Minimally-invasive Kidney Stone Surgery In Singapore

Ureteroscopy involves passing a thin, rigid scope through the urethra and bladder to reach stones in the ureter. In retrograde intra-renal surgery, a thin flexible scope is used instead to reach stones in the kidney. Once located, a laser fibre fragments the stones into tiny pieces that can be removed with a basket device or suctioned out. This technique is effective for stones in the ureter and most kidney stones. Multiple stones can also be treated at the same sitting. The procedure requires no incisions and typically allows same-day discharge or after an overnight stay in the hospital.

ESWL is a non-invasive procedure that uses focused shock waves to break kidney stones into smaller fragments, allowing them to pass naturally through the urinary tract. It is typically recommended for small to medium-sized stones located in the kidney or ureter. The procedure is performed on an outpatient basis, usually with light sedation, and recovery is generally quick with minimal downtime.

PCNL is used for larger kidney stones (typically over 2 cm) or stones in difficult locations. A small incision (up to 1 cm) is made in the back, and a nephroscope is inserted directly into the kidney. Stones are fragmented using ultrasonic, pneumatic, or laser energy and removed through the scope. Mini-PCNL and ultra-mini-PCNL techniques use smaller instruments for reduced tissue trauma.

Modern kidney stone surgery utilises digital flexible ureteroscopes with high-definition imaging, holmium or thulium laser systems for rapid and precise stone fragmentation, and flexible and navigable suction ureteric access sheaths to enhance stone removal. X-ray and ultrasound guidance enhance accuracy and safety during procedures.

Temporary blood in urine (haematuria) occurs in most patients but typically resolves within days. Mild pain or discomfort, particularly with urination, is normal and manageable with prescribed medications. If a ureteric stent is placed, patients may experience urinary frequency, urgency, or mild flank discomfort until removal.

Some patients report feeling stone fragments passing in weeks following surgery. This sensation is usually brief and indicates treatment is working.

While uncommon, potential complications include urinary tract infection despite prophylactic antibiotics, requiring prompt treatment. Ureteric injury or perforation is rare but may require ureteric stent placement for healing. Bleeding requiring transfusion occurs in less than 1% of cases.

Stone fragments may occasionally obstruct the ureter, requiring additional intervention. Injury to surrounding organs is rare with experienced surgeons using modern techniques.

Dr Tan uses meticulous surgical technique and technology to minimise risks. Careful patient selection and thorough pre-operative planning reduce complication rates.