Kidney stones can be as small as a grain of sand or as large–sometimes larger to an extent that it measures more than 5 cm in size. They can stay in your kidneys or travel through your ureters (the tubes that goes from your kidneys to the bladder and drains urine into the bladder normally), and out of your body with your urine. When a kidney stone moves through the ureters and out through urethra (tube that allows passage of urine from the bladder out of the body) with the urine, it is called passing a kidney stone. A kidney stone can also get stuck in your urinary tract and block urine from getting through. When you pass a stone or a large stone in the tube blocks the flow of your urine, it can cause unbearable pain and also other severe symptoms of kidney stones like fever, burning sensation or pain while passing urine, nausea, vomiting, blood in urine or inability to pass urine with complete blockage flow of urine. TYPES OF KIDNEY STONES Calcium stones are the most common type of kidney stones. They are usually made of calcium and oxalate (a natural chemical found in most foods), but are sometimes made of calcium and phosphate. Uric acid stones form when your urine is often too acidic. Uric acid can form stones by itself or with calcium. Struvite stones can happen when you have certain types of urinary tract infections in which bacteria make ammonia that builds up in your urine. Struvite stones are made of magnesium, ammonium and phosphate hexahydrate. Cystine stones are made of a chemical that your body makes naturally, called cystine. Cystine stones are rare, and happen in people who have a genetic disorder that causes cystine to leak from the kidneys into the urine WHAT ARE THE CAUSES AND RISK FACTORS OF KIDNEY STONES? Anyone can get a kidney stone, but some people are more likely than others to have them. Men get kidney stones more often than women do. Kidney stones are also more common in non-Hispanic white people than in people of other ethnicities. You may also be more likely to have kidney stones if: You have had kidney stones before. Someone in your family has had kidney stones. You don’t drink enough water. You follow a diet high in protein, sodium and/or sugar. You are overweight or obese. You have had gastric bypass surgery or another intestinal surgery. You have polycystic kidney disease or another cystic kidney disease. You have a certain condition that causes your urine to contain high levels of cystine, oxalate, uric acid or calcium. You have a condition that causes swelling or irritation in your bowel or your joints. You take certain medicines, such as diuretics (water pills) or calcium-based antacids. You have some structural (anatomical) problem in the urinary tract that is leading to sub-optimal urinary drainage out of the body WHAT ARE THE SYMPTOMS OF KIDNEY STONES? Sharp shooting episodic pain in your back or lower abdomen Pain while urinating Blood in your urine Nausea and vomiting Fever Why You Should Not Delay Kidney Stone Surgery? Can cause damage to the whole kidney or the urinary tract requiring additional corrective procedures Can cause blood loss through the urinary passage Can cause urinary tract infection Can cause of Chronic Kidney Disease (CKD) requiring Dialysis or Kidney transplant in the long run Treatment Option of Kidney Stones Extracorporeal Shockwave lithotripsy (ESWL) Ureteroscopy and treatment of stones (Commonly known as URS) PCNL (Percutaneous Nephrolithotomy) Flexible Nephro-ureteroscopy with LASER treatment of stones RIRS - Retrograde Intra Renal Surgery ECIRS - Endoscopic Combined Intra Renal Surgery Why Laser Surgery for Kidney Stone? Quick recovery Minimal pain Minimal bleeding Quick recovery Shortest possible hospitalisation Relatively higher stone free rate (clearance of stone)

Holmium laser enucleation of the prostate (HoLEP) is a type of laser surgery used to treat obstruction (blockage) of urine flow as a result of benign prostatic hyperplasia (BPH). In men with BPH, the prostate gland is not cancerous but has become enlarged. An enlarged prostate can result in a number of urinary tract symptoms such as frequent urination, getting up multiple times in night to pass urine, poor stream, straining or need to apply pass urine, difficulty in starting urination, or loss of bladder control. Holmium laser enucleation of the prostate (HoLEP) as more effective surgical procedure for urinary tract obstruction due to bph as compare to other surgical intervention such as Transurethral resection of the prostate (TURP (Monopalar/ Bipolar)), Transurethral resection of the vaporization prostate and potentially less costly surgery for urinary obstruction due to BPH, as compared to other surgical options such as laser vaporization and transurethral resection of the prostate. How does holmium laser enucleation of the prostate (HoLEP) work? The holmium laser is a surgical laser that has been found particularly effective in performing several types of urological surgeries. In the case of HoLEP, the laser is used to cut and remove the bulky prostate tissue that is blocking the flow of urine. Who needs to have holmium laser enucleation of the prostate (HoLEP)? BPH occurs in more than 40 percent of men over the age of 60 and is a leading cause of urination symptoms, including difficulty in passing urine. As men age, the symptoms of this condition can worsen. Although many cases of urinary obstruction from BPH can be treated without surgery, patients who do not benefit from such medical treatments may eventually need surgery to avoid or deal with long-term problems such as retention of urine, urinary tract infections, and bladder stones. Patients who are appropriate for HoLEP are typically symptomatic due to very large prostates. What are the advantages of holmium laser enucleation of the prostate (HoLEP)? Use of HoLEP in many different parts of the world has shown it to be a safe and effective procedure. Although there are many types of BPH surgeries available, HoLEP offers a unique advantage in being able to remove a large amount of tissue without any incisions on the body, even in very large prostates, while decreasing the risk of bleeding and providing tissue for pathology (to look for cancer). This decreases the need for blood transfusions during surgery, minimizes the time of stay in the hospital to one or two days, and reduces the risk of needing repeat treatment.

Laparoscopic surgery and hand-assisted laparoscopic surgery (HALS) are “minimally invasive” procedures commonly used to treat diseases of the urinary tract. Unlike traditional surgery on the intestines or any other organs of the abdomen where a long incision down the center of the abdomen is required at times, laparoscopic surgery requires only small “keyhole” incisions on the abdomen. In case of hand-assisted surgery, in addition to keyhole, a 3-4 inch incision is also used to allow the surgeons hand to gain access into the abdominal cavity for further manipulation/operative intervention. As a result, the person undergoing these laparoscopic procedures may experience less pain and scarring after surgery, and a more rapid recovery. It is a surgical procedure that employs fiber-optic instruments to inspect and operate on the organs inside the abdomen or the pelvic cavities.During laparoscopy, an instrument called a laparoscope is inserted into the abdomen through a very small incision in the abdominal wall. A laparoscope is a long, thin tube with a high-intensity light and a fibre-optic camera on the end which transmit images to an external video monitor and with the help of this visual assistance the operating surgeon completes his/her procedure, even the most difficult surgical interventions successfully with ease. Ablative Procedures Laparoscopic Nephrectomy Laparoscopic Radical nephrectomy Laparoscopic Parial nephrectomy Laparoscopic Nephroureterectomy Laparaoscopic Adrenalectomy Laparoscopic Prostatectomy Laparaoscopic Donor Nephrectomy Reconstructive Procedures Laparoscopic Pyeloplasty Laparoscopic Ureteric Reimplantataion Laparoscopic VVF repair SOME OF BENEFITS OF LAPAROSCOPIC SURGERY Lower risk of bleeding. Laparoscopic surgery can be a good option for men who take medication to thin their blood or who have a bleeding disorder that doesn't allow their blood to clot normally. Quicker recovery Accuracy Cost Effective Procedures More-immediate results. Improvements in urinary symptoms from Laparoscopic surgery are noticeable right away. It can take several weeks to months to see same level of noticeable improvement with medications