What are Kidney Stones?

Snapshot kidney stones

A kidney stone is a piece of solid material that forms in the kidney when minerals in the urine become very concentrated. Small stones often pass through the body with little discomfort, but larger stones can be very painful and even block the urinary tract. Kidney stones are more common in adults, but they can also occur in children of any age.

 Epidemiology

The lifetime risk is about 10 to 15%. Higher prevalence in hot, arid, or dry climates such as the mountains, desert, or tropical areas because of increased risk of dehydration Highest incidence in the summer months, June through September. Seasonal variation related to temperature by way of fluid losses through perspiration and perhaps by sunlight-induced increases in vitamin D. The risk of stone disease correlates with weight and body mass index, the magnitude of the association is greater in women than men About 65% of those with kidney stones are men; Men most commonly experience their first episode between 30 and 40 years of age, whereas for women, the age at first presentation is somewhat later. The age of onset shows a bimodal distribution in women, with episodes peaking at 35 and 55 years.

What causes kidney stones?

Dehydration from low fluid intake is a major factor in stone formation. High dietary intake of animal protein, pickles, salt, refined sugars, colas, diet rich in oxalates increase the risk of kidney stone formation. A person with a family history of kidney stones may be more likely to develop stones. Urinary tract infections, kidney disorders such as cystic kidney diseases, and certain metabolic disorders such as hyperparathyroidism are also linked to stone formation. Kidney stones are more common in people with Crohn’s disease. A person with recurrent kidney stones may be screened for such disorders.

What are the symptoms?

-Waves of sharp pain that start in your back and side, and move towards the groin or testicles.

-Inability to find a comfortable position, people with kidney stone pain often pace up and down.

-Nausea and vomiting with ongoing pain.

-Blood in the urine.

-The frequent urge to urinate.

-Foul smelling urine, fever with chills

 

How are kidney stones treated?

Most procedures for small stones can be performed as sameday surgery, allowing you greater flexibility and a rapid return to work and other daily activities. There are three main techniques for kidney stone surgery and the choice of technique depends upon multiple factors, including the size and type of stone, medications you may be taking, your other medical problems and patient preference.

 Ureteroscopy and laser lithotripsy (URS)

Ureteroscopy is typically performed as a same-day procedure under anesthesia. During the procedure, a small scope is passed through the urinary opening into the bladder and from there up into the ureter, (the small tube that drains urine from the kidney to the bladder). Once the stones are located, they are targeted with a laser that breaks the stone into smaller pieces, which are then extracted, or into tiny pieces of dust that wash out of the kidney with normal urine flow.

Retrograde intrarenal surgery (RIRS):

RIRS is a boon for patients with Kidney stones. RIRS is procedure for doing surgery within the kidney using a viewing tube called a fibreoptic endoscope. In RIRS the scope is placed through the urethra (the urinary opening) into the bladder and then through the ureter into the urinecollecting part of the kidney. The scope thus is moved retrograde (up the urinary tract system) to a position within the kidney (intrarenal). The technique allows us to perform surgery inside the kidney without making any incision. In RIRS the stone is seen through the scope and can then be evaporated by a holmium laser probe or grabbed by small forceps. The procedure is usually done under general or spinal anaesthesia. The advantages of RIRS over open surgery include a quicker solution of the problem, the elimination of prolonged pain after surgery, and much faster recovery. By RIRS we are able to remove 100% of stones less 1.5cm in size besides making the procedure almost painless with far less complication and morbidity.

Percutaneous nephrolithotomy (PCNL)

PCNL involves keyhole surgery performed through a 1 cm incision in the skin overlying the kidney. It is most suitable to remove kidney stones of more than 2 cm in size.

Prevention

Recurrence rates are estimated at 50% over a 10-year and 75% over 20-year period, with some people experiencing ten or more episodes over the course of a lifetime. In those who have previously had stones, prevention is recommended by drinking lots of fluids resulting in more than two litres of urine passed per day. As per stone analysis and 24 hour urine analysis report dietary advice is given to you.


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