Kidney stones

What are kidney stones?

The kidneys remove the waste from our bodies through urine or blood. Too much waste that is not removed from our bodies turns into crystals. These crystals contain salts, minerals, and other chemicals. In time, they grow in size and become big solid stones. They continue to grow unless removed from the body.

Kidney stones can be small like sand grains or as big as a golf ball. Their texture can be rough or smooth. They are brownish or yellowish. Other names of kidney stones are nephrolithiasis, renal calculi, or urolithiasis.

Kidney stones cause immense pain and discomfort. They can affect the urinary tract including the bladder and the kidneys. Sometimes the stones pass through the urine without causing much discomfort. But if the stones clog up, they can block the normal flow of urine and cause infection and pain.

Types of kidney stones

There are four types of kidney stones. Depending on each type, doctors prescribe medications or plan the course of treatment.

Calcium stones

These are the most common type of kidney stones found in the body. Oxalate is a chemical produced by the liver or is absorbed from the food we eat. Overconsumption of certain foods like chocolates, fruits, or nuts increases oxalate in our body.

Calcium stones are concentrated forms of calcium oxalate. Gastric bypass patients have chances of retaining higher oxalates in the body. Certain medications and metabolic disorders may cause calcium stones. People who sweat a lot or do not drink enough fluids have a high chance of getting kidney stones.

Struvite stones

They occur in adults who have repeated UTIs (urinary tract infections). The stones form in the urinary tract and cause infections.

Cystine stones

This is a genetic disorder. People with cystinuria produce too much cystine (chemical compound). This chemical accumulates in the urine and causes cystine stones.

Uric acid stones

Consuming too much animal protein or diabetes can lead to uric acid stones. Gastric bypass surgery or metabolic disorders can cause uric acid kidney stones.

Causes for kidney stones

Men have greater chances of getting kidney stones than women. Kidney stones occur when there are high levels of oxalate, calcium, and uric acid in the urine. If the body does not have enough urine, it fails to drain out the body’s wastes. These minerals form chunks of solids and develop into kidney stones. People over 40 are more prone to the disease.

Risk factors for getting kidney stones:

• Obesity
• Chronic diarrhea.
• Dehydration.
• Family history of the disease.
• Sedentary lifestyle.
• High sodium and protein diets.
• Pregnancy.
• High blood pressure.
• Medical conditions like inflammatory bowel disease, gout, hyperparathyroidism, cystinuria, Dent’s disease, etc.
• Gastric bypass surgery.
• Certain medications, diuretics, corticosteroids, antiseizure drugs, etc.
• Vitamin C supplements.

Treatment options

All kidney stones do not need treatment. Some kidney stones are very small and are removed from the body during urination. If you are having any symptoms, it is best to talk to your doctor and decide on the treatment plan.

Pass the urine

If the kidney stone is very small, it can pass through the urine. To help pass the kidney stone:

• Drink six to eight glasses of water. It will keep the urine clean and prevent the building up of wastes in urine.
• If the pain is severe, over-the-counter medications like naproxen or ibuprofen can help. Consult the doctor before taking any medication.
• Some doctors prescribe alpha-blockers. They relax the ureter muscles and help ease the passage of urine.
• Doctors may ask to send the urine to the laboratory for testing.

Medications

Sometimes the kidney stone(s) are big in size. In that case, doctors prescribe medications to break the kidney stones into small particles to easily remove them from the body. Tamsulosin is a medication that relaxes the ureter muscles and helps the kidney stone to pass easily. Diuretics are prescribed to reduce the release of calcium in the urine.

Surgery

A doctor recommends surgery if:

• The stones fail to pass through the urine.
• The patient is in a lot of pain.
• The stone is getting bigger.
• It is blocking the normal passage of urine.
• There is an infection.

Patients who have small stones can ask for surgery because they fear that the stones may pass, get bigger in size, or cause pain.

Diagnosis

If the doctor suspects a kidney stone, he/she will order some tests.

• Blood tests to measure the level of uric acid or calcium in the blood.
• A 24-hour urine test to see the residues of kidney stones in the urine. The doctor may ask to collect two urine samples in 2 consecutive days.
• Abdominal x-rays and CT scans to examine the stones.
• Patients are often asked to use a strainer to collect the stones after urination. It helps the doctors to examine the structure and nature of the stones.

Preparation

The medical team will give you certain instructions before surgery.

• Do not smoke.
• Stop certain medications like blood thinners.
• Avoid eating or drinking anything the night before the surgery.
• Ask a friend or a relative to drive you home after surgery.

Sometimes doctors put an internal stent in the ureter. This dilates the ureter and makes the removal of stones easy. It also reduces pain and removes the infection from the body.

