Crushing kidney stones through a 5 mm hole

Ho Chi Minh City Through a small 5mm hole in the back, the doctor inserted a specialized tool into the kidney of Mr. Nam, 71 years old, to crush and suck out the coral gravel.

Mr. Nam, a resident of Long An, had a high fever and chills. Two months ago, he was diagnosed with a urinary tract infection at a local hospital. He was treated with antibiotics for two weeks without improvement, so he went to Tam Anh General Hospital in Ho Chi Minh City for examination.

On April 16, Master, Specialist Doctor II Pham Thanh Truc, Department of Urology, Center for Urology - Nephrology - Andrology, said that Mr. Nam's left kidney had a multi-branched coral stone, measuring 10x5 cm, the size of a large ginger root, almost occupying the entire renal pelvis. He also had underlying diseases such as high blood pressure, diabetes, and stage 3 chronic kidney failure.

Because the patient was elderly and had many underlying diseases, especially kidney failure, Dr. Truc prescribed percutaneous nephrolithotomy using a small tunnel (mini-PCNL) to minimize invasiveness and preserve kidney function.

Under the guidance of the C-Arm X-ray machine and 3D ultrasound machine, Dr. Truc used a small needle (2 mm in size) with a probe attached to poke a hole in the patient's back. A larger specialized metal tube was inserted to widen it, creating a "tunnel" measuring only 5 mm leading into the patient's renal pelvis. From this "tunnel", a laser lithotripsy device was inserted to break up the stones.

Observing on the endoscope screen, the coral stone mass was gradually broken into small pieces by laser energy. The stone fragments were then sucked out through the "tunnel". The surgery was completed after 180 minutes. Two days after the surgery, Mr. Nam ate, walked normally, had no pain, and was discharged from the hospital.

Doctors of the Department of Urology, Center for Urology - Nephrology - Andrology, perform percutaneous nephrolithotomy for a patient. Illustration: Tam Anh General Hospital, Ho Chi Minh City

According to Dr. Truc, before laparoscopic surgery was widely applied as it is now, large coral stone cases like Mr. Nam's could only be treated with open surgery. The disadvantage of this method is that the patient had to undergo a long surgery with a 12-15 cm incision on the abdomen. After surgery, the patient needed a long recovery time, the large incision caused pain, was susceptible to surgical site infection, formed unsightly scars, suffered from lifelong paresthesia (tingling, prickling sensation) in the lower back, and suffered 10-25% damage to kidney function due to having to open the kidney.

"Currently, only 1-1.5% of coral stones need to be treated with open surgery," said Dr. Truc.

With percutaneous nephrolithotomy, surgery is performed through a very small incision, patients have limited blood loss, less pain, quick recovery, early return to normal life, reduced risk of postoperative infection, and minimal damage to kidney function. Thanks to the application of modern machinery systems, doctors can check the entire renal pelvis during lithotripsy, ensuring that the stones are completely crushed, reducing the risk of recurrence.

Percutaneous nephrolithotomy has some potential complications such as damage to organs around the kidney, damage to large blood vessels leading to heavy bleeding, so it requires a highly skilled and experienced surgeon; supported by a modern machinery system.

Coral stones are stones that fill two or more renal calyces, forming a coral-like shape. The composition of coral stones is usually calcium and oxalate. Doctor Truc said that although they only account for about 30% of kidney stones, coral stones are the most complex and dangerous. If not treated early, large stones can cause pus-producing kidney infections, even blood infections, impaired kidney function, and threaten the health and life of the patient.

Treatment of coral stones is complicated, with a high chance of recurrence. Even a single piece of stone left after treatment can quickly develop into a new stone. Percutaneous nephrolithotomy using a small tunnel is a special solution for treating this type of stone. At the Department of Urology, Center for Urology - Nephrology - Andrology, Tam Anh General Hospital, Ho Chi Minh City, there are an average of 8-10 cases of percutaneous nephrolithotomy performed each month.

To prevent coral stones in particular and urinary stones in general, Dr. Truc advises people to drink enough 1.5-2 liters of water per day (increase water intake when it is hot) to dilute urine, reducing the possibility of stone formation. Limit salty foods, animal protein, foods rich in oxalate (chocolate, white radish, spinach...).

People with signs of hematuria, painful urination, difficulty urinating, frequent urination, weight loss, fever, chills, recurrent urinary tract infections, need to go to the hospital for examination and timely treatment, to avoid long-term complications that are dangerous to health and life.

Thang Vu

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