WHAT IS KIDNEY STONE?
The kidneys, one of the most important organs of the excretory system, located on the right and left of the body, ensure the removal of wastes from the blood. While the kidneys send the clean blood back to the body after clearing the wastes in the blood, they transmit the wastes to the urinary tract and ensure the discharge takes place. In addition, the kidneys have the task of filtering certain substances necessary for the body and regulating their levels. Due to the problems in the mechanism related to this task, kidney stone formation can be seen.
The reasons for the deterioration of this mechanism are still not fully known. It is thought that many factors such as genetic predisposition, nutrition, obesity, insufficient water consumption, sedentary living conditions, geography, gender, and age play a role in the formation of kidney stones. Kidney stone diseases are one of the most common diseases all over the world. It is more common in middle-aged male patients.
Kidney and urinary tract stones can be anywhere from the kidney to the mouth of the external urinary tract, and their sizes can vary from sugar grains to egg size.
HOW ARE KIDNEY STONES FORMED?
While some minerals in the blood are excreted through the kidneys, they are dissolved in the urine in a balanced way. However, sometimes for a number of reasons, the solubility of these mineral crystals decreases and begins to accumulate. In the chamber-like collecting systems in the kidney, these crystals precipitate, and stone formation is observed.
About 80% of these stones are calcium oxalate stones. Apart from this, uric acid stones, infection-related stones, cystine stones, and calcium phosphate stones can also be seen.
KIDNEY STONE SYMPTOMS
Although the symptoms of kidney stones vary according to the patient’s gender, age, genetic predisposition, and the level of the disease, common symptoms are;
- Changes in urine
- Difficulty urinating
- Nausea or/and vomiting
- Fever and shivering
Very small stones can pass through the urinary tract without any symptoms. Larger stones can get stuck in the kidney and ureter. Although there are no symptoms in some patients, kidney stones can be detected incidentally as a result of tests performed for other purposes.
With or without symptoms, as kidney stone diseases progress, they can cause severe damage to kidney functions and even cause kidney loss. Therefore, kidney stones should never be neglected.
Kidney Stone Treatment
There are many factors that need to be considered in the planning of kidney stone treatment in order to determine the right treatment option. Treatment planning is carried out taking into account many factors such as the size of the stone and its placement in the kidney, the severity of the patient’s pain due to kidney stones, whether the stone causes any damage to the kidney, and whether it damages kidney function.
Kidney stone treatment methods include:
In stones that have fallen into the canal with a diameter of 3-5 mm, follow-up is an option instead of intervention. In the same way, follow-up can be considered for small-diameter stones in the kidney collector system. If the stone is small and the kidney collector is located at the top of the system, the patient has a chance to drop the stone on his own.
Kidney Stone Crushing with External Shock Wave (ESWL)
For this method applied to kidney and urinary tract stones, the diameter of the stone should be less than 2 cm. It can be completed in 1-3 sessions. Session intervals should be 1 week. It is not a method that can be applied to every patient.
Laser refraction of kidney stones by entering through the urinary tract (RIRS)
This procedure is performed in the operating room with local or general anesthesia. It is entered through the urinary tract to the kidney and the stones are broken with laser and dusted. Usually the patient sheds the stones spontaneously, in some cases it can be collected by the doctor. It is a procedure that can take 1-3 hours, after which you need to stay in the hospital for 1 day.
Percutan Nephrolithotomy (PNL)
It is a kidney stone surgery called laphoroscopic system. In the operating room environment, in this method applied with general anesthesia, the kidney stone is reached by entering through a small hole in the back of the patient lying face down and the pieces are taken out. It is an operation that can take 1-3 hours depending on the size and position of the stone. It is necessary to stay in the hospital for 1 day after surgery. It is a method that can save the patient 80-90% of the stone.
Although it is no longer applied much today, it can be preferred if there are some conditions that require open surgery. Open surgery may be an option in cases such as urinary tract stenosis that requires repair with kidney stones or if the stone is large enough to fill the entire kidney.
In line with the patient’s condition and wishes, the most appropriate treatment should be selected and treatment should be started as soon as possible. Neglected kidney stones can cause many serious problems, from kidney failure to kidney loss.
In addition, in the case of frequent recurrent kidney stones, it is extremely important to identify the underlying causes that cause kidney stones. For this purpose, detailed laboratory tests should be performed and calcium, uric acid, magnesium, phosphorus, vitamin D and parathormone levels should be examined in the blood. Cystin, uric acid and oxalate levels should be examined in the urine, so that if an underlying metabolic or hormonal cause is detected, they can be treated and kidney stones can be prevented again. In addition, medication can be applied to the patient in stubborn kidney stones. Although the drugs to be used according to the type of stone vary, the main purpose of the treatment of kidney stones with the drug is to increase the resolution of the crystals in the urine, preventing the crystals from collapsing and petrification.