Kidney Stone Disease
The kidneys are two bean-shaped organs that help in the removal of wastes from the body.
As the kidneys filter the 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.
Kidney stones form when certain salts and minerals in the urine build up and become highly concentrated. This can happen due to:
- Insufficient water intake
- Diet high in salt and animal protein
- Family history
- Intestinal diseases such as Crohn’s disease or previous gastric bypass surgery
- Treatments for kidney diseases and cancer
Symptoms of Kidney Stones
Symptoms of kidney stone formation usually do not manifest until the stone moves down into the urinary tract.
Symptoms may include:
- Severe pain below the ribs on the sides
- Pain may also occur over the lower abdomen, groin and during urination
- Pain that fluctuates in intensity
- Frequent urge to urinate
- 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 by fever, chills or vomiting.
Diagnosis of Kidney Stones
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 the kidney stones, to be tested in the lab. The results will help your doctor to determine the cause and formulate an appropriate plan for treatment.
Treatment of Kidney Stones
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.
Procedures to Treat Kidney Stones
ESWL (Extracorporeal 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 then pass out through the urine.
Ureteroscopy and Laser Tripsy
A tiny telescope is passed into the ureter through the urethra under general anesthesia. Once the stone is located, a 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 inserts a hollow tube with a rigid telescope to 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 facilitates faster recovery.
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.
Kidney stones can be prevented by making some lifestyle changes such as drinking more water and reducing the intake of excess salt and animal proteins.