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There are different types of stones based on the composition of minerals calcium oxalate stones are the most common type- they can be monohydrate or dihydrate, uric acid stones, cystine stones, triple phosphate (staghorn) stones- very large stones can occupy the whole kidney, commonly forms in infected urine, can damage kidney and lead to failure.
Small stones often pass through with little discomfort without requiring interventions, but larger stones are usually very painful and block the urinary tract. Kidney stones are more commonly found in the adult population but they can also be present in young children.
CAUSES:
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• Stones are more common in people who live in hot climate conditions and are exposed to hot working conditions.
• Obesity, Diabetes, and metabolic syndrome also increase the risk for stones.
• A high dietary intake of animal protein increases the chance of uric acid stones and calcium oxalate, pickles, salt, refined sugars, and carbonated drinks like colas, and a diet high in oxalates also increases the risk of developing kidney stones.
• A person with a family history of kidney stones may also have an increased risk for stone formation.
• Urinary tract infections (UTIs), kidney disorders (like cystic kidney diseases), and metabolic disorders (hyperparathyroidism) can also increase your chance of stone formation.
• A person with a history of recurrent kidney stones may be screened for such disorders.
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SYMPTOMS:
Symptoms usually depend on the location of the stone and the degree of obstruction to urine flow.
Stones in the kidney- Usually, they will be asymptomatic or have vague abdominal pain in the loin. Large stones in the kidney can lead to a decrease in renal function.
Stones in the renal pelvis or the ureter- They present with sharp colicky type of pain that is on and off usually associated with nausea or vomiting along with pain that is felt in the back and side and radiates to the groin or testicles region.
Other symptoms are:
• Blood in the urine.• The frequent urge to urinate.
• Foul-smelling urine, fever with chills when infection sets in. TREATMENT: Depending on the size of the stone, location, and severity of symptoms,, Medical management strategies include:
• Painkillers to reduce pain. Please keep in mind: too many painkillers use can also affect kidney function, Increased fluid intake- 2-3 litre/day.
• Citrate syrups help in increasing the solubility of minerals in urine, which decreases the stone risk.
• Low salt diet and restriction of protein diet
• For small stones in the ureter or vesicoureteric junction (VUJ), alpha-blockers like tamsulosin or siladosin relax the ureter and help to pass the stone. Even low doses of steroids like deflazacort in combination with alpha-blockers increase the chance of stone passage.
Surgical management:
Surgery for smaller stones is usually done as daycare surgery. This allows patients with greater flexibility, aiding in quicker return to work and other daily activities. The choice of treatment depends upon multiple factors, including the size, location of the stone, other medical problems, and patient preference. Retrograde Intrarenal Surgery (RIRS) RIRS has greatly changed the management of kidney stones and upper ureteric stones. RIRS is the procedure done within the kidney using a fiberoptic flexible ureteroscope. A ureteroscope is inserted through the urethra (the urinary opening) to the bladder and the kidney where the stone forms. This technique allows Urologists to perform surgery inside the kidney without making any incisions. Performed under general or spinal anesthesia, the stone is dusted or fragmented into small powders using a laser (helium/thulium). This procedure is ideal for stones less than 1.5 cm. If more stone burden or the stone’s size is more than 1.5 cm and the patient prefers this method, then multiple sitting is required to clear out all the stones.
Advantages – It’s a totally endoscopic procedure. The patient can be discharged the next day if stable and recovery is fast. Disadvantage – more chances of infection. Percutaneous Nephrolithotomy (PCNL) This involves making a small keyhole in a kidney stone through a 1 cm incision in the skin and removing kidney stones. It is preferred for stones more than 2 cm. Advantages – greater stone-free rate
Disadvantage – increased risk of bleeding
ESWL:
This procedure is performed for stones less than 1 cm in the kidney and can be done as an outpatient procedure. Here, kidney stones are focused using USG or X-ray (fluoroscopic) and shock ways are delivered which helps in fragmenting the stone.
Disadvantage: There is an increased failure rate in hard stones and the need for the same endoscopic procedure if failed. Stone fragments can block in ureter leading to pain. With the advent of RIRS, this method is slowly getting absolute. Ureteroscopy and laser lithotripsy (URS) URS is carried out in patients with ureteric stones. A small scope is passed through the urinary opening into the bladder and, from there, up into the ureter. Once the stones are located, they are fragmented with a laser or pneumatic lithoclast. Fragments are removed with a basket or grasper. Open/lap surgery: Open/lap surgery is done only in patients with very large stones and huge stone burdens. Recurrence rates are estimated at approximately 50% over a 10-year and 75% over 20 years, with some people experiencing ten or more episodes throughout a lifetime. Prevention: In patients with a previous history of stones, certain home remedies can help prevent its recurrence. Drinking lots of fluids results in more than two liters of urine passing daily. As per the reports of 24-hour urine analysis and stone analysis, dietary advice is given to patients which may include – restricting a high protein diet and low salt diet. An increased intake of citrate juices also can prevent stone formation in the future. This article is authored by Dr. Vinay MH, Consultant – Urology, Manipal Hospital Hebbal