Kidney stone disease, which is one of the kidney diseases and is frequently encountered, can lead to kidney loss and kidney failure if it is not treated by the formation of stones in the area where the kidney filters urine. Therefore, it is very important to be diagnosed and treated in a timely manner.
Factors that increase the risk of kidney stone formation include:
Recurrent urinary tract infections
Having a kidney stone problem before
Insufficient physical activity
Congenital kidney abnormalities
Presence of any other disease in the kidneys
Chronic bowel problems
Kidney Stone Symptoms
The most common known symptoms of kidney stone disease are:
Severe chest, abdominal and lower back and side pains
Nausea and vomiting
Blood in the urine
Burning sensation during urination?
Types of Kidney Stone
Calcium stones: They are stones formed by various compounds of calcium, such as calcium oxalate and calcium phosphate, which are composed of calcium components. Approximately 75% of all kidney stone cases consist of calcium stones.
Uric acid stones: It is a type of kidney stone seen in individuals with gout who are fed a high-protein diet that increases the amount of uric acid in the blood.
Cystine stones: It is a rare type of kidney stone caused by metabolic disorders.
Citruvitis (infection) stones: This type of stone, which is formed due to urinary tract infections, can cause serious kidney damage in a short time due to its very rapid growth.
How Is Kidney Stone Diagnosed?
In the diagnosis of kidney stones, physical examination and medical history as well as various laboratory tests and medical imaging techniques are used.
Some of these diagnostic tests include:
Computarized tomography (CT)
Urinalysis and culture
Kidney function tests in blood
Kidney Stone Treatment
The size of the stone and its placement in the kidney are the most important factors in the planning of the treatment to be applied after the diagnosis of kidney stones.
As the size of the kidney stone increases, the chance of the patient dropping the stone spontaneously or medically decreases. In addition, the stone has a higher chance of reducing the placement in the kidney in the upper parts of the kidney compared to the ones in the lower part.
In patients with frequently recurring stones, identifying the underlying cause of stone formation is very important in terms of reducing the risk of recurrence and treatment.
In particular, stone analysis, examination of calcium, magnesium, phosphorus, uric acid, vitamin D and parathormone levels in the blood, examination of urinary pH, cystine, uric acid, oxalate levels in the urine, and treatment of underlying metabolic or hormonal causes are important in the treatment and prevention of kidney stones.
In recurrent kidney stones, drug treatment may vary according to the type of stone. The purpose of medical treatment is to increase the solubility of crystals in the urine and prevent them from precipitating in the kidney.
Methods of Treatment
Rock Breaking with Sound Waves (ESWL)
ESWL (Out of Body Shock Waves with Stone Crushing
Sound waves from a source are transmitted from the skin to the kidney stone by fluoroscopy (X-ray), and small pieces broken by sound waves are excreted through the urinary tract. The success of the procedure is affected by many factors such as stone location, hardness, number, anatomical structure of the kidney, and skin kidney distance. Generally, stones smaller than 2 cm are suitable for eswl. The process takes 30-45 minutes, depending on the location of the stone, its size and the device used. If necessary, it can be applied for up to 3 sessions.
While the most important advantages of the procedure are that it is performed outpatiently and does not require anesthesia, the most important disadvantage is that the stone cannot be broken, the broken parts cannot be shed or it causes pain during shedding.
It is a closed surgical technique used in the treatment of stones that have passed through the ureter (the urinary canal between the bladder and the kidney) and entered through the external urinary tract.
The procedure can be performed under general or spinal anesthesia. By using rigid or flexible endoscopic devices, the stone is accessed through the external urinary tract and then the stone is broken down with the laser sent through the device. If necessary, parts are removed with a basket catheter. If edema occurs in the ureter after the procedure, if the broken stone is too large or if there is an injury in the urinary tract, a temporary stent can be placed.
The stent is usually removed after two weeks. Since there is no incision or drilling process during the procedure, it is very fast to return to normal life. The chance of success is very high.
It can be easily applied except for patients with active urinary tract infection.
The most important risks;
If there is a stenosis in the urinary canal that will prevent the passage of the device, a stent can be placed and the stone can be intervened in 2 sessions.
Injury of urinary tract
There is bleeding and fever in the urine.
It is the process of breaking or removing the stones from the urinary tract to the kidney without making any incisions or holes in the body through a thin endoscope with a flexible structure.
Specially manufactured endoscopes (flexible ureterorenoscope) are used for this procedure. The tip of these instruments, which are approximately 3 mm thick and 60-70 cm long, can be controlled by the surgeon from the back of the device. In this way, every chamber of the kidney can be accessed and the stones here can be broken with the help of laser.
What Are The Advantages?
Since no incision or drilling is performed, the patient can be discharged on the same day; the next day, he can return to his normal daily life. The chance of success is quite high, and the rate of complications (unwanted side effects) is low. It can be safely applied to all patients except patients with active urinary tract infection.
Percutaneous Nephrolithotomy (PCNL)
It is an endoscopic (closed) surgical technique used for the treatment of kidney stones by entering the kidney with a hole small from the back. It is usually preferred in case of failure in methods larger than 2-3 cm or in other methods (ESWL, RIRs).
Under general anesthesia, a 1 cm incision is made from the back to reach the kidney and the stones are broken or the smaller ones are taken out as a whole. If necessary after the procedure, a plastic tube can be placed from the incision for 1-2 days. PCNL surgery can be performed from smaller incisions thanks to new devices developed. While 30 fr (1cm) diameter tubes are required in the standard method, these 15-18 fr (5-6mm) in mini-PCNL and ultra-mini-PCNL have been reduced to 12-14 fr (3-4mm) tube diameter. As the thickness of the device used decreases, the risk of side effects such as bleeding decreases, and recovery after the procedure is faster.