Stones

Sometimes "silent" stones - those that cause no symptoms - are found on X-rays . These stones would likely pass unnoticed. If they are large, then treatment should be offered. More often, ureteral stones are found on a X-ray or sonogram taken on someone who complains of blood in the urine or sudden pain. These diagnostic images give us valuable information about the stone's size and location. Blood and urine tests also help detect any abnormal substance that might promote stone formation.

If we suspect a stone but is unable to make a diagnosis from a simple X-ray, he/she may scan the urinary system with intravenous pyelography (IVP). It is an imaging technique that utilizes radiopaque injections of dye followed, during excretion by the kidneys, by abdominal X-rays. A kidney obstructed by a stone will not be able to excrete the dye as quickly and may also appear enlarged when compared to the normal organ.

Treating kidney stone disease depends largely on the size, position and number of stones in your system. Luckily, the majority of small stones (0.2 inch or 5 mm in diameter) that are not causing infection, blockage or symptoms will pass if you simply drink plenty of fluids each day. Consuming two to three quarts of water increases urine production, which eventually washes kidney or other stones out of the system. Once they have passed, no other treatment is necessary. We usually asks one to save the passed stone(s) for testing.

Also, the sudden pain that occurs when small stones start down the ureter can usually be treated with rest and analgesics or painkillers. Certain types of stones, such as those made of uric acid, can be shattered with medical therapy. The majority, however, are composed of calcium and are not responsive to medicine.
Surgery should be reserved as an option for cases where other approaches have failed or should not be tried. Surgery may be needed if a stone:

• does not pass after a reasonable period of time and causes constant pain
• is too large to pass on its own
• blocks the flow or urine
• causes ongoing urinary tract infection
• damages kidney tissue or causes constant bleeding
• has grown larger (as seen as follow-up X-ray studies)

Extracorporeal shock wave lithotripsy (ESWL®).

Shock wave treatment that uses a machine called a lithotripter. Lithotripsy fragments a stone into pieces small enough to pass out with urination. "Extracorporeal" means the shock waves come from outside the body. For treatment with ESWL®, the patient is placed on a specialised table against a water filled cushion. A lithotripter makes shock waves, and the doctor, using ultrasound or X-rays, focuses the waves exactly on the stone inside the patient's body. They travel easily through both the water and the patient's soft body tissues, until they hit the stone. The impact causes stress on the stone. Repeated shock waves cause more stress, until the stone eventually crumbles into small pieces. Because of possible discomfort during the procedure, the patient may need general, regional or local anesthesia or some form of sedation.

Ureteroscopy (URS) with HOLMIUM LASER:

Ureteroscopy involves the use of ureteroscopes, small flexible or semi-rigid telescopes that can be inserted up the urethra, through the bladder and into the ureter without an incision. These instruments allow us to view a ureteral stone directly. They also have small working channels through which various devices can be passed to remove or fragment the stone. Fragmentation is achieved with a pneumatic lithoclast or Holmium laser device. Anesthesia is generally used, and a stent is left in the ureter for a few days after treatment while healing takes place.

Percutaneous nephrolithotomy (PCNL)/ MiniPERC with Laser

This procedure is the treatment of choice for patients with large kidney stones(>2.5 cm) or for large impacted upper ureteric stone In this procedure, the surgeon makes a tiny cut in the flank area and then uses an instrument called a nephroscope to locate and remove the stone. For larger stones, a type of energy probe (pneumatic lithoclast, Holomium Laser) may be needed to break the stone into small pieces. All of this is done while the patient is sedated or under anesthesia.

One advantage of this procedure over SWL is that the surgeon removes the stone fragments instead of relying on their natural passage from the ureters.

RETROGRADE INTRARENAL SURGERY ( RIRS ) With LASER

It is newest treatment modality which uses a small flexible ureteroscope which goes right upto the kidney and fragment stone with use of miniature Laser fibre .

Although stone recurrence rates differ with individuals, in general you have a 50 percent chance of redeveloping stones within the next five years. So prevention is essential. We follow-up with several tests to determine which factors - e.g., medication or diet - should be changed to reduce your further risk.

