Kidney stones
What are kidney stones?
A stone is called a hard mass that is initially formed by crystals that settle in the urine in the kidney area. They grow in size, inside the kidney and form kidney stones. Some of these stones may pass through the ureter (the tube that connects the kidneys to your bladder) and be excreted, while others may remain in the ureter or kidney and grow even larger. When a kidney stone "sticks" to the ureter and is not expelled, it causes kidney pain called renal colic.
Anyone can develop kidney stones at some point in their lives. Stones form when there is an imbalance in the salts that are dissolved in the urine. This may be related to the amount of water we drink as well as the various substances in the urine that trigger the formation of stones.
Symptoms
The people are most at risk of developing kidney stones are those with a family history of lithiasis. when stones form as a result of a urinary tract infection, those who have a genetic predisposition and when there is a narrowing at some point of the ureter. There are also diseases that could lead to formation of kidney stones as hyperparathyroidism, gastrointestinal disorders (intestinal resection, Crohn's disease, malabsorption, urine diversion), Sarcoidosis.
A stone located in the kidney usually does not cause symptoms but it can give a feeling of deep, dull loin pain. However, when the stone moves into the ureter, a severe pain called renal colic usually occurs. Depending on the location of the stone, colic occurs in the kidney, on the side of the abdomen or in the genitals. Sometimes accompanied by nausea or vomiting, blood in the urine, difficulty urinating or pain. Always after a colic episode, the patient should at least have a kidney ultrasound scan or CT scan.
Intervention
The colic is treated conservatively with painkillers. If the stone is likely to be expelled automatically, then a wait approach is acceptable. When it cannot be eliminated and the pain is strong and continuous or causes significant hydronephrosis or fever, urgent surgical intervention is required.
The intervention consists of either emergency stent placement ( a tube that is placed from the bladder to the kidney and bypasses the stone) or endoscopic stone removal called ureteroscopic lithotripsy.
When a stone is still high in the kidney then it is treated either with extracorporeal lithotripsy (if appropriate) or with endoscopic, surgical removal. The procedures specialist use to remove such stones are percutaneous lithotripsy or flexible ureter-pyeloscopic lithotripsy.
What can I do to prevent kidney stones from forming again?
This is the question everyone asks when they have had a kidney stone episode or kidney colic. Prevention of kidney stones.
However, the general measures that apply to all patients are:
- Stay hydrated throughout the day, drink 2.5 to 3 liters of liquid, mainly water.
- In the summer or when you sweat from exercise you need even more water, add fresh lemon juice to your water
- Avoid excessive consumption of coffee or tea.
- Have a balanced diet.
- Eat less sodium
- Eat less animal protein and increase fruits and vegetables.
- Do not avoid dairy products but consume them in moderation. Calcium intake is essential, but not above a limit.
- Check your body weight.
- Pay attention to dietary supplements, especially those that contain calcium.
- Have variety in your diet and avoid dietary excesses.
You can tell how diluted your urine is by looking at its colour. The darker your urine is, the more concentrated it is. Keeping your urine clear helps to stop waste products from getting too concentrated and forming stones.
Ureteroscopy
Ureteroscopy is an endoscopic operation performed with a special instrument called ureteroscope, a small-diameter endoscopic instrument. Depending from the location of the stone the ureteroscopes divided to rigid or flexible. The ureteroscope has a special camera and is inserted from the urethra (from where the patient urinates) and can reach the ureter and kidney.
Ureteroscopy is used to remove stones from the ureter or kidney. It reaches the position where the stone is located and the stone is fragmented using a laser fibre. The fragments of the stone are removed with special baskets and at the end of the operation, the urologist decides whether to place an ureteral stent (tube) inside, which is removed usually after a few days. Laser fragmentation of the stones is a very effective and safe method, although it is done under general anesthesia.
Extracorporeal shock wave lithotripsy (ESWL)
It is the breaking of stones with a machine that produces percussion wavesIt is not an invasive procedureas patient does not need incisions, just comes in contact with the lithotripsy. Extracorporeal lithotripsy is very effective for stones up to two centimeters in diameter. Kidney stones have an excellent response to treatment. However, the lower the position of the stone (ureter, bladder), the lower the efficiency rates.
Absolute contraindications of ESWL are patients with clotting disorders, patients who cannot stop their anticoagulants, pregnant women, and patients with active urinary tract infection.
Percutaneous nephrolithotomy (PCNL)
PNL is a surgery that aims to remove large stones directly from the kidneys. Its advantage is that even very large stones are removed with a single operation. However, compared to extracorporeal lithotripsy and ureteroscopy, it is a more invasive method with a higher risk of complications. The most common complications of percutaneous nephrolithotripsy are bleeding and fever.
PNL is performed under general anesthesia. The surgeon punctures the kidney with a needle through your skin while you are under anesthesia.The nephroscope is insterted into the kidney where the stone is located and is fragmented with laser fibre. The stone fragments are removed with special baskets. At the end of the operation a stent or a percutaneous nephrostomy tube is placed to ensure the urine leaves the kidney
