The truth about gallstones

The emperor had nearly total autocratic power and was the head of the army. The effects of the gallstones were excruciating, debilitating pain, which affected Napoleon’s ability to make decisions.

However, that is merely a legend. France lost the war not because of the emperor’s gallstones but because the Prussians had a much better army – with much better training and stronger leadership.

While the story about Napoleon may not be true, gallstones are a fact of life. Stones in the urinary tract, the kidneys, or the gall bladder are an extremely painful ailment. Except in extremely rare cases, it does not cause death, but the pain is agonizing.

What exactly are gallstones, what causes them, and how can they be dealt with?

Zohar Dotan, head of the Department of Urology at Sheba Medical Center at Tel Hashomer, explains that gallstones are formed by the hardening deposits of digestive fluids that form in the gallbladder, a small, pear-shaped organ on the right side of the abdomen.

“A gallstone can be as small as a grain of sand or, in extreme cases, as large as a golf ball. These stone formations may have genetic causes. People whose family members have had gallstones are more apt to have them themselves. In addition, gallstones are affected by geographic location. People living in hotter climates are more liable to get stone formations than those living in colder climates.”

Gallstones can cause great pain. Small ones that do not cause any pain or symptoms pass normally through the urinary tract and are expelled from the body. In other cases, the stone passing through the urinary tract causes tremendous pain and discomfort. The journey through the urinary tract may take a few agonizing days.

In these cases when the stone is being excreted naturally, many people choose to undergo minimally invasive surgery. Because the natural process is so painful, most people want to get it over with as soon as possible and opt for such treatment – especially since there is no guarantee that the natural excretion process will be successful. This treatment is called retrograde uretero nephroscopy lithotripsy.

Dr. Nir Kleinmann, senior physician at the Department of Urology at Sheba Medical Center, is in charge of conducting these operations. He explains that “an optic fiber is inserted through the urinary tract. It activates a laser beam, which fragments the gallstone. The fragmented pieces are then removed, thereby solving the problem. With this technique, no incisions are made. People who undergo this treatment are discharged from the hospital the next day. Since it is a short and minimally invasive  process, it is very popular. In addition it has a high success rate of over 90%, which further increases its popularity.”

Kleinmann further adds that while it is by far and large the most popular way to get rid of gallstones, they are not the only ones. There are two other process. One is called extracorporeal shock wave lithotripsy (ESWL), which works through shock waves that disintegrate the gallstone. The advantage is that it is completely non-invasive. The disadvantage is that it is not always effective.

The second method is called percutaneous nephrolithotomy (PCNL). It is implemented to disintegrate very large stones when other processes are not very successful.

And there is, of course, the traditional totally invasive procedure, However, to the best of my knowledge, it is rarely used nowadays.