones