What is a kidney stone ?

A kidney stone is also called as renal caluculus or nephrolithiasis. These are hard deposits made up of small tiny crystals. A single or multiple stones can be formed in the kidney or ureter at the same time.

Urine  has various solutes dissolved in it. When the concentration of dissolved solutes is increased or if there is little liquid to dissolve the solutes, the solution reaches a metastable state. In such a state, crystallization occurs, and they act as nidus and attract other elements and join together to form a solid that will grow larger.

 

Types of kidney stones

There are four varieties of kidney stones. Calcium oxalate, Struvite stones, Uric acid stones and cystine stones.

  • Among all Calcium oxalate are the most common stones.
  • Struvite stones are usually seen in urinary infection and often called infection stones.
  • Uric acid stones are associated with high blood uric acid levels or in people consuming high protein diet like red meat.
  • Cystine stones are less common and are formed due to an inherited defect in the transport of the amino acid cystine leading to excessive excretion in the kidney.

Symptoms of kidney stones

  1. Severe pain on either side of lower back. The  pain is typically colicky in nature. The pain usually radiates from back to front.
  2. Recurrence of pain in episodes and is so severe that patient cannot sit or sleep in one particular posture. Patients rolls over the bed in pain.
  3. The pain is not releived by antacids.
  4. Sensation of vomiting.
  5. Burning or painful urination.
  6. Blood in urine.
  7. Foul smelling urine.
  8. Fever associated with chills

Diagnosis of kidney stone

Kidney stones are suspected based on the symptoms which are discussed above. Consult a doctor to diagnose the renal stone. They are  usually diagnosed by radiological investigations.

  1. X ray 
  2. Ultrasound
  3. CT scan. 

Treatment of kidney stone

The management of the kidney stone depends on the following 

  1. The size of the renal stone
  2. The site of the renal stone.
  3. It also depends on the complications caused by it like infection, blood in urine , deterioration in kidney function.
  4. Is it a obstructive or non obstructive renal stone.
Medical management

Renal caluculi less than 10 mm size with no complications can be managed medically. Following principles help in removal of kidney stones.

  1. Plenty of fluids to wash out the stones 
  2. Smooth muscle relaxants, to relax the urinary system so that stone can pass through.
  3. Anti spasmodics
  4. Analgesics or pain killers ( caution- To check renal function before using)
  5. Anti-emetics in case of nausea or vomitings.

What is the kidney stone removal surgery?

Surgical management of renal stones is considered when the the size of stone is more than 10 mm or is causing any complication (like infection or obstruction)

The various surgical modalities available are

  1. ESWL
  2. URSL
  3. PCNL
  4. RIRS
ESWL

Extracorporeal shockwave lithotripsy, is a very common method used for treating kidney stones. It utilizes an energy source which generates a shock wave that is directed at the stone. Shock waves are transmitted to the patient using a water-filled cushion that is placed against the skin. X-rays help aim the shockwaves at the stone and the repeated force caused by the shock waves fragments the stone into small pieces which can then be collected by a urethroscopy.

 

URSL

Ureteroscopic lithotripsy is a highly effective and minimal invasive procedure in the treatment of ureteric stones. Nowadays, most of the ureteric stones can be treated with URSL.It is a minimally invasive option for treating stones in which the doctor inserts a scope with a camera attached to it down the urethra through the ureter to reach the bladder. Stones smaller in size can be removed with additional instruments like a small basket.

 

PCNL 

Percutaneous nephrolithotomy is a surgery to remove large stones directly from the kidney. It is an excellent option for patients with large kidney or ureteral stones (generally > 2 cm), multiple large stones, or stones resistant to prior treatments. It is performed through a small cut in the skin, it is highly effective with a success rate between 75% and 99%.

RIRS

Retrograde Intrarenal Surgery is performed without giving a incision on the kidney. It is done by negotiating a scope through the urethra into the the ureter and finally  into the urine-collecting part of the kidney. The scope is therefore moved retrograde, i.e. up the urinary tract system to within the kidney, i.e. intrarenal. Once the scope is in place, the doctor can see the stone and can proceed to manipulate or crush it by an ultrasound probe or be evaporated by a laser probe or even grabbed by small forceps.

What is the best procedure to remove kidney stones ?

A renal stone left in place is always a risk for an infection and can damage the kidney function as well. It is always advisable to remove the renal stones whenever posible. The laser therapy ( extra corporeal shock wave lithotripsy) will help in breaking the stone into small particles and that can be removed with the help of suction.

We are specialized in doing all surgical interventions in renal stone removal.