Laser Surgery for Stone Removal in Delhi, India

Laser lithotripsy or Laser surgery for stone removal is a minimally invasive procedure used to break down and remove stones in the urinary tract. It involves using laser energy to fragment the stones into smaller pieces, which pass through natural urine flow. 

Types of Laser Surgery for Stone Removal

There are two major types of laser surgery for stone removal:

• Flexible Ureteroscopy with Laser Lithotripsy: Flexible ureteroscopy involves passing a thin, flexible tube (ureteroscope) through the urinary tract to reach the stone. The ureteroscope has a laser fibre attached to it, which emits laser energy to break down the stone.
• Percutaneous Nephrolithotomy (PCNL) with Laser Lithotripsy: PCNL involves creating a small incision in the back and inserting a hollow tube (nephroscope) directly into the kidney to access and remove the stone. Laser energy is then used to fragment the stone, allowing for its removal. This procedure is usually reserved for larger stones or cases where other treatments have been ineffective.

Indications for Laser Surgery for Stone Removal

Laser surgery for stone removal may be recommended in the following situations:

• Stones that are too large to pass naturally.
• Stones causing severe pain or discomfort.
• Stones causing urinary tract infections.
• Stones causing urinary obstruction.
• Stones that have not responded to conservative treatments such as medications or dietary changes.
• Patients with anatomical abnormalities or medical conditions that make other treatment options less suitable.

Who Is the Right Candidate for Laser Surgery for Stone Removal? 

The following factors make an individual the right candidate for laser stone removal surgery-

• Stones that are less than 2 centimetres in size.
• Stones located in the ureter or kidney.
• Stones are composed of materials that are amenable to laser fragmentation, such as calcium oxalate or uric acid.
• Good overall health without significant comorbidities that may increase the surgical risks.

Preparation for Laser Surgery for Stone Removal

Before undergoing laser surgery for stone removal, the following steps may be involved:

• Consultation: The urologist will discuss the procedure, review medical history, and conduct necessary diagnostic tests.
• Imaging: Imaging studies such as X-rays, ultrasound, or CT scans may be performed to determine the size, location, and number of stones.
• Medication Adjustment: The urologist may adjust or discontinue certain medications, such as blood thinners.
• Fasting: The patient will typically be instructed to fast for a specific period before the surgery, usually from midnight the night before.
• Bowel Preparation: In some cases, bowel preparation may be required to ensure the bowels are empty before the procedure.
• Antibiotics: Prophylactic antibiotics may be prescribed to reduce the risk of post-operative infection.

Procedure Details for Laser Surgery for Stone Removal

The procedure for laser surgery for stone removal may vary depending on the type of surgery performed (flexible ureteroscopy or PCNL). The following provides an overview of each procedure:

Flexible Ureteroscopy with Laser Lithotripsy:

• Anaesthesia: The patient is usually administered general anaesthesia or occasionally given spinal or local anaesthesia.
• Ureteroscope Insertion: The urologist inserts a flexible ureteroscope through the urethra and bladder, advancing it into the ureter and kidney.
• Laser Lithotripsy: Once the stone is visualised, the laser fibre is used to deliver laser energy, breaking the stone into smaller fragments.
• Stone Removal: The fragments are either extracted using a small basket or left to pass out naturally through urine.
• Stent Placement: In some cases, a temporary ureteral stent may be placed to promote healing and reduce swelling.

Percutaneous Nephrolithotomy (PCNL) with Laser Lithotripsy:

• Anaesthesia: General anaesthesia is administered.
• Incision and Access: The urologist makes a small incision in the back, creating a tunnel to access the kidney. A nephroscope is inserted through this incision to reach the stone.
• Laser Lithotripsy: The laser fibre is passed through the nephroscope and used to fragment the stone into smaller pieces.
• Stone Removal: The fragmented stones are either removed with a small basket or suctioned out through the nephroscope.
• Drainage Tube Placement: A tube may be placed to drain the kidney temporarily and facilitate healing.

Recovery and Follow-Up after Laser Surgery for Stone Removal

The recovery and follow-up process typically involves the following:

• Pain Management: Medications will be prescribed to manage post-operative pain and discomfort.
• Hydration: Adequate fluid intake is encouraged to help flush out the stone fragments and prevent urinary tract infection.
• Physical Activity: Patients are generally advised to limit strenuous activities and follow any specific post-operative restrictions provided by their urologist.

Complications of Laser Surgery for Stone Removal

Like any surgery, laser surgery for stone removal carries certain risks and potential complications. Some possible complications include:

• Bleeding: In some cases, there may be bleeding from the surgical site.
• Infection: Infection may occur, requiring antibiotics and additional treatment.
• Ureteral Injury: There is a small risk of injury to the ureter during the procedure, leading to potential complications.
• Urinary Strictures: Scar tissue formation may cause narrowing of the ureter or urethra, resulting in urinary flow problems.
• Urinary Retention: Temporary difficulty in passing urine may occur due to swelling or irritation.
• Fragment Migration: The stone fragments may not fully pass out and require additional interventions for removal.

Frequently Asked Questions (FAQs)

• How long does laser surgery for stone removal take?
  The duration of the procedure depends on various factors, such as the size and number of stones and the complexity of the case. It can range from 30 minutes to a few hours.
• Is laser surgery for stone removal painful?
  The procedure is performed under anaesthesia, so you won't feel any pain during the surgery. However, some discomfort or pain may be experienced during the recovery period.
• How long does it take to recover from laser surgery for stone removal?
  Recovery time varies depending on the type of procedure, stone size, and individual factors. It may take a few days to a few weeks for complete recovery.
• Will I have a scar after laser surgery for stone removal?
  In flexible ureteroscopy, there are no external incisions, so scarring is minimal. In PCNL, the incision made in the back is typically small, resulting in a small scar that fades over time.
• Can laser surgery for stone removal be performed on pregnant women?
  Laser surgery for stone removal is generally avoided during pregnancy due to potential risks to the fetus. Alternative treatments or conservative management may be considered until after delivery.
• Can laser surgery for stone removal treat all types of stones?
  Laser surgery is effective for most types of stones, including calcium oxalate, uric acid, and cystine stones. However, certain types of stones, such as large or hard struvite stones, may require additional treatments.
• Are there any dietary restrictions after laser surgery for stone removal?
  Your urologist may provide specific dietary recommendations based on the type of stone and your medical history. In general, it is advisable to maintain a balanced diet, drink plenty of fluids, and limit foods high in oxalate or purines.
• Can laser surgery for stone removal cause infertility?
  Laser surgery itself does not cause infertility. However, underlying conditions or complications related to stone disease may affect fertility. Consult with your urologist for personalised guidance.
• Will I need multiple sessions of laser surgery for stone removal?
  In some cases, a single session of laser surgery may be sufficient to remove all stones. However, for larger or more complex cases, multiple sessions or additional interventions may be required.
• What are the alternatives to laser surgery for stone removal?
  Alternative treatments for stone removal include extracorporeal shock wave lithotripsy (ESWL), percutaneous stone removal without laser lithotripsy, and open surgery.

Review

Reviewed by Dr. Pankaj Gaur, Senior Consultant, Renal Transplant, Urology.