Symptoms
Common symptoms are:
- recurrent urinary infections
- abdominal or loin pain
- fever, nausea and vomiting
- blood in the urine
These must be investigated to find the underlying cause and allow prompt treatment to prevent harm or kidney damage. Occasionally, blockage of the kidney can result from stones or from congenital narrowing where the kidney joins the ureter (pelvi-ureteric junction or PUJ obstruction).
Kidney Cancer
Kidney cancers may occur and are a serious cause of bleeding. Increasingly, they can be found on ultrasound scanning for unrelated symptoms. Often they are small, confined within the kidney and without any symptoms, but they can be large, causing abdominal symptoms, such pain, bloating or indigestion.
Diagnosis and Treatment
Investigation of urinary infections or bleeding is usually simple and quick using ultrasonogaphy, X-rays or CT scanning. Often inspection of the bladder under local anaesthetic is required with a flexible telescope, to ensure no bladder problems. These tests are all rapidly available as an outpatient.
Treatments
Laparoscopic nephrectomy
Laparoscopic (key-hole) removal of the kidney to treat kidney cancer or other conditions is now standard practise in specialist units. The kidney is freed on the inside using specialist instruments through tiny incisions in the loin or abdomen, and the kidney is removed in a bag through a small incision low down in the abdomen, similar to a hernia repair or appendix removal. This is significantly less painful than open kidney surgery, with a faster recovery, shorter stay in hospital (commonly only 1 or 2 days) and faster return to work/leisure activities etc.
Laparoscopic pyeloplasty
This procedure is used to treat PUJ obstruction, by removing the narrowed area responsible for causing kidney blockage and symptoms, and reconstructing the kidney's drainage. It was one of the first procedures in urology to be developed as a laparoscopic operation. Technical skill and significant training is required to achieve the delicate suturing for this reconstructive procedure.
Stone disease management
Many smaller stones will cause few symptoms and can be managed by altering fluid intake, and observation with regular check-ups and X-rays. Stones that are enlarging or causing pain, blockage or infections can be treated in a number of ways, depending on their size and position.
Telescopic removal of stones can be done through the bladder and up the ureter tube (ureterosopy), or directly through the skin into the kidney (percutaneous removal). Stones can be removed whole, but more commonly require fragmentation by an instrument or laser. Selected smaller kidney stones are often best treated by ESWL (shockwave treatment), which is performed as an outpatient procedure without the need for anaesthesia or surgery.
Midlands Urology work in partnership with the Birmingham and Solihull Bladder clinic to offer specialist complex stone management.