RIRS with Flex X2 using Holimum Urological Laser
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On a bleak Sunday morning, as I was on duty working as a doctor in newborn medicine at the Royal London hospital in the UK, I got the ....

Urinary Tract Stones

Stones are a common problem affecting the urinary tract. They commonly occur in the kidney or the ureter (the tube that conducts urine from the kidneys to the bladder) but can occur at other sites such as the bladder or urethra (tube through which we pass urine from the bladder).

These stones are ‘real’ stones just like the stones one sees in nature! Patients with stones commonly present with pain, blood in the urine, burning sensation in urine or fever. Rarely there may be no symptoms and the stone is identified incidentally on imaging done for some other problem. Confirmation of diagnosis may require various combinations of ultrasonography, X-rays, IVU (intravenous urogram) or CT scan.

Small stones may be managed by medication alone. Larger stones or those causing swelling in the kidney or infection need to be treated, sometimes urgently. Removal of stones can be accomplished by ESWL (extracorporeal shock wave lithotripsy), keyhole removal (PCNL), removal by ureteroscopy (URS) or rarely by laparoscopy. Small stones are well suited to ESWL which is non invasive although some patients may require the placement of a small tube in the kidney called a stent. Larger stones are best removed by PCNL or URS.

We remove even large and complex stones (such as staghorn stones) by minimally invasive methods and have a large experience with the removal of such stones in normal or even congenitally malformed kidneys such as horseshoe kidneys or malrotated kidneys.

Watch Video
Congenital duplication of ureter with multiple stones in both renal moieties and the ureter. Stone clearance by combined ureteroscopy and PCNL
Initial Xray showing large stones in both kidneys- these were removed by PCNL

ESWL is good for small stones

PCNL for large stones

Even large stones can be removed by percutaneous (keyhole) surgery called PCNL or Percutaneous Nephrolithotomy by a skilled urologist. This gentleman had failed attempts at extracorporeal lithotripsy, ESWL (commonly referred to as ‘laser’). We removed all his stones from both kidneys in 2 sittings (one for each side) with an interval of 2 weeks between the procedures.

After PCNL on one side
After PCNL on the second side
Initial IVP X-Ray Huge stones in both kidneys with good kidney function
Initial X-Ray showing huge stones in both kidneys (4)

PCNL in Horseshoe kidney

Keyhole PCNL for Horseshoe kidney following treatment
Keyhole PCNL for Horseshoe kidney IVP
Plain Xray showing huge stone bulk

PCNL in a child

12y boy with complex stone in the kidney.
PCNL in child

Laparoscopic pyelolithotomy

Photo showing minimally invasive removal of giant stone
Plain X-ray KUB showing huge stone in kidney
Stone after laparoscopic removal


Flexible Ureteroscopy and RIRS (Retrograde Intrarenal Surgery)

Retrograde Intrarenal Surgery represents a triumphant convergence of cutting edge medicine and engineering. Incredible miniaturization, precise optics and matching accessories, chiefly Holmium Laser provides the technology. Surgical skill takes care of the rest! RIRS and mini-PERC (miniature drill removal of stones) are the latest in urological stone management.

Stones sitting in calyces or occasionally in the renal pelvis that are not easily amenable to shock wave lithotripsy can be challenging. RIRS can help avoid the use of percutaneous drilling in many patients. Select tumors can also be managed.

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