Urinary stones are common, seen in more than 5% of adults. It is a painful condition and requires immediate medical attention. The need for medical attention is to get relieved of pain and to avoid the further consequences of presence of obstruction and the stone itself.
THE NORMAL URINARY TRACT
We have a pair of kidneys located in the abdomen . Kidneys produce urine. Urine is transported via 2 tubes called ureters to the bladder. Bladder stores the urine to its capacity and it is passed out intermittently.
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.
The Urinary stone disease usually presents with certain symptoms, they are.
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
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-
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. 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 | (click to see procedure details)
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.
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)| Click for procedure details
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
Flexible Ureteroscopes
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.
Open Procedure
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.
