Dr. Shohaib Virani, MD

Adrenal surgery can be open or laparoscopic. Laparoscopic adrenalectomy is a minimally invasive procedure that inserts a thin tube with a camera (laparoscope) through several small incisions on the abdomen. The surgeon uses the laparoscope to guide the procedure and is able to access and remove adrenal glands through the small incisions. Laparoscopic adrenal surgery lasts approximately 1-2 hours.

Laparoscopic adrenalectomy is associated with shorter recovery periods, reduced risk of infection, and smaller scars. Although these factors may be desirable, the location of the tumor, its size, and the severity of the condition may require that an individual instead undergo open surgery. An open adrenalectomy is typically done for larger adrenal tumors and requires a single, large incision on the abdomen. Open adrenal surgery takes around 2-4 hours.

Following the operation, patients will remain in the hospital for 1-2 days for a laparoscopic adrenalectomy or 3-5 days for an open adrenalectomy. Patients will likely have a liquid diet immediately after their surgery, but should be able to return to solid foods after a day. If both of the glands are removed, patients will be given drug therapy to replace the hormones they produced.

Kidney stones can be smooth or jagged and are yellow to brown in color. They are mostly comprised of the minerals calcium, oxalate, and phosphorus. Examining the stones to see what they are made of can show what caused the stone to be formed in the first place. For example, a stone made of mostly calcium, which is the most common type, can happen any time the urine becomes too concentrated due to dehydration or a blockage in the kidney. A uric acid stone forms when acid levels in the urine get too high, usually due to excessive consumption of animal protein such as meat and fish. A struvite stone is a sign of certain infections, and a cystine stone can be due to a genetic disorder that raises the risk of kidney stones.

The most common symptom of kidney stones is pain, either in the back or lower abdomen, or severe pain when urinating. There may also be blood in the urine. Treatment for kidney stones depends on how large the stone is. Very small stones can pass out of the body on their own, and they do not require treatment other than drinking adequate water and taking pain killers. Larger stones need to be broken apart and removed. The main treatment options are:

• Shock wave lithotripsy, which uses sound wave vibrations to break apart the stone
• Percutaneous nephrolithotomy, or the use of a very tiny tool (like a wire inserted through the back) to break apart and remove the stone
• Ureteroscopy, a thin tube inserted through the urethra and bladder to the stone, where tiny tools can grasp the stone and remove

People who have had one kidney stone are at risk of developing another. To reduce this risk, patients are given instructions specific to the type of stone they developed. Generally the instructions will include drinking more water to dilute the urine, but it may also involve lowering sodium intake or eating less meat.

SNS surgery has two parts. The first part is an evaluation phase, during which it is determined if neurostimulation is effective treatment option for patients. Patients lie on their stomachs while a temporary electrode lead, through which electrical signals will travel, is inserted into their lower back. A permanent lead may also be used, and it would remain in place should the trial period prove successful. The lead is connected to an external neurostimulator. The procedure takes approximately one hour and may be performed in a doctor's office, hospital, or surgical center. After the procedure, patients are required to keep a log of their toilet habits over approximately two weeks, and they may need to limit their activities during this time. If patients' symptoms do not improve after the trial, they may repeat the test phase or discuss other treatment options with their doctors.

If the trial stimulator is effective, patients will undergo the second phase of SNS surgery, which is permanent implantation. In the second stage of surgery, the temporary lead (if used) will be replaced with a permanent lead. Then the sacral nerve stimulator will be implanted subcutaneously (under the skin) in the upper buttock. Patients should be able to return home the day of their procedure.

If patients are sore after surgery, their doctors may give them medication. The sacral nerve stimulator will be programmed after the procedure, and when it is turned on, patients should feel a sensation similar to pulling, tapping, tingling, or pulsing. Patients will need to work with their doctors during follow-up appointments to determine the most effective settings for the stimulator. Patients will be given instructions on how to adjust it themselves at home. The stimulator is powered by a battery that will last approximately five years, after which it can be replaced.