Renal calculus/ kidney stones

Wednesday, 11 December 2019

Renal calculus/ kidney stones

Kidney stones are deposits of crystals of oxallates, calcium or uric acid that form inside the kidneys. It is also known as a renal calculus. Kidney stones could be either small or big. These are classified based on their location in the kidney, ureter, or bladder. Kidney stones are mainly caused due to less intake of fluids and high dietary intake of animal protein, sodium, refined sugars, and related products.

Kidney stones can be quite painful, but usually, the stones will not cause permanent damage if identified and treated on time. Small stones can be treated by certain medications and drinking a lot of water will pass a kidney stone. For larger stones , doctors would suggest surgery.

Medical care
Treatment for kidney stones depends on the size of the stone and the cause of it. Medical management is mainly by increasing water intake, dietary restrictions of animal protein and food rich in calcium and oxallates , reduction of carbonated soft drinks.

The various procedures to break down the kidney stone would be as follows:

Extracorporeal Shock Wave Lithotripsy (ESWL) - This is one of the most common treatments recommended by the doctor to break kidney stones. Shockwaves are used to break the kidney stone so that it can easily pass through the urinary tract. It is a opd procedure. No anaesthesia is required for the procedure. All the people will be able to return to their routine activities on the same day.

Percutaneous Nephrolithotomy (PCNL) - This is a procedure where a tiny tube known as nephrostomy is placed trough the kidney from the small incisions made from the back. The kidney stones are removed with the help of other instruments passed from the nephrostomy tube. Doctors suggest PCNL for large, complex large stones or for patients who have the presence of nephrostomy or unique anatomic problems in their urinary tract .

Ureterorenoscopic Lithotripsy - URS or ureteroscopy is a versatile form of stone therapy. Doctors use special laser fibers, or machanical lithotripter which can be deployed through the ureteroscope to break the stone. If there are any stone fragments, then the doctor would use special baskets that will be deployed through the ureteroscope to retrieve the stones. URS is usually used to remove the stones from the ureter, especially the lower ureter.

Retrograde Intrarenal Surgery with Holmium Laser (RIRS) - without any incisions, doctors could perform the surgery inside the kidney. Doctors would put the RIRS instruments through the body’s natural opening, through the bladder and the ureter, and finally into the kidney. Then stones are fragmented by LASER . RIRS can be used to remove kidney stones, kidney tumors, and strictures.

Open nephro/pyelolithotomy - this was one of the procedures to remove the stones within the renal pelvis. When ESWL and PCNL are not feasible, like in very large stones doctors used to perform pyelolithotomy to break the stones.

For complex or large stones, doctors would suggest URS, ESWL, and PCNL. At times certain stones would require a combination of two or more treatment modalities.