By: Jamin V. Brahmbhatt, MD | Posted on: 25 Apr 2018
Today, there are many great treatment options to give patients relief from the pain of kidney stones. If you and your doctor have discussed your choices and decided Holmium laser treatment is best for you, here are answers to some common questions about this procedure.
How does laser stone surgery work?
The surgery is minimally invasive and requires no incisions on your body. Once you are asleep, a small lighted instrument (ureteroscope) is placed into your urethra and bladder to access your ureter and kidney.
Once the stone is seen, a laser fiber is used to transmit Holmium energy to break up your kidney stones. The surgeon removes some pieces through the urethra with a small basket, and smaller pieces can be passed later with urination. The surgeon may also use a high-powered holmium laser with high-frequency emissions that "dust" the stones into a fine powder. You can then pass the fine particles in your urine after surgery. An even more efficient way of transmitting the holmium laser is by modulating the pulse using the Moses effect, which may result in more efficient stone dusting or fragmentation.
The surgeon will likely insert a tube called a stent between the kidney and urethra. This promotes healing and lets small stone fragments pass more easily. Most importantly, this stent allows your kidney to drain during the healing process. The stent is removed about 1 week after surgery. The length of surgery is generally under 1 hour, depending on the size and number of your kidney stones. Use of the dusting technique combined with the Moses effect may decrease the need to remove stones with a basket, thereby minimizing the need to use a stent.
What happens on surgery day?
Your surgeon will give you specific instructions on what to do with your medications and diet before the date of your procedure. Most laser kidney stone treatments are done on an outpatient basis, so you can go home the same day.
You will have general anesthesia, so you will sleep through surgery. This helps make sure that you are still when the small instruments are inside your body. Newer lasers are precise and powerful which can make it easier for the surgeon to control and fragment the stone. This helps reduce the time of your surgery, so you can spend less time asleep and get back to your normal routine faster.
How will I feel after surgery?
You may still experience pain after laser surgery. If you have a stent between the kidney and ureter, most pain will likely come from the stent because it can rub on the kidney or bladder. It also can make you feel like you have to urinate, and it may cause some blood in the urine. Men may have pain in the penis or testicles as well.
Your doctor will prescribe medications after surgery. Generally, these may include an antibiotic to prevent infection, pain medication, and perhaps something to treat bladder spasms and burning with urination.
Drink plenty of water to lubricate the stent and encourage any small stones to move out of the kidney. You will likely feel a more frequent urge to urinate, so you may want to stay close to a bathroom.
You can resume normal activities the next day, or as soon as you feel comfortable. Skip high-intensity workouts until after your stent is removed. Some pain medications restrict activities like driving, so check the warnings on the label. Your doctor will have additional recommendations for you to follow.
What follow-up care will I need?
You will see your surgeon or his assistants about 1 week after surgery. If you have a stent, it will be removed at this point with a small lighted instrument (cystoscope). This again is done through your bladder and can be done with you awake in the office. Sometimes, the stent is left in longer if your surgeon feels it will help with healing. The stent can stay in for up to 3 months, so don't worry if your stent removal is delayed. The stent does have to be removed, so don't forget to make your post-surgery appointment for its removal.
After removing your kidney stones, the surgeon will have sent one for analysis. Based on the stone's composition, your doctor will recommend ways to prevent future kidney stones. The doctor also may make recommendations based on analysis of your urine. For example, the doctor might suggest making changes in your diet or taking supplements or medications.
Because kidney stones are a chronic problem, it is possible for them to form again sometime in the future. Now you know the symptoms and understand that effective treatments are available. Follow your urologist's advice to help prevent future kidney stones, and do not hesitate to make an appointment if symptoms return.
Jamin V. Brahmbhatt, MD is co-Director of the Personalized Urology and Robotics (PUR) Clinic, Orlando Health South Lake Hospital, Clermont, Florida. He is also co-Founder, Drive for Men's Health.