Treatment of renal stones not only includes removal of existing stones to relieve symptoms but also to prevent future stone recurrence.
Treatment of existing stone depends on three important factors which are stone size, location of stone in the urinary tract, and composition or hardness of stone. Some less important factors are patients choice and surgeon experience in particular modality of treatment.
Less than 5mm stones have significantly higher chances of spontaneous passage in urine. Patients with less than 5mm stones can be observed with analgesics and plenty of oral liquids, which aids in stone passage. As the size of stone increases the chances of spontaneous passage decreases, and surgical options are required. Before describing the modalities of treatment for renal stones, it is important to look at the possible complications that can occur if one ignores urinary stones.
What are the potential adverse outcome with renal stones besides pain?
Long standing kidney stones can lead to kidney damage. Kidney stones cause obstruction to the flow of urine, which is responsible for the complications. This can be uro-sepsis, or pus in urinary system, which can become a life threatening situation. Permanent dysfunction of the involved kidney and renal failure in case if both the kidneys are involved leading to dialysis and renal transplantation.
Also Read: Renal stones-Symptoms and diagnosis.
What are the surgical options for treatment of urinary stones?
Ureteroscopy: Ureteroscopy refers to passing of a semi rigid endoscope into the ureter through the urethra. It is used for the visualisation and treatment of lower ureter stones. With expertise and favourable anatomy, sometimes middle ureter stones are also amenable to this modality. After the stone is visualised, it can be removed under vision using special forceps or a basket like device. No stitch or incision is required. Generally one day hospital admission is required unless patient is suffering from additional medical co-morbidities or complications like infection. This procedure can not be used for kidney stones and upper ureteric stones.
ESWL or Extra Corporeal Shockwave Lithotripsy: Also commonly known as lithotripsy. In this procedure kidney stone is fragmented with the help of Shock Waves. The Shock Waves are focused on to the Kidney Stones from outside the body which fragment stones into smaller pieces. The smaller fragmented stones pass through the urine. The success rate is variable depending on size, location of stone and hardness of stone. It is effective for kidney and upper ureteric calculus but is not a modality for middle and lower ureteric calculus.
It is a non-invasive way of treating stone as no cuts or incision is required. It can be performed as an out-patient procedure or with one day hospitalisation. ESWL however has a lower stone free rate as compared to other modalities. Another side effect of this therapy is pain during the passage of stone fragments which can range from mild to excruciating. After ESWL patients are advised to drink plenty of oral liquids and analgesics. The passage of fragmented stones may take days to a few weeks .
RIRS or Retrograde Intra Renal Surgery is usually performed with the help of Flexible Ureteroscope for stones in the upper ureter and kidney. Kidney stones can be fragmented with holmium laser. After fragmentation, the fragments of the kidney stones are caught and removed. This procedure is also done through urethra without any incision. RIRS usually requires single day hospitalisation. The procedure may need to be staged depending on factors like size of stone and capacity of ureter to accept the flexible ureteroscope, but it is one of safest way of treating kidney stones. It is suitable for upper ureteric calculus and small size kidney stones in the renal calyces.
PCNL or Percutaneous nephrolithotomy: PCNL is a widely practiced keyhole surgery for kidney stones & has good results particularly for large stones in kidney. A small hollow tube is passed directly through a patient’s back using a small 1cm into the kidney under x-ray guidance. A nephroscope is then passed through this working channel to visualise, fragment and extract the stone.
Various modifications are being currently practised which decreases the hole size making it less invasive with fewer complications. This surgical technique is suitable for large stones but with potential risk of bleeding occasionally.
When can I resume work after stone treatment?
Recovery depends on multiple factors like patient pre-operative status, underlying medical problems and treatment modality. Once patient is discharged from hospital, patient requires one or two day additional rest, then most of patients can resume their work barring few patients who have pre-existing medical or surgical comorbidities or complications. There is role of patient motivation and urologist advice on the timing of a return to normal activities.
How to avoid stone recurrence?
Stone formation and recurrence is very important part of treatment. Once stone is removed from your body, it does not guarantee a stone free status forever. Only existing stones can be removed surgically, the future recurrence needs lifelong commitment from patient. It is observed that 5 to 10%of patient develop new stone within one year of treatment, and 25%-30% develop new stones within 5 years. Almost 50% of patients would have develop new stones by ten years. Stone recurrence can not be completely prevented. However, 70%-80% of stone recurrences are preventable.
Drink more liquids: Liquids help flush out the substances that cause kidney stones to form. Water is your best choice. It prevents kidney stones by keeping the kidneys flush out all stone forming substrates in a less concentrated urine. Drink water with aim to have two litres of urine per day, and it should be a light, barely yellow colour. Avoid caffeinated beverages, because they dry you out rather than hydrate you.
Avoid salt: One of the main causes of kidney stones is concentrated urine. Salt can dehydrate you, which produces a more concentrated urine. If you do eat salt, you need to counteract its effects by drinking a big glass of water afterward.
Eat less meat: Animal proteins can cause concentrated urine, one of the risk factors for kidney stones. Waste from these extra proteins gets into the urine and increase the possibility of forming kidney stones.
Consume more fibre: Insoluble fibre combines with excess calcium in intestine and is excreted in stools. This helps decrease the amount of calcium left in the urine. Good sources of fibre include Whole grains like oatmeal, bran.
Avoid spinach, chocolate, beets and rhubarb as all these are high in oxalate. Beans, green peppers, tea, and peanuts also contain oxalate.
Disclaimer: This is for the general awareness of the patients and cannot replace expert medical advice. Patient treatments need to be individualised and that can be decided based on clinical examination and evaluation by a trained physician.
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