Innovative and Cost-Effective Treatment of Renal Stones in Remote Areas by the Surgical Services Initiative

Urinary calculi affect about 5-15% of the population in industrialized countries [1]. With ureteric stones of sizes up to 5mm, 71-98% generally pass within a few weeks [2]. The incidence of urinary calculi in industrialized countries ranges from 0.5 to 1.9%. However, in India, the incidence has a wider regional variation and could be as high as 7.6% [3].

In patients with renal stones, extracorporeal shockwave lithotripsy (ESWL), flexible ureterorenoscopy (URS), and percutaneous nephrolithotripsy (PCNL) are the available options for treatment. ESWL was a major development in the 1980s, with a minimally-invasive approach and few complications. An alternative is ureterorenoscopic stone removal (URS), which has been improved by miniaturization. Small flexible and semi-rigid equipment now has good optical quality, and the holmium/YAG lasers currently in use only penetrate 0.5mm, lowering the risks of damage and improving stone clearance. Lastly, percutaneous nephrolithotripsy (PCNL) is mostly used on large stones above 20mm, staghorn calculi, and impacted stones over 15mm in the upper ureter [4].

However, the primary drawbacks of all these procedures in rural areas are their high costs and difficulty in setting up minimally invasive units. Here we describe the low-cost methods of dealing with renal stones in rural areas that were carried out at the innovative surgical and diagnostic camps in North and Northeast India [5].

METHOD

The Surgical Services Initiative is a group of Doctors who have come together as a non-profit organization to provide quality multispecialty, cost-effective surgical services to rural-based Christian hospitals and other charitable hospitals in India. The local doctors also receive training in our fields.

Patients with renal stones in the rural and remote areas are diagnosed at high-tech diagnostic camps [5]. In the first stage of treatment, also often carried out at the diagnostic camps, the patient has...

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This entry was posted in Primary Care, Surgery and tagged , , , , , . Volume: .

4 Comments

  1. Girijadutt Sharma
    Posted Jun 2014 at 4:14 pm | Permalink

    Good method , but once fragmented the fragments go to all calyces, the suprior is accessible , the other two r not
    For over 25 yrs , i pracice posterior lumbotomy and find it an excellent technique for a poor mans pcnl.
    Pl tell u r views on lumbotomy…girijadutt sharma

    • Dr. J. Gnanaraj
      Posted Jun 2014 at 5:50 am | Permalink

      We do not have much experience with posterior lumbotomy. However it might be a good option if we are able to combine with cystoscopy to visualize the calyces and break the stones with lithotripsy.

      • Dr. J. Gnanaraj
        Posted Jun 2014 at 5:54 am | Permalink

        During the last lumbotomy that we did several years ago we were not able to give complete clearance and had residual stones

        • Dr. J. Gnanaraj
          Posted Jun 2014 at 5:58 am | Permalink

          May be you could join us in Northeast for a surgical camp and we can try a small incision lumbotomy with Cystoscope and lithotripsy. Please write to jgnanaraj@gmail.com. Thanks

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