Ministry of Health improves urology services on offer | 12 June 2019
• “Less than 1 percent of persons suffering from kidney stones need to be operated on”
With technological advancements and developments in modern medicine and healthcare, surgical procedures are becoming less risky for patients while also being more effective than traditional open surgeries.
Patients in Seychelles who suffer from kidney stones now have access to better medical intervention for the treatment of kidney stones, since the Ministry of Health has introduced keyhole and minimally-invasive surgeries for the removal of stones in the kidney, urethra and bladder.
According to Dr Loren Reginald, special advisor to the Minister for Health Jean- Paul Adam, less than 1 percent of patients suffering from kidney stones need to be operated on.
“The treatment for kidney stones depends on the localisation in the kidney. Nowadays, if the stone is more than 2 to 2.5cm, we opt for Percutaneous nephrolithotomy. This is where a small incision is made on the skin, the stone is localised, the professional introduces a canula and the stone is removed through a tube. If it is slightly too big to be pulled out, it can be hit by a laser and removed in fragments. A catheter is kept in place which is removed after 2 days and the patient is discharged for home,” Dr Reginald explained.
The traditional procedure was to conduct open surgery requiring the patient to be hospitalised for two or three weeks and such procedures increased the risk of patients suffering from hernia or other complications such as bleeding and infections.
Dr Reginald explained that there are four types of stones that are common in Seychelles including calcium stones, uric acid stones, strovite stones and stag horn stones.
“Stag horn stones are different from all other stones. It is more dangerous because it fills the whole kidney and the patient does not feel it until it is too late. It is essential to remember that kidney stones do not give any pain but repeat infections or the person may urinate blood. It is only when it is in the urinary tract that it hurts and this is what we refer to as the real colic, it is a pain that dilates the cavity. The danger with stag horn stones, by the time we discover many times it is too late. The procedure before was to open the kidney in half and remove the stone and then stitch up the kidney,” Dr Reginald explained.
For stones located in the urethra passage, Dr Reginald notes that the ministry, since 2015 has been employing Extracorporeal shock wave lithotripsy (ESWL) which uses shock waves to break a kidney stone into small pieces that can more easily travel through the urinary tract and pass from the body, so there is no need to hospitalise the patient
He added that it is important to differentiate between the different types of stones as they require different treatments.
“Stones in the bladder are not the same as stones in the gallbladder as the production mechanism is different. Stones in the bladder is produced when urine does not flow properly and this causes an infection. Stones in the gallbladder are caused by fat in the body. Most times, patients are confused and the treatment differs. It is rare to see females with stones in the bladder but for a male patient, if there is a stone in the bladder, it is advisable to also remove the prostate as the prostate is what causes the stone,” he added.
If there is a need for the prostate to be removed, such is also possible through laparoscopic surgery.
For stones located lower in the body, in places where it may be obstructed by bones, a uteroscopy can be performed whereby a thin, flexible scope is inserted to find and remove stones. No cuts are made and the scope through the bladder and ureter and into your kidney. A small basket is then used to remove small stones. If the stones are larger, the doctor will pass a laser through the scope to break them up and patients are able to go home on the same day.
Asides from patients suffering from kidney stones in the kidney, urethra and bladder, it is also fairly common for persons to have stones in the gallbladder caused by an excess of fat in the body. For such patients, treatment in the form of laparoscopic surgery is also available and on offer at the Seychelles Hospital.
Swimming coach Barnsley Albert, who had stones removed from his gallbladder just under three weeks ago, recounted that he experienced no discomfort or pain following the procedure and that he made a speedy recovery.
“I had the surgery just less than three weeks ago and I can say the whole experience from the surgery to the level of care on D’Offay Ward was impressive. I had conducted research on the risks of the procedure and read that they were minimal but I had not expected to make such a speedy recovery. I was operated on on a Wednesday and was able to return to work the following Monday after spending the few days at home. Impressively I didn’t even need any painkillers,” Mr Albert stated.
Two other patients, who have both had similar procedures, recently, shared similar sentiments. Serge, a 62-year-old, thanked the ministry for the procedure, stating that he made a speedy recovery as well while Elsa Padayachy noted that she was also surprised by how she didn’t feel any discomfort and pain after the procedure.
“I’m not sure how long I spent in theatre but I remember only feeling slight discomfort after I had just awaken. After that the pain totally disappeared and I did not even need any painkillers and now I feel fine,” Ms Padayachy noted.
Ears, Nose and Throat (ENT)
Dr Phillip Jumeau, a visiting ears, nose and throat (ENT) consultant from Australia who is of Seychellois origin says that Seychellois patients are lucky to have as many improvements in the health sector over recent years.
“The changes in the theatre, the staff, the anaesthetic, the experience and in the skills of staff, we are in a good position to keep moving forward and get us to a world class standard,” Dr Jumeau noted.
Dr Jumeau has been working alongside an ENT specialist at the Seychelles Hospital to perform surgeries over the past week.
“We’ve been quite limited in the scope of operations on offer and ENT has a broad range of procedures particularly in tropical climates such as the Seychelles. We are treating minor and major ear disease, nasal obstruction, sinus disease, allergies, head and neck cancer and some children diseases including tonsil infections, sleeping and breathing problems,” he noted.
Similarly to other new procedures introduced at the Seychelles Hospital, ENT operations are minimally-invasive, and performed through telescopic surgery.
“By being able to do it this way, this can be done extremely safely, with minimal discomfort, with a quick recovery and our expectation is to make it better,” Dr Jumeau stated.
He concluded by stating that most persons only require minor surgeries but that even more advance telescopic surgeries can be performed if necessary.