Overview
What are these?
The kidneys are two bean-shaped organs that help in the removal of wastes from the body. As the kidneys filter blood of impurities, minerals and acid salts can accumulate and harden over time. These solid crystalline deposits are called kidney stones and can form in one or both kidneys. The stones can travel down the urinary tract and block the flow of urine, causing pain and bleeding. Small kidney stones can also travel down to the bladder and grow into bladder stones.
Causes
Stone formation is a common urinary system disorder that can form in any individual. However, men, and overweight people are at a higher risk of developing them.
Diagnosis
The doctor usually arrives at a diagnosis of kidney stones based on the symptoms and medical history. Blood tests, urine tests, and other investigations may be ordered to confirm the diagnosis. Several diagnostic techniques such as X-ray, ultrasound, CT and intravenous urogram may also be used to identify the location of the kidney stones. Intravenous urography is a test that involves injecting dye into a vein in the arm and taking X-rays, as the dye travels through the kidneys, to identify the presence of any stones.
Treatments
Ureteroscopy +/- Biopsies, Laser fragmentation of stone and removal of stone fragments
A narrow rigid or flexible scope (tube with a camera) is used to negotiate the narrow passageways of the urinary tract. There are no cuts in the skin required. A laser device is used to break the stone up into small pieces, which then pass naturally or are removed piece by piece. Occasionally a plastic tube called a ureteric stent will need to stay inside the body for a period of time to help healing after surgery and to allow stone fragments to pass. There can be some mild pain and discomfort after the procedure, and patients may feel an urgent need to urinate. Infection is rare and antibiotics are effective in cases where this occurs.
Percutaneous Nephrolithotomy (PCNL)
A ‘keyhole’ operation that is performed under general or spinal anaesthesia and is used to remove large stones from the hollow centre of the kidney. An incision is made in the back, with a hollow tube inserted through the kidney to reach the stones. A ballistic device is used to break the large stone into smaller pieces, which are then plucked out of the kidney. This is a major operation but it is very effective in removing all the stone in a single go.
The procedure is indicated for stones resistant to shockwave lithotripsy (a non-invasive method that uses sound waves), large stones (more than 2 cm) that occur as a result of kidney infections which require complete removal, and stones that are high up in the ureter near the kidney.
Extra Corporeal Shock Wave Lithotripsy (ESWL)
This technology uses ‘shock waves’ (like sound waves) to break kidney stones into small fragments. It is the most common procedure for the management of kidney stones. Lithotripsy takes about 45 to 60 minutes to complete. During the procedure, a patient will lie on a water-filled cushion. High-energy sound waves are created outside of the body by a machine and these waves travel through the body until they hit the kidney stones and break them into tiny pieces. A patient may feel a tapping sensation on their skin as the shockwaves enter the body. A tube is inserted through the bladder or back into the kidney to help drain urine from the kidneys until all the tiny fragments of stone pass out of the body through urine. The tube may be inserted before or after the procedure. A series of treatments is usually required. ESWL is performed in the day surgery unit. Lithotripsy is indicated in people with large kidney stones causing pain, urinary tract infection, bleeding, and renal damage.
Laser Cystolitholapaxy
An operation to break up a sizable bladder stone using a telescope and a laser is performed under a general anaesthetic. A catheter is temporarily placed after the procedure.
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