healthmedicinet

By
Diana Pilkington

PUBLISHED:

18:57 EST, 24 March 2014

|
UPDATED:

18:57 EST, 24 March 2014

Kidney
stones can cause severe pain and infections. When they occur in both
kidneys, they are usually treated in separate operations, weeks apart.
Lorna Brown, 58, a senior AE sister from Southampton, had a new
procedure, as she tells DIANA PILKINGTON.

THE PATIENT

Kidney
stones have been a pain for years, causing such bad infections I had to
take weeks off work and once ended up in intensive care.

It all
started on a family trip to Disneyland, Paris, in 2000. One night I woke
with sweat pouring off me and excruciating pain in my back and
abdominal muscles – it was worse than childbirth. #

Lorna Brown, photographed at her home in Southampton, had been suffering from kidney stones

I tried a hot
bath, ibuprofen and paracetamol, but nothing touched the pain. Worried I
was actually dying, I woke my husband, Robbie, a paramedic, who called
for an ambulance.

Hospital scans revealed I had fairly large kidney
stones. I was surprised, I’d seen patients with them but never realised
they could be so painful.

I was given intravenous paracetamol and a
week later had a lithotripsy – where they break up the stones with sound
waves so you can pass them in your urine – and for five years I was
free from stones.

But in 2005 the pain returned, this time in spasms
rather than a constant ache. Recognising the signs, I came to AE at
Southampton General Hospital where I work, and was referred to urology.
I had small stones – about 7mm – in both kidneys, and a urinary tract
infection (UTI) as a result.

This time lithotripsy didn’t work, so
surgeons broke the stones using a laser. It was standard practice to
treat the two kidneys separately, six to eight weeks apart, to reduce
the risk of complications.

However, while I waited for treatment on
my second kidney, the stones in the first would come back. I had about
five procedures in all and numerous sick days.

The senior AE sister from Southampton, had a new two-in-one procedure

Then, five years ago,
I collapsed in the hospital and ended up in intensive care. I was in
peri-cardiac arrest, where your blood pressure drops very low.

A
urinary tract infection, caused by my kidney stones, had led to sepsis –
where the body’s immune system over-reacts to an infection – and I
needed lots of antibiotics to clear it.

This cycle of repeated
operations and infections continued until about 18 months ago, when
Bhaskar Somani, an expert in kidney stones, arrived at the hospital. He
said he’d try to treat my latest bout of stones in just one procedure.

I was slightly worried. I’d always been told you had to do them separately, but he was very reassuring.

So
I went in for the procedure. I was given a general anaesthetic and woke
about an hour later. I had flexible tubes called stents in my ureters
[which carry urine from the kidney] to allow urine to flow easily after
the operation, but these were removed after a week.

The operation has
changed my life. My infections have all cleared up and I’ve had no more
sick days. I also have type 2 diabetes, and the infections were making
it hard to control my blood sugar, but now that’s no longer a problem. I
haven’t felt this well for years.

THE SURGEON

Bhaskar Somani is a consultant urologist at Southampton General Hospital.

Kidney
stones affect about  10 to 15 per cent of men and 3 to 7 per cent of
women aged 20 to 60. They occur when waste products removed from the
blood form crystals, which over time form hard stones that may be too
large to pass out naturally. They can be extremely painful and lead to
infections.

There are four main ways to manage kidney stones. You can
observe them, and if they’re not blocking the kidney tube completely
they should pass naturally within five weeks.

We can use shockwave
treatment, a non-invasive procedure in which sound waves break them up,
so the patient can then pass them out.

For very big stones, there’s
percutaneous nephrolithotomy, where we remove them via keyhole surgery,
but this is more invasive and the risk of complications is higher.

A
fourth option is ureteroscopy, where we pass a telescope up the kidney
tube and use a laser to break up the stone. This needs a full
anaesthetic, but one advantage is you can treat multiple stones at once,
and can see clearly when you’ve treated them all. Previously, if
patients had stones in both kidneys, doctors tackled them separately,
because the risk of complications was considered higher if you did them
at once.

But I have now performed 25 bilateral simultaneous
ureteroscopies – where we treat both kidneys in the same operation – and
found that the risks can be as low as doing it separately.

By doing
it this way the patient doesn’t have to come back for a second
operation. Suitable patients will have stones in both kidneys up to 2cm
in size that are easy to access.

We start with the kidney that has
the larger stones. With the patient under general anaesthetic, we pass a
guide wire up into the kidney via the bladder and kidney tube, followed
by a semi-rigid ureteroscope. At this point I use a laser to break up
any stones in the kidney tube.

Then we pass a ureteroscope into the
kidney and blast the laser again to turn the stones into dust. I clear
any large fragments with a special tool.

The operation has changed her life. Her infections have all cleared up

Once we’ve done one side,
we repeat the procedure on the other kidney. We then insert stents in
the ureter to allow the debris to drain out; they are removed under
local anaesthetic a few weeks later.

I try and limit operating time
to under two hours, as this keeps the risk of complications down.  The
risks are similar to doing the operation separately – infection,
bleeding, a small risk of being unable to pass urine, and injury to the
kidney tube. You may also have discomfort in the bladder from the stent.

When I met Lorna she was acutely unwell. She had multiple small
stones and I didn’t know which were causing her infections, so the best
approach was to take them all out at once. It’s also logical to subject
someone who is unwell to one procedure rather than two.

The procedure costs between £8,000 and £10,000 privately, and costs £2,000 to £4,000 to the NHS.

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