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TREATMENT FOR KIDNEY STONES

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Kidney Stones and Urinary Tract Stones

Kidney stones are hard collections of salt and minerals often made up of calcium or uric acid. They form inside the kidney and can travel to other parts of the urinary tract. Stones vary in size, some being small- a fraction of an inch, while others can grow to a few inches across. Some kidney stones become so large they take up the whole kidney. A kidney stone forms when too much of certain minerals accumulate in your urine. When you are not well hydrated, the urine becomes concentrated with those minerals.

Types of Kidney Stones

Most kidney stones are calcium stones, usually in the form of calcium Oxalate. Calcium stones may also occur in the form of calcium phosphate.

Struvite stones form in response to an infection, such as a urinary tract infection. These stones can grow quickly and become quite large, sometimes with few symptoms or little warning.

Uric acid stones can form in people who do not drink enough fluids or who lose too much fluid, those who eat a high-protein diet, and those who have gout. Certain genetic factors also may increase your risk of uric acid stones.

These stones form in people with a hereditary disorder that causes the kidneys to excrete too much of certain amino acids (Cystinuria).

Treatment Options

Extracorporeal shock wave lithotripsy (ESWL) is the procedure to break the kidney stones in smaller parts for their easy passage through the urinary tract. The patient may feel discomfort and there would be dull ache for 1-2 days after treatment.

Laser URS can be recommended by your surgeon if you have large stone. It is a minimally invasive procedure where your doctor inserts telescope like instrument called Uretroscope through the opening of your urinary tract and examine kidneys, ureters & bladder then locates the kidney stone and breaks apart using laser energy which means there are no cuts and incision made.

Retrograde intrarenal surgery (RIRS) is a type of endoscopic surgery. It has become an attractive technique because of its high efficacy and low level of pain as compared to ESWL and PCNL.

Percutaneous nephrolithotomy (PCNL) is a minimally-invasive procedure for kidney stones. Pain may occur for a few days but can easily be managed through medications.

STONE CLINIC

Kidney Stones

Kidney Stone Symptoms

If you face any of these stymptoms please contact your Urologist at the earliest

SYMPTOMS

  • Pain in the back, belly or side
  • Pain or burning during urination
  • Urgent need to go and urinate
  • Cloudy and foul odor in urine
  • Going a small amount at a time
  • Nausea and vomiting
  • Fever and chills
  • Blood in urine

Prevalence of Kidney Stones

  • Formation of stones is very rare in babies (0-5 years), Children (6-18 years).
  • It is common in young adults(19--40 years)
  • It is very common in adults (41-60 years) and seniors (60+ years)
  • Among men kidney stones was prevalent in 10.6% while in women it was 7.1%
  • Obesity and diabetes were strongly associated with a history of kidney stones
  • Diet and lifestyle factors likely play an important role in the changing epidemiology of kidney stones.

Diagnosis of kidney Stones

Learn about the investigations and the diagnosis

  • Blood testing:- Blood tests may reveal too much calcium or uric acid in your blood. This test helps monitor the health of kidneys and may lead your doctor to check for other medical conditions.
  • Urine testing :- The 24 hour urine test may show that you are excreting too many stone-forming minerals. You may be asked to perform urine collections over two consecutive days.
  • Imaging:- Imaging tests may show kidney stones in your urinary tract. They could be in the form of a simple abdominal X-ray, high speed or dual energy computerized tomography(CT) that can reveal even tiny stones.
  • Analysis of passed stones:- You would be asked to urinate through a strainer to catch stones that you may pass. Lab analysis will reveal the makeup of those kidney stones.
  • The above test helps the doctor to determine the cause of kidney stones and help him plan how to prevent them.

Removal of Kidney Stones

● Small symptoms with minimal symptoms

A) Drinking water-- Drinking as much as 1.9 to 2.8 liters of water may help flush out your urinary system.

B) Pain relievers-- To relieve mild pain, doctor may recommend pain relievers such as ibuprofen, acetaminophen and others.

C) Medical therapy-- Doctor may give you a medication to help pass your kidney stone. This medication is known as an alpha blocker,relaxes the muscles of the ureter. This helps pass kidney stones more easily with less pain,

● Large stones and those that cause symptoms:

A) Using sound waves to break up stones-- For certain kidney stones, depending upon size and location, your doctor may recommend a procedure called extracorporeal shock wave lithotripsy(ESWL).

