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Kidney Stones

 

Stone disease is quite common nowadays. This situation can be attributed to reasons such as inactivity, unbalanced nutrition and low water consumption.    

 

How are Kidney Stones Formed?

 

There are many reasons for kidney stones. These can be classified as metabolic causes, anatomical causes and infections. In fact, there is a common mechanism in almost all kidney stone formation cases. This is because we all have a large amount of various substances in the urine (eg hypercalciuria), urine can not be excreted properly (for example, urinary tract stenosis), or for reasons such as low consumption of water, causing sediment settling to the bottom of urinary tract. It is known as sand casting, as we all know, when this sediment crystallizes with a rich content of various minerals (eg calcium). And if a suitable environment is formed, these crystals combine to form kidney stones. This is one of the main reasons why it is recommended that each adult consume 2 liters of water per day. The most common stones are calcium stones. The use of high amounts of vitamin D is also a common cause of calcium stones. In addition, uric acid, cystine, struvite (infectious stone) and rare stone types are available.

 

What are the common symptoms of kidney stones?

 

If kidney stones cause urinary obstruction, especially when mobilized, they may cause serious pain (renal colic) especially in the back and lateral areas if they enter the urinary canal. Urine bleeding and burning may occur. It may also cause symptoms such as nausea and vomiting, as the kidney and urinary nerves originate from the stomach.

 

How are kidney stones diagnosed?

 

An imaging method must be used for the diagnosis of kidney stones. Anyone with suspicion is first given a urinary system ultrasound (USG). With this ultrasonography, the kidneys, ureters and bladder are evaluated. Although ultrasound is a good way of assessing the condition of the kidney, it is not the gold standard for stone. A computed tomography (CT) that will be taken without contrast will give the most accurate results. CT can be used to evaluate the location and size of the stone, as well as the condition of the urinary tract and kidney.

 

Which tests should be done to people with kidney stones?

 

Anyone with a kidney stone must undergo an urine analysis (TIT), blood urea and creatinine (renal function tests) and US / CT. Depending on their results, additional investigations may be required.

 

Can kidney stones be prevented? Do you need a special diet for kidney stone prophylaxis?

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It is possible to prevent many kidney stones. First of all, we need to find the cause of kidney stone formation. For this, metabolic analysis of all kidney stone patients (urine and blood tests, if possible, examination of the stone sample) is required. If a metabolic cause of kidney stone formation is found, it may be possible to prevent it with medication and prevent the formation of another kidney stone. In addition, if there is an anatomical problem (eg, urinary narrowing) that causes kidney stone formation, treatment of this will prevent the kidney stone from regenerating. Although these analyzes should be performed to prevent the formation of kidney stones, the most important dietary rule is that daily water intake is over 2 liters. Apart from this, it is recommended to take less of animal foods, basically mediterranean type diet is a good choice. Caffeinated beverages, nuts, high amounts of vitamin D, and excess amounts of milk and dairy products will facilitate stone formation.
 

Should all kidney stones be treated?

 

No. Your urologist will decide which stones will require treatment. Stones that disrupt kidney function, damage the kidney, cause enlargement of the urinary tract (hydronephrosis), and cause severe pain are intervened as soon as possible. However, there are also stones that can be followed for years without any symptoms.

 

How are stones treated?

 

1-Medical Treatment, waiting for spontaneous stone passage

The majority of stones up to 5 mm can be passed with urine just with the help of some painkillers, antispasmodic medication and plenty of fluids. The larger the size of the stone, the less likely it is to pass without intervention.

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2-ESWL ( Shock Wave Lithotripsy)

Shock waves generated outside the body, focus on the stone and break the stone into small pieces as much as possible during this treatment. These parts are then expected to be excreted in the urine. In order to reduce pain during the procedure, it may be necessary to use sedatives or mild anesthesia. After ESWL, it may take days or even weeks for stone particles to fall out. In this method, it cannot be predicted how small the stone is to be divided into small pieces, and problems may occur in the following period. Patients may experience pain and develop urinary tract inflammation. Rarely, there may be delay in the accumulation of fragments in the ureter canal (sand path, stone path) and this may require additional treatments like ureteroscopy. 

 

3-Percutaneous Nephrolithotripsy (PCNL, Closed Kidney Stone Surgery)

Percutaneous kidney stone surgery is a technique used if endoscopic laser treatment cannot be performed. In this method, especially large stones in the lower part of the kidney are intervened. Although it is a much more invasive technique than endoscopy, it is still a more comfortable technique than open surgery. Unlike endoscopic surgery, instead of waiting for the stones to fall out, the stones are taken out through a hole in the side of the patient's back side. Blood is always kept ready for the risk of bleeding during surgery. It also requires 3-5 days of hospitalization after surgery.

 

4-Ureteroscopy

If the stones in the ureter cannot pass spontaneously, they can be treated by a device entering through urethra to the urinary tract with the help of instruments called ureteroscopes. Rigid ureteroscopes are used to pass the urinary tract and bladder into the ureter and the stones are treated with Holmium laser or pneumatic stone crusher. Stones in the lower and middle ureters can be treated with these ureteroscopes. Flexible curling ureteroscopes are used in the treatment of stones in the upper ureter and pockets called ponds and calices in the kidney, since their tips can be rotated in various directions and angles. After uretereroscopic stone treatment, patients are discharged home on the same day or the day after.

 

5-Flexible Ureterorenoscopy (Full Endoscopic Renal Stone Surgery, Retrograde Intrarenal Surgery, RIRS)

The kidney from the ureter is accessed by a thin wire-like device. After the stone is imaged endoscopically, it is fragmented by laser until it becomes sand-sized. Subsequently these sand-sized fragments are passed spontaneously. This method is the easiest and most successful method among all kidney stone treatments. It requires high technology and experience. Success is very high if done in competent hands.

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6- Open Surgery

Today, thanks to technological advances, open stone surgeries are almost never performed. However, it is still used in cases where stones larger than 4 cm are treated in a single session and stone placement does not allow endoscopic treatments.