Treating Kidney Stones With Ureteroscopy

Transcript

• 00:05The kidney's primary job is
• 00:08to filter the blood of
• 00:09excess waste, minerals,
• 00:12and fluid.
• 00:13So anything that you've consumed
• 00:15in excess that the body
• 00:16doesn't need or is trying
• 00:17to get rid of, the,
• 00:18kidneys will filter the blood,
• 00:19convert it into urine, and
• 00:21then pass it on to
• 00:21the urinary tract or the
• 00:23bladder.
• 00:24If the concentration or the
• 00:26amount of minerals relative to
• 00:28the fluid is high, then
• 00:30a crystallization of minerals can
• 00:32come together and form a
• 00:33stone.
• 00:35The classic kidney stone symptom
• 00:37is severe pain and that
• 00:39usually happens when a small
• 00:41enough kidney stone gets on
• 00:42the move and tries to
• 00:44pass. And as it's going
• 00:45down the ureter, which is
• 00:46the narrow tube that connects
• 00:48the kidney to the bladder,
• 00:50it can block the ureter
• 00:51almost like a cork in
• 00:52a bottle. And as the
• 00:54ureter becomes blocked, the urine
• 00:56being created by the kidney
• 00:57starts to back up into
• 00:58the kidney,
• 00:59balloon the kidney up, and
• 01:01stretch the capsule or the
• 01:02skin of the kidney, and
• 01:03that's where all the nerves
• 01:04are. And so with that
• 01:06stretching,
• 01:07you get really bad pain
• 01:08referred to as a colic,
• 01:09very similar to really severe
• 01:11gas pain.
• 01:14When a kidney is blocked
• 01:15by a kidney stone and
• 01:17the kidney starts to back
• 01:18up with urine,
• 01:19that kidney becomes congested.
• 01:22If the kidney's blocked for
• 01:23a long period of time
• 01:24with poor blood flow, it
• 01:25can deteriorate the kidney. And
• 01:26so even if someone is
• 01:28not having symptoms necessarily from
• 01:30a blocked kidney, we don't
• 01:31like to sit on that
• 01:32for too long. We'll give
• 01:33them a chance to try
• 01:34to pass the stone if
• 01:34it's practical.
• 01:36However, at some point, we
• 01:37need to unblock that kidney
• 01:38because you could deteriorate the
• 01:40kidney over time, and it'll
• 01:41affect your kidney function.
• 01:47Most patient stones are treated
• 01:50via ureteroscopy.
• 01:52This is a procedure in
• 01:53which we would pass a
• 01:54very small flexible camera into
• 01:57the urinary tract, up the
• 01:58ureter, and into the kidney,
• 02:00see the stone, visualize it,
• 02:02break it with a laser,
• 02:03and then recover the stone
• 02:05fragments.
• 02:06The main benefit of ureteroscopy
• 02:09is that you have incredible
• 02:10flexibility
• 02:11to address stones in any
• 02:12region of the urinary tract.
• 02:14So all the way down
• 02:15low in the ureter close
• 02:16to the bladder, higher up
• 02:17in the kidney throughout multiple
• 02:19spots in the kidney.
• 02:21Under a single anesthesia, they
• 02:22can have all of their
• 02:23stones treated. They're less likely
• 02:25to need multiple procedures to
• 02:26get them out. It's less
• 02:28invasive in that we're not
• 02:30making an incision into the
• 02:31body to get to the
• 02:32stones.
• 02:34It is generally an outpatient
• 02:36procedure.
• 02:37People are back to normal
• 02:39activities within a couple days
• 02:40and fully recovered usually about
• 02:42a week afterwards.
• 02:45One of the things I'm
• 02:46most proud about here at
• 02:47Yale is being on the
• 02:48cutting edge of surgical interventions
• 02:50for kidney stones.
• 02:52We offer
• 02:53the whole host of operations
• 02:55and procedures available to treating
• 02:57kidney stones.
• 02:58Within the realm of ureteroscopy,
• 03:00we've adopted aspiration
• 03:02sheets, which are almost like
• 03:04a Dyson vacuum cleaner that
• 03:05we can maneuver throughout the
• 03:06kidney, break up the stones,
• 03:08and suck out the pieces
• 03:10and the dust,
• 03:11which is the best predictor
• 03:12of preventing a stone event
• 03:14in the future, getting every
• 03:16single morsel of stone out.
• 03:17It also has allowed us
• 03:19to tackle larger stones that
• 03:22previously had to be addressed
• 03:23through an incision in the
• 03:25back of percutaneous nephrolithotomy.
• 03:27Now we can go in,
• 03:28dust them up with a
• 03:29high power laser, suck out
• 03:31all the pieces, and convert
• 03:32it to an outpatient procedure
• 03:33with a much easier recovery
• 03:35for the patient.
• 03:37So we've really been able
• 03:39to miniaturize
• 03:40and minimize the amount of
• 03:42morbidity and pain and recovery
• 03:44period for patients
• 03:46requiring kidney stone surgery.