B) Surgery to remove very large stones in the kidney-- A procedure called percutaneous nephrolithotomy, which involves surgically removing a kidney stone using small telescopes and instruments inserted through a small incision in your back.

C) Using a scope to remove stones-- to remove a smaller stone in your kidney your doctor may pass a thin lighted tube (urethroscope) equipped with a camera through your urethra and bladder . 

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Prevention of Kidney Stones

Prevention of kidney stones may include a combination of lifestyle changes and medications.You may reduce the risk of kidney stones with the following methods

  • Drink water throughout the day, you may be asked to measure the output of your urine to make sure of the required quantity
  • Eat fewer oxalate-rich foods if your body has a tendency to form calcium oxalate stones. The foods rich in oxalates are rhubarb, beets, okra, spinach,Swiss chard, sweet potatoes, nuts, tea, chocolate and soy products.
  • Diet low in salt and animal protein is good to keep you free from kidney stones. Choose nominal protein sources such as legumes and use Mrs Dash instead of normal salt.
  • Continue eating calcium-rich foods unless your doctor advises otherwise.
  • Follow the set of medications prescribed by your doctor with regular visits.

What's important after discharge?

● You may have small amount of blood in urine for a few days after the procedure.
● You may have pain and nausea when the stones pieces pass out.
● This condition may last for 4 to 6 weeks. 

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STONE CLINIC

Ureteral Stones

Ureteral Stones Symptoms

Ureteral stones are kidney stones that have gotten stuck in one or both ureters (the tube that carries urine from kidneys to the bladder. Larger stones can cause pain. They are of 3 types: a) lower ureteric, b) mid ureteric, c) upper ureteric. The first two being treated by pneumatic laser and the last one by a simple laser.

SYMPTOMS

  • Pain in the back and side , often just below the ribs
  • Pain that changes.
  • Pain during urination
  • Nausea and/or vomiting
  • More frequent urination
  • Urine that is cloudy or has a strong foul smell
  • Blood in urine

Prevalence of Ureteral Stones

  • Formation of stones is very rare in babies (0-5 years), Children (6-18 years).
  • It is common in young adults(19--40 years)
  • It is very common in adults (41-60 years) and seniors (60+ years)
  • Among men kidney stones was prevalent in 10.6% while in women it was 7.1%
  • Obesity and diabetes were strongly associated with a history of kidney stones
  • Diet and lifestyle factors likely play an important role in the changing epidemiology of kidney stones.

Diagnosis of Ureteral Stones

Learn about the investigations and the diagnosis

  • A blood or urine test could help detect stones in ureter
  • A urinary CT scan could be recommended
  • An intravenous pyelogram (IVP) could be done where a diagnostic uses iodine as a contrast agent with X-rays to diagnose ureter stones.

Treatment of Ureteral Stones

● To remove smaller stones in the ureter, the doctor may pass a thin lighted tube (urethroscope) equipped with a camera through your urethra and bladder to your ureter. Once the stone is located, special tools are used to snare the stone to pieces and hence pass through the urine.

● Treatment of ureteral calculi is by extracorporeal shock wave called lithotripsy(ESWL). There are several kinds of ESWL, some use X-rays and others use ultrasound.

● Percutaneous nephrolithotomy(PNL):-- This is a primary method to remove large stones or stones that do not respond to ESWL. Here a small incision is made directly to the kidney, where a device called a nephroscope is used to locate and remove the stone. Larger stones are broken up either with ultrasound or an electrohydraulic device. This procedure requires hospitalisation for several days. 

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Patient safety is our priority

  • Drink water throughout the day, you may be asked to measure the output of your urine to make sure of the required quantity
  • Eat fewer oxalate-rich foods if your body has a tendency to form calcium oxalate stones. The foods rich in oxalates are rhubarb, beets, okra, spinach,Swiss chard, sweet potatoes, nuts, tea, chocolate and soy products.
  • Diet low in salt and animal protein is good to keep you free from kidney stones. Choose nominal protein sources such as legumes and use Mrs Dash instead of normal salt.
  • Continue eating calcium-rich foods unless your doctor advises otherwise.
  • Follow the set of medications prescribed by your doctor with regular visits.

