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Kidney Stones

How are kidney stones formed?

The kidneys are two bean-shaped organs that help in the removal of wastes from the body. As the kidneys filter blood of impurities, minerals and acid salts can accumulate and harden over time. These solid crystalline deposits are called kidney stones, and can form in one or both kidneys. The stones can travel down the urinary tract and block the flow of urine, causing severe pain and bleeding.

Kidney stone formation is a common urinary system disorder that can form in any individual. However, men and overweight people are at a higher risk of developing them.

What are the different causes of kidney stones?

Kidney stones form when certain salts and minerals in the urine build up and become highly concentrated. This can happen due to

  1. Insufficient water intake
  2. Diet high in salt and animal protein
  3. Family history
  4. Intestinal disease such as Crohn’s disease or previous gastric bypass surgery
  5. Treatments for kidney diseases and cancer
  6. Obesity

What symptoms indicate the presence of kidney stones?

Symptoms of kidney stone formation usually does not manifest until the stone moves down into the urinary tract.

Symptoms may include:

  1. Severe pain below the ribs on the sides
  2. Pain may also occur over the lower abdomen, groin and during urination
  3. Pain that fluctuates in intensity
  4. Frequent urge to urinate
  5. Pink, brown or red urine that is cloudy or foul smelling

You should visit the emergency department or contact your doctor immediately if the pain increases and is accompanied with fever, chills or vomiting.

How are kidney stones diagnosed?

When kidney stones are suspected, your doctor may order blood, urine and imaging tests (X-ray, CT scans) to diagnose the condition. You may also be asked to urinate through a sieve to collect and test the kidney stones that pass in the lab. The results will help your doctor to determine the cause and formulate an appropriate plan for treatment.

How are kidney stones treated?

Treatment depends on the type of stone and its underlying cause. Small kidney stones < 4mm can usually pass without medical intervention. Your doctor may prescribe medication to relieve pain or medication to improve the chances of stone passage.

For larger stones, your doctor may suggest certain procedures based on the location and size of the kidney stones. If there is associated infection, loss of renal function or excessive pain not relieved by medication, urgent emergency surgery is required.

Surgical options include:

ESWL (extracorporal shock wave lithotripsy):
Using a device called a lithotripter, high energy sound waves are focused on the kidney stone from outside the body. The shock waves vibrate and break the stones to pieces without harming the rest of the body. The stone fragments can thenpass out through the urine.

Ureteroscopy and laser tripsy:
A tiny telescope is passed into the ureter through the urethra under general anaesthesia. Once the stone is located, tiny basket shaped instrument at the end of the scope grabs and removes the stones. Larger stones are first broken down with a laser before removal.

PCNL and mini-PCNL:
Sometimes, a more invasive procedure called percutaneous nephrolithotomy may be required for very large stones. Your surgeon will make an incision in your back and insertsa hollow tube with a rigidtelescopeto remove the stones directly or break them into fragments before removing them.

Mini-PCNL is a new technique that uses a smaller tube and smaller incision. The incision is smaller (approximately 7 mm), and allows for less bleeding, pain and facilitate faster recovery

Ureteric stent:
Sometimes, your surgeon may insert a stent or tube before or after kidney stone procedures through the bladder into the kidney to hold the urinary tube open. This prevents ureteric swelling and stone pieces from blocking the ureter and causing pain.
The stent itself can cause some discomfort with flank pain during urination, urinary frequency and urgency, and blood in the urine. We will only use the stent if it is necessary and we will aim to leave the stent in for as short a time as it is safe medically.

Can kidney stones be prevented?

Kidney stones can be prevented by making some lifestyle changes such asdrinking more water, and reducing the intake of excess salt and animal proteins.

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