Procedures

ESWL or Extracorporeal shock wave lithotripsy

An ultrasound helps to locate the kidney stone. Repeated shock waves break the kidney stones into pieces. The stones pass through urine within a few weeks. The procedure takes approximately one hour and is done under sedation, general, or local anesthesia. Patients can go home after one hour. There are no incisions but patients can feel some pain after the procedure.

URS or Ureteroscopy

The procedure removes kidney stones from the ureter and the kidney. The surgeon passes a ureteroscope, a thin telescope through the bladder and up to the kidney. For bigger stones, a laser is used to break them. The stones are collected in a basket and removed from the body. After the procedure, the surgeon places a temporary stent in the ureter. It helps the urine to pass through the bladder. There are no cuts involved. Patients can home the same day and resume normal activities after 2 or 3 days.

PCNL or Percutaneous nephrolithotomy

PCNL method is best for removing large stones. The procedure is done under general anesthesia. An incision cut of about half an inch is made on the back to allow the nephroscope to enter. The nephroscope breaks the stones and sucks them out. A tube is placed in the kidney to help the urine pass into a bag and to stop bleeding. Patients have to stay the night in the hospital. The tube is removed after one day or a few days.

Laparoscopic surgery

This procedure is done when the stone is abnormally large or resists fragmentation. It is normally done when the other procedures fail to remove the stones. Small incisions are made to remove the stones. After the procedure, a stent is placed which is removed after one or two weeks.

When should you go for treatment?

Some kidney stones are asymptomatic. You can move and do your normal daily activities without noticing any discomfort or pain.

You will start getting the symptoms once the kidney stones start to move. They move around the kidney or the bladder. This is the time to ask for a doctor’s consultation.

Symptoms:

• Renal colic. It causes severe pain between the ribs and the hip, side of the body, or lower abdomen. The pain can spread to the groin.
• Severe intermittent pains.
• Painful urination.
• Frequent urge to urinate.
• Pinkish, reddish, brownish, or cloudy urine.
• Vomiting and nausea.
• Fevers and chills.
• Burning sensation while urinating.
• The amount of urine is less during each urination.
• Blood in the urine.
• Pungent-smelling urine.
• Weakness.
• Diarrhea.

Surgery options

Kidney stone surgery may require an overnight hospital stay. Some procedures require the placement of a stent. In that case, patients have to stay in the hospital for a few days for observation. In extracorporeal shock wave lithotripsy, patients can go home after some rest.

Once you decide to have the surgery, the next step is to choose a hospital or clinic where you can have the procedure. Many doctors prefer to have the surgery in their own clinic or refer their patients to other hospitals.

Small clinics

Pros

• Outpatient surgeries are cheaper than hospitals.
• Personalized care.
• Patients can schedule surgeries at their convenience.

Cons

• Low staff members.
• Small clinics may lack the expertise or staff to handle critical patients.

Big hospitals

Pros

• A larger team of staff members.
• Multispecialty services.
• Varied equipment and expertise to handle complications post-surgery.

Cons

• High cost of surgery.
• Patients have to wait for long hours to get a consultation.

Cost of surgery

Before estimating the cost of kidney stone surgery, you must consider certain factors.

• The facility or hospital where you are having the surgery.
• The size of the stone and the symptoms.
• A hospital stay will cost you more than an outpatient surgery.
• Surgery team fees.
• Medications
• Diagnostic tests.
• Follow-up visits.
• Aftercare service.

Post-op care and things to keep in mind

It is usual to feel some nausea and pain in the region from where the stones were removed. Patients may notice some blood in the urine. The symptoms resolve after some days.

Self-care tips:

• Drink plenty of fluids. This helps easy passage of urine. Drinking fluids also help leftover kidney stones to pass through the urine.
• Follow your normal diet.
• If you have a stent implanted, do not pull it without asking your doctor.
• Avoid doing strenuous activities.
• Do not get constipated. Add roughage to your diet.
• Take your medications as directed.
• Come for follow-up visits.

Complications of kidney stone surgery

Complications include:

• Infection
• Bleeding
• Fever
• Leftover fragments of stones
• Ureteral injury
• Nausea
• Blood during urination
• Urine infection
• Digestive problems
• Anesthesia complications

Best options

Treatment depends on the type and size of the kidney stone. Doctors recommend surgeries if the kidney stone does not pass through urine. 

There are different surgical procedures. Laparoscopic surgery emoves stones that are difficult to remove through other procedures. Goficure is a healthcare provider in elective surgeries. They have a dedicated team of experts called Medi-Pals. They assist the patients throughout the surgery process.

References