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Symptoms of Kidney Stones:

The main symptom is severe pain that starts suddenly and may go away suddenly:

• Pain may be felt in the belly area or side of the back
• Pain may move to groin area (groin pain) or testicles (testicle pain)



Other symptoms can include:

• Abnormal urine color
• Blood in the urine
• Chills
• Fever
• Nausea
• Vomiting

What are the different modalities of stone treatment?

Medicines:

A doctor prescribes certain medications to help prevent calcium and uric acid stones. These medicines control the amount of acid or alkali in the urine, key factors in crystal formation. The medicine allopurinol may also be useful in some cases of hyperuricosuria. We usually try to control hypercalciuria, and thus prevent calcium stones, by prescribing certain diuretics, such as hydrochlorothiazide. These medicines decrease the amount of calcium released by the kidneys into the urine by favoring calcium retention in bone. They work best when sodium intake is low.
Small stones (6 mm) lying in lower half of ureter can be given a trial of medicine, involving antibiotics, painkillers and medicines to relax the ureter. Persistence of pain, stone remaining at the same place for 2 weeks or development of fever with chills warrants immediate surgical intervention. Any stone obstructing the kidney/ ureter for four weeks can cause permanent damage to the kidney.

ESWL (Lithotripsy)

This is a non-invasive treatment wherein; stones are broken by shock waves generated by the machine. The patient lies on the table and focused shock waves are targeted on the stone. The stone is fragmented into small pieces, and are gradually washed out of the body in the urine. Stones up to size one to two cm, favorably placed in the urinary system can be effectively treated by this system with clearance rates ranging from 50% to 90%.

Advantage: Avoiding anaesthesia and surgery, no risk of blood loss

Disadvantage: Possibility of incomplete clearance; need for multiple sessions, re-treatment.

This procedure of removal of stone from a 1 cm incision using nephroscope has revolutionized the treatment of stone. In the hands of experts, >95% clearance rates are achieved, even in large sized stones. In uneventful surgery, all tubes are removed and patient is discharged on 3rd to 4th day after surgery. These high success rates are associated with small risk of excessive bleeding requiring blood transfusion or severe infection.

PCNL is required if: –

• A patient has a large stone burden (classically more than 2 cm). At times the entire kidney is filled with branched stones (staghorn calculus), or if there are multiple large stones in all calyces of the kidney.
• In cases of stones which have not been fragmented after ESWL (Extracorporeal Shock Wave Lithotripsy).
• Stones in locations of the kidney which are not suitable for removal using flexible ureteroscope, i.e. RIRS (Retrograde Intra-Renal Surgery).
• In certain cases of malformed kidneys such as horseshoe kidney where one can attempt a laparoscopic-assisted PCNL.

What are the advantages of PCNL over open surgery for stone removal?

• Avoidance of a large skin incision which in turn is cosmetically better.
• Experience less post-operative pain
• Earlier resumption of normal diet
• Early ambulation of the patient
• Early ambulation of the patient

This surgery is not advised in certain conditions such as: –

• If there is a urinary tract infection. A sterile urine culture is a pre-requisite to this surgery. In the case of documented urine infection, the patient needs to be treated with antibiotics and a urine culture repeated to confirm the absence of infection.
• Patients who are on blood thinners, in such cases, the medicines need to be stopped for 7-10 days in consultation with the physician who prescribed them.
• This procedure is not done for pregnant patients because of the fluoroscopy (X-ray exposure) involved.