Breaking up kidney, ureter and bladder stones in Niš

Lithotripsy means breaking up a stone in the urinary tract into small pieces, so that they can be removed or passed out in the urine. A stone most often forms in the kidney, when minerals from the urine settle and clump together. It can stay in the kidney or move into the ureter (the tube that carries urine from the kidney to the bladder). A bladder stone can come down from the kidney, but in adults it more often forms in the bladder itself, when the bladder does not empty completely, for example because of an enlarged prostate. In everyday speech, this procedure is often also called kidney stone surgery.

In an endoscopic procedure, the urologist passes a thin instrument with a camera through the urethra and reaches the stone. A source of energy, most often a laser, is passed through the instrument and breaks the stone into pieces or into fine dust. Larger pieces can be removed with a small basket, and tiny ones pass out in the urine in the days after the procedure. No cut is made in the skin.

Procedures to break up stones are listed in the urology price list of Maja Hospital in Niš, at Vizantijski bulevar 39.

Not every stone needs to be broken up. Smaller stones often pass on their own, with monitoring and the treatment prescribed by the doctor. Breaking up a stone is most often considered when:

• the stone is too large to pass on its own
• the stone stays in the same place for a long time despite treatment
• the stone blocks the flow of urine from the kidney
• severe pain or urinary tract infections keep coming back
• a bladder stone causes problems when passing urine

The decision is made after a consultation with a urologist and scans. An ultrasound scan is usually done, and often also a CT scan (MSCT) without contrast, which shows the exact size and position of the stone. The scans can also be done at Maja Radiology, at the same address.

A high temperature and shivering together with pain in the side (loin pain), as well as being unable to pass urine, are reasons to be seen urgently, without delay, at the nearest emergency department. When a stone is accompanied by an infection and a blocked flow of urine, the first step is to make sure the urine can drain (with a stent or a nephrostomy, a thin tube passed through the skin into the kidney) and to treat the infection, and the stone is broken up later.

The choice of method depends on the size, number, hardness and position of the stone, on the structure of the urinary tract and on your general health. The Maja Hospital urology price list includes FURS laser lithotripsy, breaking up a stone in the ureter, endoscopic lithotripsy, lithotripsy of bladder stones and lithotripsy by stone size (up to 1.5 cm, over 1.5 cm and a large stone mass). In general, the endoscopic approaches work as follows:

• Ureteroscopy: a thin instrument is passed through the urethra and the bladder up to the stone in the ureter, where the stone is broken up and the pieces are removed.
• FURS (flexible ureterorenoscopy): a flexible instrument goes up inside the kidney, so stones in the kidney can also be broken up with a laser.
• Lithotripsy of bladder stones: the instrument is passed through the urethra into the bladder, where the stone is broken up and the pieces are washed out. The urologist also checks why the stone formed (for example, because of an enlarged prostate), because if the cause is not treated, a bladder stone often forms again.

With a larger stone mass, the procedure usually takes longer and is sometimes done in two stages. For very large kidney stones, there are also other approaches, for example through a small cut in the back (percutaneous nephrolithotomy). This approach is not listed in the Maja Hospital price list. At the consultation, the urologist explains which method each price list item refers to and which approach is right in your case.

On the day of the procedure, you arrive at the agreed time, having fasted, with your medical reports and scans. After you are admitted, your test results are checked, and the anaesthetist talks to you about the anaesthetic.

The procedure is most often done under general or spinal anaesthetic. The urologist passes the instrument through the urethra, finds the stone and breaks it up. At the end, a temporary stent or catheter is fitted if needed.

After the procedure, you stay under the supervision of the medical staff until the anaesthetic wears off. A catheter, if one was fitted, is usually removed soon after the procedure. When you are discharged, you are given written instructions, your medication and a follow-up appointment, and, if a stent was fitted, the date for its removal. You go home accompanied by someone, and you should not drive on the same day.

A J-J stent is a thin, soft tube placed between the kidney and the bladder. It makes sure that urine can drain freely from the kidney while the ureter recovers from the swelling after the procedure. A stent is not always fitted; the urologist decides on this during the procedure.

While you have a stent, you may need to pass urine more often, feel an urge to pass urine, have discomfort in your side when passing urine and occasionally have pink urine. A stent is usually kept in for a few days to a few weeks. It is removed with a short procedure through the urethra.

The stent must not stay in the body longer than the time set by the doctor: a stent that is left in for too long can become coated with stone deposits, cause an infection and damage the kidney. That is why it is important that the removal appointment is booked and written down. In the urology price list, insertion and removal of a J-J stent are listed as separate items; the urologist explains before the procedure whether they are included in the price of the procedure in your case.

Like any procedure, breaking up stones carries certain risks. The most common ones are temporary: blood in the urine, stinging and pain when passing urine, and discomfort caused by the stent. Less often, a urinary tract infection with a high temperature, remaining pieces of stone or an injury to the wall of the ureter may occur. Tiny fragments usually pass out in the urine in the days after the procedure. If the follow-up scan shows larger pieces remaining, the urologist may suggest a repeat procedure.

Rare complications include a more serious infection that spreads to the blood (sepsis), which needs urgent hospital treatment, and later narrowing of the ureter. Sometimes the ureter is too narrow for the instrument: in that case a stent is fitted, and the stone is broken up in a second procedure, after one to several weeks, as assessed by the urologist. There are also the general risks of anaesthesia, which the anaesthetist will discuss with you. At the consultation, the urologist explains the risks in your case and how they are reduced.

The price depends mainly on the position and size of the stone and on the method. The Maja Hospital urology price list has separate items for FURS laser lithotripsy, endoscopic lithotripsy, a stone up to 1.5 cm, a stone over 1.5 cm, a large stone mass, a stone in the ureter and a stone in the bladder (small, medium and large). The prices of the main procedures are shown in the table below.

A repeat procedure (reintervention) has a separate item in the urology price list, as do the insertion and removal of a J-J stent. You will find out exactly what the price includes in your case after a consultation with the urologist and a review of your scans.