Treatment of Kidney Stones

Kidney stone treatment has seen dramatic changes in last three decades. Open Kidney Stone Surgery was replaced by Extracorporeal Shock Wave Lithotripsy & Percutaneous Surgery of Kidney Stones in Nineteen eighties & the incidence of Open Kidney Stone Surgery was reduced to 1 to 2 %. Similarly Open Surgery for Ureteric Stones was replaced by rigid Ureteroscopy.

Extracorporeal Shock Wave Lithotripsy:-

Has a limited but definite use today. It should be used for stones of around one cm. preferably in upper part of Kidney.

Percutaneous Surgery of Kidney Stones:-

This is a widely practiced Key hole surgery for Kidney stones & has good results particularly for large stones in Kidney. The Surgery has a significant complication rate.

Flexible Ureteroscopy / Retrograde Intrarenal Surgery:-

During last one decade, a new modality of treatment in the form of Flexible Ureteroscopy/Retrograde intrarenal Surgery is picking up fast for treatment of Kidney Stones. This procedure is a natural hole surgery & is associated with minimal complications. The procedure is expensive because of higher cost of Equipment & disposables & also has a long learning curve.

Has a limited but definite use today. It should be u sed for stones of around one cm. preferably in upper part of Kidney.

This is a widely practiced Key hole surgery for Kidney stones & has good results particularly for large stones in Kidney. The Surgery has a significant complication rate.

During last one decade, a new modality of treatment in the form of Flexible Ureteroscopy/Retrograde intrarenal Surgery is picking up fast for treatment of Kidney Stones. This procedure is a natural hole surgery & is associated with minimal

The procedure is expensive because of higher cost of Equipment & disposables & also has a long learning curve.

Types of Kidney Stones

Kidney stone is a mass formed inside the Kidney and is composed of substances from the urine. It is a mixture of crystalline & non – crystalline material.
It could be:-

• Calcium oxalate:- Common ( 60 % )
• Calcium phosphate & mixed ( 20% )
• Uric Acid ( 5 to 10 % )
• Struvitte ( 5 to 10 % )
• Cystine (1 to 3 % )
• Rare 3 %

Symptoms/ Complaints

Patient of Kidney stone may present with:-

a) Excruciating pain in the abdomen, back & groin, pain may radiate to the genitalia on the side which bears the stone. Pain is colicky in nature & may be associated with nausea & vomiting.

b) Blood in the urine

c) Difficulty in passing urine

d) Fever if there is associated urinary tract infection.

Investigations:-

Laboratory Tests

1. Urine Examination for

a) Nitrites (Dipstick Test)
Indicates Urinary tract infection Negative test result is Normal Further action should be mid stream urine culture & Sensitivity
Basis of the test: -
(Gram Negative bacteria in the urine reduces dietary nitrates in to nitrites)
b)  Leukocyte esterase in urine: -
     Positive test (Dipstick Test) suggests white Blood cells in urine & urinary tract infection
c)    Microscopic Examination of urine for Pus cells & RBC
d)    Ph of urine

2. Blood Tests: -

Diagnostic test for kidney stones:-

a) A non contrast spiral CT scan is the best test. However plain X-ray KUB should always be done to have better orientation, to assess the radio-opacity of stone, to monitor stone progression, and to guide shock wave lithotripsy.

b) IUV can also be used for diagnosing a Kidney Stone but can miss some stones & has associated risk of administering contrast.

c) Ultrasound scan is good for detecting dilated upper urinary tract (also called hydronephrosis), can also detect Kidney Stones, Urinary bladder stones & some Ureteric stones. However, Ultrasound is an Operator Oriented study and is not accepted as final diagnostic test.