KIDNEY STONES

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Kidneys are paired fist sized organs located at the upper back of the abdomen. They filter blood to remove excess water and waste products from the body to form urine. Urine is produced in the kidney and then it travels along a tube called ureter to be stored in urinary bladder. When the bladder becomes full, urine is expelled from the body through Urethra.

WHAT ARE KIDNEY STONES?

Kidney stones are deposits of calcium and other minerals in the kidney. These deposits increase in size over a period of time to form a stone. They can be of different sizes and shapes. Stones range from as small as 3.0mm to as large as 30.0 mm. They can form in Men, Women and children. Kidney Stones occur in about 15-20 % of the general population. They can occur at any age but most commonly occur between the ages of 20 and 40. Stone formers have about 50% potential risk of recurrence.

WHAT ARE THE TYPES OF KIDNEY STONES?

There are Five major types of kidney stones :

Calcium Oxatate stones ( Most Common )
Uric Acid Stones
Struvite Stones
Calcium Phosphate stone
Cystine stones

WHAT ARE THE SYMPTOMS OF KIDNEY STONES?

Most of the kidney stones do not cause any symptoms until they block the urinary passage. One may not be aware that a stone has formed in the kidney until an Ultrasound Scan is Performed. When the stone moves down the ureter, the symptoms occur. They include one or more of the following:

Dull aching pain at the back.
Severe pain in the side of the Stomach associated with Nausea and Vomiting.
Blood in the Urine
Urinary symptoms like Frequency, Urgency and sense of incomplete bladder emptying.

WHAT INVESTIGATIONS ARE REQUIRED TO DIAGNOSE KIDNEY STONES?

The simplest investigation to diagnose a kidney stone is the Ultrasound Scan of Abdomen and Pelvis. In Special situations especially in acute pain, a Plain CT Scan may be required.

WHAT ARE THE TREATMENT OPTIONS FOR KIDNEY AND URETERIC STONES

Treatment of Kidney and Ureteric Stone depends upon the size, number, type and location of the stone.

Kidney Stones

Treatment of Kidney Stones has undergone major changes. Just a few decade back, the only option was an open surgery. But now there has been so many innovations that a Urologist can offer various treatment options to the patients depending upon their preference.

Small stones upto 5mm are expected to pass in the urine over a period of time. Drinking a glass of water at regular interval and skipping will encourage its passage. However these stones may cause pain when passing down the Ureter. A simple analgesics should take care of this pain after consultation with a Urologist.

Kidney Stones between 5-20 mm can be treated with ESWL, RIRS and PCNL. RIRS and PCNL are Surgical procedures which requires Anaesthesia and Hospitalisation.

ESWL is an ideal treatment option for Kidney stones upto 20 mm. It is a short day care procedure which does not require an anaesthesia. Patient will be discharged back home within couple of hours.

Percutaneous Nephrolithotomy (PCNL) is usually preferred for stones larger than 2 cms. However in certain situations, PCNL remains the treatment of choice for smaller stones as well. Through a small skin incision at the back, a scope is passed into the kidney. The stone is broken up with laser and the fragments are removed through the scope. This procedure is usually done under general anaesthesia.

RIRS ( Retrograde Intra Renal Surgery) is done by using a thin flexible scope which is passed from the urethral opening into the kidney. Using a laser beam, the stone is fragmented and a soft tube called DJ Stent is placed inside. These fragments over a period of time are expected to pass out. Once all the stones are cleared, the stent has to be removed by a small endoscopic procedure.

Kindly Stones larger than 2 cms should be ideally managed by PCNL. RIRS and ESWL can also be attempted in certain situations, but may need multiple sitings and may not be the ideal choice.

Ureteric Stones

Ureteric stones treatment largely depend upon the size and location of the stones.

Stones upto 5 mm in the Ureter can be managed with medications and in majority of the patients they should pass out within in a span of 1-2 weeks with medications. Stones bigger than 5 mm may find it difficult to pass out with medications. The spontaneous passage rates with medications depends upon the location and size of the stone. A 6 mm stone has 50% probability, 7mm stone has 30%, 8mm stone has 20% and 9mm stone has just 10 % and stones bigger than 10 mm very rarely pass out spontaneously. If a stone fails to expel out within this period of conservative treatment, then an intervention either in the form of ESWL or RIRS is required.

Stones in the Upper Ureter and VUJ

Stones upto 15 mm in the Upper Ureter and at the VUJ (Vesico Ureteric Junction) can be treated with ESWL with a success rates in the range of 80-90 percent. An endoscopic Intervention in the from of Ureteroscopy with Laser is required if ESWL fails to break the stone.

Stones in the Mid and Lower Ureter

ESWL is not an ideal choice of treatment for mid ureteric stones. The success rates are poor and invariably the patient requires an endoscopic surgery. It is recommended to undergo an URS if conservative treatment fails.

Stones in the Lower Ureter & VUJ

ESWL and Ureteroscopy are both good options for Lower Ureteric & VUJ Stones. ESWL has a good success rates about 80-90% and offers many advantage over Ureteroscopy.

Consult our Urologist for the Detailed information

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