Urinary Stone

Properly functioning Kidney is as important to health as heart or lungs.

Normally, there are two kidneys, one on either side of the spine under the lower ribs. They are reddish brown in color and shaped like kidney beans. Each kidney is about the size of the clenched fist. The main job of the kidneys is to remove wastes from the blood and return the cleaned blood back to the body. The urine is collected from the tubules in a funnel-like renal pelvis and then flows through a tube called the ureter into the muscular sac like urinary bladder. Once the bladder is filled to an optimum capacity (350-500 milliliter), one gets an urge to pass urine. Bladder is emptied to the exterior by the urethral tube.

 

Functions of kidneys are :

  1. Kidneys regulate water:
  2. Kidneys remove wastes
  3. Kidneys produce hormones. These hormones circulate in the bloodstream and regulate some body functions such as blood pressure, the making of red blood    cells, and the uptake of calcium from the intestine.
  4. Kidney regulates Blood Pressure by releasing the substance called Renin.

Urinary Stones Disease

Theory of Stone Formation

Stones are nothing but an aggregation and concentration of the crystals of calcium, phosphate, uric acid etc in the urinary tract. The process by which the stone formation occurs is “Supersaturation of urine”.

Imagine a glass of water containing little salt .If you add some more salt, it dissolves. When you add more and more salt, a stage is reached when the water is no longer able to dissolve the salt added to it. This is because the solution is supersaturated with the salt. Above this point, any little amount of salt added to the solution will start precipitating. This is exactly the mechanism by which kidney stones form except that the solution is urine and the chemical composition of the salt is different.

Incidence of Stone Formation.
  • There is incidence of 12% have stone in their lifetime.
  • 12% of men will suffer from kidney stone by age of 70.
  • 5% of women will suffer from kidney stone by age of 70.
  • 50% have recurrence with in 5-10 yrs.
  • Highest incidence of kidney stone is in 30-45 years of age group, and incidence declines after age of 50.
  • 7-10 of every 1000 hospital admission is of renal stone.
  • There is incidence of 12% have stone in their lifetime.
Symptoms of Stone
  1. Pain:
  2. Pain depends on size and site of the stone. Stone can be in kidney, Ureter and Bladder. Pain of Kidney stone arise from back and may or may not radiate in front to lower abdomen and is dull ache at the back that gets relieved by oral painkillers.

    Pain in Ureter is Acute pain radiating from back to the lower abdomen in front. This pain is associated with vomiting and not relieved in any position.

  3. Nausea and Vomiting.
  4. Blood in urine.
  5. Fever
  6. Urgency and frequency of Urination.
Diagnosis

In addition to a complete medical history and physical examination diagnosis prodecure for urinary stone include

  1. Abdominal Sonography.
  2. Intra Venous Pyelography.
  3. Intra Venous Pyelography.

Treatment for Urinary Stones

Specific treatment for the urinary stone disease will be determined by doctor on

  1. Your age, over all health and medical history.
  2. Extent if disease.
  3. Your tolerance for specific medication, procedure or therapies.
  4. Expectation of the course of disease.
  5. Your opinion or preferences

 

Mode of treatment available for urinary stone disease are :
ESWL (Extra Corporeal Shockwave Lithotripsy)

In this modality a machine is used to send the high frequency sound wave from outside the body directly to the kidney stone. These shoackwaves break the larger stone into fine gravel which eventually are flushed out in urine.

Usually renal stone less than 15 mm are opted for these modality, only after confirming on IVU that passage of stone inside the kidney is open.

Ureteroscopy

    Ureteroscopic Lithotripsy with Holmium Laser - This procedure is performed under regional Anaesthesia to treat stones located in the ureter. A small, fiberoptic instrument (ureteroscope) is passed into the ureter. Stones are fragmented using Holmium Laser. The laser fragments stone into sand like particles, which are then flushed out through the natural urinary passage. The advantage of Holmium Laser is its ability to fragment stones of all compositions and precision and in any part of ureter without pushing stone back in to. Thus, it is the most effective laser for the treatment of ureteric stones.. Patient is hospitalized for 24 hours for ureteroscopy

PCNL

Percutaneous Nephrostolithotomy (PCNL) This minimal invasive procedure is performed under local anesthesia. Percutaneous (i.e., through the skin) removal of kidney stones (lithotomy) is accomplished through the most direct route . A telescope along with mechanical lithotriptor in inserted to break stone into fine particles to achieve stone-free status in large and complicated stones. This procedure usually requires hospitalization, and most patients resume normal activity within 2 weeks.

Percutaneous Nephrolithotripsy (PCNL)

In this technique the stone is removed by making a small tunnel into the kidney from the back. A fine needle is used to puncture the renal collecting system with the aid of X-ray and/or Ultrasonograpy, and a guide wire is led into the kidney through the needle. This tract is dilated over the guide wire and a Nephroscope (kidney telescope) is inserted into the pelvis of the kidney. The stones are visualized, fragmented using Lithoclast and extracted using fine forceps, allowing the kidney to become free of stones at the end of the operation, in the vast majority patients. This is of course an operation, needing full general anesthesia, average 90 minutes of operation time, 3 -4 day hospitalization, Patient returns to light work in 5-7 days time. Nevertheless the operation is safe, for both the patients and the kidney.

Retrograde Intra Renal Surgery (RIRS)

This is the minimal invasive surgery were in stones inside the kidney are fragmented using the special flexible scope is inserted urethra and kidney is reached and stone is located in side the kidney. These stone is then fragmented with Holmium laser in to fine sand like particle which later on passed in to the urine..