Page 9 - Seniors Today October 2020

order blood and urine tests to determine small surgical margin without violating
the specific microbe causing the infection principles of cancer surgery, the standard of
and to check the level of infection in the care today is to remove ONLY the tumour
blood and assess kidney function. In while leaving the involved kidney intact
addition he will order an imaging study to whenever that is technically feasible.
determine the underlying cause. Treatment This is known as Partial Nephrectomy
will involve appropriate antibiotics and is best done utilising Robot Assisted
administered intravenously or orally, and Laparoscopy. It is important to realise
treatment addressing the underlying cause. that the technical feasibility of removing
Kidney infections are not to be trifled with difficult tumours (in terms of size and
especially in the elderly or diabetic, because situation) increases with experience and
of the concern for septicaemia which could expertise of the urologist, and there is no
be life-threatening. gainsaying that these procedures should
be done in tertiary centres with significant
Kidney Tumours experience. Removal of the entire kidney
It is not uncommon to have spherical (Radical Nephrectomy) when indicated
collections of clear fluid in the kidneys owing to the size and location of the tumour
especially in older individuals. These are is relatively simpler and should be done
called kidney cysts and as long as they laparoscopically in most cases. Even
have a thin wall and clear fluid within, are today, large tumours which have invaded
Kidney infections must not be taken lightly specially if you are diabetic, because of the risk of septicaemia referred to as simple cysts which warrant surrounding tissues may still require open
usually done endoscopically (URS) using Nephrolithotomy). Either way the pain no concern. If cysts have a thick vascular surgery for optimal removal.
a fine ureteroscope (the size of an average is minimal and patients are usually wall or have partitions within or solid It is important to realise that most kidney
ball-point refill), which may be semi-rigid discharged home within 2-3 days. For contents, these are called complex cysts cancers do not respond to standard
or flexible passed up the natural urinary larger stones within the kidney including and certainly warrant careful scrutiny chemotherapy or radiation regimes,
passage to visualise the stone and fragment staghorn or ramified stones that form a cast and removal if required. All solid tumours surgery being the best option in the initial
it using energy (usually a laser). A fine of part or all of the kidney, the procedure of (swellings) within the kidney have a high phase. Recent research has thrown up
plastic tube called a Double J Stent may be choice is PCNL. Majority of urinary stones probability of being a cancer, and need targeted therapies and immunotherapy
left in the patient from kidney to bladder (>95%) will be amenable to one of these careful scrutiny and removal as soon as that have given a ray of hope in advanced or
for a week or longer. The patient usually three techniques (URS, RIRS or PCNL). The possible. recurrent cases.
goes home within 1-2 days and can resume occasional stone may require open surgical Until as late as a decade ago it was
normal work and activities immediately. removal. Shock Wave Lithotripsy (ESWL) common urological practice to remove
If the stone is in the kidney and is unlikely is often used by some urologists for kidney the entire kidney in the case of a solid
to pass on its own, it will need removal. stone less than 15 mm in size. tumour within it. Removal of the tumour
For stones in the kidney up to 20 mm in only, while sparing the involved kidney,
size, the same procedure mentioned above Kidney Infections was reserved only for special cases such
using a flexible ureteroscope (Retrograde Infections may reach the kidney as single kidneys or small tumours well
IntraRenal Surgery - RIRS) is preferred by (Pyelonephritis) either by travelling up amenable to resection with a wide margin.
most urologists. Alternatively, a small tract from the lower urinary tract (bladder or With the advent of minimally invasive
from the skin of the flank to the interior ureter) or directly via the blood. The patient surgical techniques such as Laparoscopy
of the kidney is made and an endoscope usually has high fever with chills and and Robot Assisted Laparoscopy, and the
(nephroscope) introduced to fragment and may have moderate to severe pain in the realisation through evidence that kidney Chronic use of prescribed medications such as some pain-
remove fragments (PCNL -Percutaneous affected kidney. The urologist will usually cancers can be safely removed with a killers or antibiotics may affect kidney function

8 SENIORS TODAY | ISSUE #16 | OCTOBER 2020 9