How do urinary stones form?
The waste products of body metabolism are excreted by kidneys as Urine. Urine contains various salts and minerals. Urine needs to be constantly excreted out to maintain good health. When ever there is increase in concentration of these salts and minerals in urine, they bind together to form stones.
How to identify stone disease ?
The Urinary stone disease usually presents with certain symptoms, they are.
- Severe one sided abdominal pain associated with nausea
- Blood in urine
- Urgency and increase in frequency to pass urine
- Fever with chills.
The above mentioned symptoms vary based upon the size, location and number of stones. In the presence of these symptoms, diagnosis of urinary stone can be confirmed by a set of investigations. They are
- Urine routine
- X-ray KUB
- USG Abdomen
Once the diagnosis is confirmed by these above mentioned investigations, the patient may require further investigations Like CT KUB and IVU to individualize the treatment plan.
Treatment Plan For Urinary Stones
Majority of stones can be managed with medicines. Some stones however need further treatments.Based on location this can be-
- RENAL STONES - ESWL, RIRS, PCNL, Open pyelolithotomy.
- URETERIC STONES - ESWL, URS AND LITHOTRIPSY, Open ureterolithotomy.
- BLADDER STONES - Cystolithotripsy, Open cystolithotomy.
ESWL ( Extracorporeal Shock Wave Lithotripsy )
Shock waves are produced by an external energy source. They are aimed at the Renal stone from outside the body by means of X-ray.This treatment is used for stones in kidney and upper ureter 8mm – 15mm in size.This is an outpatient treatment and modern machines do not require anaesthesia to be administered to the patient.
URS (Ureteroscopy) and Lithotripsy
Used for managing ureteric stones. It is an endoscopic procedure where very narrow 1.3mm and 2.6mm endoscopes are passed into ureter and stones identified and broken (lithotripsy) using Lasers or Pneumatic lithotriptors. No skin incisions are required.
Requires anesthesia. Patient can resume normal activities on the next day of surgery
Technique of Ureteroscopy
The use of thin and flexible endoscopes combined with Laser can greatly improve the success of the procedure and decrease the complication rate.
PCNL (PerCutaneous NephroLithotomy)
Used for treatment of larger Renal stones. This is also an endoscopic procedure, but requires a 1 cm incision in the flank. Kidney will be approached via a hole in the flank and the stone will be cleared by lithotripsy. Efficient method of stone removal especially for large bulky stones. Requires 4 days hospital stay after surgery. Patient will be able to resume his normal activities from 14th day of surgery.
RIRS (Retrograde Intra Renal Surgery)
Latest innovation in stone management. Used for treatment of renal stones less than 3 cms. A flexible 2.7mm Ureteroscope is passed into kidney via normal urinary passage and lithotripsy is done. Patient will be able to resume normal activities the 2nd day following surgery.
Actual view of Flexible Ureteroscope in use
Laparoscopic stone removal
Few very large and complicated stones which would otherwise require open surgery, can be managed laparoscopically. Laparoscopy involves making small 1cm and 0.5cm key holes in the abdomen to do internal surgery.
Used for stone removal in olden days. Not very commonly used now a days. Used now for very complex stones in anomalous kidneys.
How does one prevent stone formation/ recurrence ?
A person who has had a renal stone in the past, is 30 -50% more likely to have a stone in the next 5 years than a non stone former. Therefore it is very important to follow certain diet and life style modification to prevent stone formation.
- Maintain 2-2.5 liters of urine output a day, by drinking about 3 liters of water.
- Regular exercise.
- Reduce salt and sugar intake.
- Reduce intake of Non vegetarian diet.
- Restrict intake of milk to not more than 2 cups per day.
- Avoid soda and other aerated drinks
- Intake of foods which prevent stone formation. - Bananas, Citrus fruits (lime, orange), Tender coconut water, Pine apple, Carrots and bitter guard.