A good first step for prevention is to drink more liquids - water is the best. If you tend to form stones, you should try to drink enough liquids throughout the day to produce at least two quarts of urine in every 24-hour period. People who form calcium stones used to be told to avoid dairy products and other foods with high calcium content. However, recent studies have shown that foods high in calcium, including dairy foods, help prevent calcium stones. Taking calcium in pill form, however, may increase the risk of developing stones. Women taking vitamin D and calcium pills in the post-menopausal period to prevent osteoporosis, especially with family history of stones, need to be careful.

In general, you are facing surgery if your stones are large enough to obstruct urine flow, if they are potentially harmful to your kidneys or if they are causing symptoms for which medication does not help.

Any person with a family history of stones may be at higher risk. Stone disease in a first degree relative, such as a parent or sibling, can dramatically increase the probability for you. In addition, more than 70 percent of people with certain rare hereditary disorders are prone to the problem. Those conditions include cystinuria, an excess of the amino acid, cystine, that does not dissolve in urine and instead forms stones of cystine; and primary hyperoxaluria, an excess production of the compound oxalate, which also does not dissolve in urine, forming stones of oxalate and calcium.

No, there is no known link. They are formed in different areas of the body. Also, if you have a gallstone, you are not necessarily more likely to develop kidney stones.

Stones occur with sudden agonizing pain which comes in waves, starting from the lower back and spreading towards the groins.

Some Kidney stones are silent: they produce no pain. 80% of Kidney stones are passed naturally without damage to the Kidneys or the urinary tract system, while 20% can prove harmful. Timely diagnosis and prompt action reduces the suffering and preserves Kidney function. The stone once removed is prevented from recurring.

The presentation of symptoms depends upon the location, size and shape of the stone.

Sudden, severe pain - starting at the flanks and moving towards groins.

• Nausea and Vomiting.
• Blood in Urine.
• Urinary frequency.
• Burning sensation on passing Urine.
• Infection in Urine.

People who tend to form stones have certain risic factors in common.

Those who have lived or are still living in the stone belt of the country e.g. Punjab - Rajasthan - North Gujarat Kutch-Saurashtra

Those with a family history of stones.

Those whose fluid intake is minimal.

Each human being has two Kidneys - one on either side of the spine in the lower back, shaped like a bean, each is the size of an adult fist and is pinkish - brown in colour. Kidneys are complex, versatile filtering as well as manufacturing units:

Those with a family history of stones.

They remove fatal toxic substances from the blood stream and maintain normal chemical composition by forming urine.

They regulate the blood pressure of the human system.

They process Vitamin - D.

They produce chemicals that go to form the red blood cells.

If certain chemicals concentrate within the Kidney they can form a stone ranging in size from microscopic to about as large as a golf-ball. Stones may stay in the Kidney or move into the urinary tract.

Stones form due to many reasons:

A. Fluid loss: Commonly known as dehydration, makes concentrated urine which in turn precipitates salts which result in stone formation.

B. Certain Foods: Contain high amounts of the chemicals which in particular situations crystallize and grow into stones.

C. Kidney Infection: Foster stones due to the process of precipitation of certain chemicals.

D. Abnormal Urinary Tract Anatomy: Results into obstruction and stagnation of urine resulting into stone formation e.g. horseshoe Kidney, ectopic Kidney, obstruction.

Identifying Kidney Stones:

Kidney stones are identified by their size, shape and composition.

Some of the stones are formed due to infection.

In the Kidney calyx they pass spontaneously or lodge else where in the urinary tract - stay and grow.

Some stones move to the Kidney pelvis and increase in size blocking the flow of urine, thus compromising Kidney function giving rise to pain, swelling and sometimes infection.

Stones which grow in the Kidney and occupy all its area form a staghorn calculus. They are of different types depending upon presence or absence of infection.

A stone if small (less than 7 mm) comes down further into the ureter, blocks the flow of urine, producing symptoms like pain, blood in urine, burning during urination.

Water helps flush out stones by increasing urine production. Water also reduces your risk of new stones by diluting the chemicals in your urine. Also avoid liquids that dehydrate you, such as caffeine and alcohol.