What's important after discharge?

● You may have small amount of blood in urine for a few days after the procedure.
● You may have pain and nausea when the stones pieces pass out.
● This condition may last for 4 to 6 weeks. 

  • DO YOU HAVE QUESTIONS ABOUT AKI?
  • TELE CONSULT WITH YOUR UROLOGIST

STONE CLINIC

Bladder Stones

Bladder Stones and Symptoms

Bladder stones are hard masses of minerals in your bladder. Bladder stones develop when minerals in concentrated urine crystallize.

SYMPTOMS

  • Severe abdominal pain
  • Blood in urine
  • Sometimes no symptoms
  • Smaller stones may pass without treatment, but some need medications or surgery.
  • In men, pain or discomfort in penis or testicles
  • A burning sensation during urination
  • Frequent urination
  • Difficulty in urinating or interrupted urine flow.
  • Cloudy or abnormally colored urine

Causes of Bladder Stones

  • When your bladder does not empty fully, and the urine forms crystals.
  • Some infections can lead to bladder stones.
  • Sometimes an underlying condition that affects the ability of the bladder to hold, store, or eliminate urine may result in bladder stones.
  • Any foreign material left in the bladder may tend to cause bladder stones.
  • Most common cause could be prostate gland enlargement.
  • Damaged nerves(neurogenic bladder)
  • Inflammation caused by urinary tract infections or radiation therapy to pelvis.
  • Medical devices like catheters can cause bladder stones.
  • Some objects like contraceptive device or urinary stent may cause bladder stones.
  • Small kidney stones may travel down the ureters into the bladder and if not expelled may turn into bladder stones.

Diagnosis of Bladder Stones

Learn about the investigations and the diagnosis

  • A physical examination will help the doctor to diagnose bladder stones if your bladder is enlarged, or a rectal exam to determine your prostate is enlarged.
  • Analysis of your urine will determine the amounts of bacteria, blood and crystallized minerals present in urine.
  • Computerized tomography (CT) uses X-rays and computers to quickly scan and provide clear images.
  • Ultrasound bounces sound waves off organs and structures in your body to create pictures that help doctor to detect bladder stones.
  • X-ray of your kidneys, ureters and bladder helps doctor determine stones in your urinary system.

Treatment of Bladder Stones

Preparation and Procedure

● A transurethral cystolitholapaxy is the most common procedure used to treat adults with bladder stones. The surgeon inserts a small, rigid tube with a camera at the end (cystoscope) into the urethra and up into the bladder.The camera helps to locate the bladder stones, then a crushing device, lasers or ultrasound waves transmitted from cystoscope can be used to break up the stones into smaller fragments, which can be washed out of the bladder with fluids.

● A transurethral cystolitholapaxy is done under local anaesthesia or general anaesthesia, so you do not feel the pain during the procedure.

● You would be prescribed a set of antibiotics to rule out any infections during and after the procedure.

● A percutaneous suprapubic cystolitholapaxy is used to treat children to avoid damaging the urethra, and also in adults with bigger bladder stones.

● In the above procedure a small cut is made on the skin of the lower abdomen. Another cut is made in the bladder so the stones can be removed.

● This procedure is done on general anaesthesia.

● Open cystostomy is a procedure followed to remove bladder stones in men with a large prostate, or if the stone itself is very large. This procedure is similar to percutaneous suprapubic cystolitholapaxy, except that the surgeon makes a bigger but in the abdomen and bladder.

● You will need a catheter for a day or two after the procedure.

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Patient safety is our priority

● Infection of the bladder or urethra known as urinary tract infection (UTI).

● These are usually treated with antibiotics. 

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What's important after discharge?

● After the transurethral cystolitholapaxy or percutaneous suprabic cystolitholapaxy, you will need to stay in the hospital for a few days to recover.  

● If you have undergone cystostomy, it may be several days before you are well and go home.

● After surgery, you may be asked to attend a follow-up appointment where an X-ray or CT scan can be used to check whether all fragments of the bladder stones have been removed. 

  • DO YOU HAVE QUESTIONS ABOUT BLADDER STONES?
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