Urology is a medical and surgical specialty that deals with urinary tracts of males and females, and the reproductive system of males. Indian hospitals have some of the finest urologists who have valuable expertise to diagnose, treat, and manage patients with urological disorders. The organs covered by urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs (testes, epididymis, vas deferens, seminal vesicles and prostate).
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Percutaneous Nephrolithotomy, or PCNL, is a procedure for removing medium-sized or larger kidney stones from the patient’s urinary tract by means of a nephroscope passed into the kidney through a track created in the patient’s back.
The term “percutaneous” means that the procedure is done through the skin and Nephrolithotomy is a term formed from two Greek words that mean “kidney” and “removing stones by cutting.”
Kidney stones range in size from microscopic groups of crystals to objects as large as golf balls. Most calculi, however, pass through the urinary tract without causing problems. They are formed when the urine becomes supersaturated (overloaded) with mineral compounds that can form stones.
This super saturation may occur because the patient has low urinary output, is excreting too much salt, or has very acid urine. The purpose of PCNL is the removal of renal calculi in order to relieve pain, bleeding into or obstruction of the urinary tract, and/or urinary tract infections resulting from blockages.
Open surgery : Open surgery is the most invasive form of treatment for urolithiasis. As of 2003, it is performed primarily to remove very large and complex staghorn calculi or extremely hard stones that cannot be broken down by lithotripsy.
Other indications for open surgery are extreme obesity, an anatomically abnormal kidney, or an infected and nonfunctioning kidney requiring complete removal. Patients are usually hospitalized for a week after open kidney surgery and take about six weeks to recover at home.
Extracorporeal Shock Wave Lithotripsy (ESWL) : ESWL is a noninvasive procedure that was developed in the 1980s as a less invasive alternative to PCNL. It is presently used more often than PCNL to treat smaller renal calculi.
In ESWL, the patient is given a local anesthetic and placed in a water bath or on a soft cushion while shock waves are transmitted through the tissues of the back to the stones inside the kidney. The shock waves cause the calculi to break up into smaller pieces that can be passed easily in the urine.
Although patients need less time to recuperate from ESWL, it has several disadvantages. It has lower success rates (50–90%) than PCNL. Moreover, it cannot be used to treat cystine calculi or calculi larger than 1.2 in (3 cm). An additional concern with shock wave lithotripsy is its safety in treating small or anatomically abnormal kidneys; it has been reported to cause temporary damage to kidney tubules in smaller-than-average kidneys.
Ureteroscopy : Ureteroscopy refers to removal of calculi that have moved downward into the ureter with the help of a special instrument. A ureteroscope is a small fiberoptic endoscope that can be passed through the patient’s urethra and bladder into the ureter.
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