Kidney Stone

Kidney Stone is a low morbidity disease ( having fewer or no complications & minimal affects on the overall health of the patient ) if treated earlier or it may be a killer disease if not treated in time & left to progress in both kidneys causing Kidney failure & leading to death. I have seen several patients in my professional carrier of 40 years ( 1980 to 2020, exclusively dedicated to the treatment of Kidney Stones) who have died because of chronic kidney disease(CKD) arising out of untreated kidney stones. This is a pathetic situation & I have felt helpless & frustrated so many times when I examine these patients in my OPD with serum creatinine of more than 10 mg/dl, blood urea of more than 200 mg/dl and serum potassium of more than 6.0mEq/L. Non-Contrast CT scan in these patients usually shows multiple bilateral kidney stones with little or no kidney tissue left behind. This does not happen overnight but takes years. The reasons for this avoidable death warrant in our Country include poor health education, poverty, fear of operation, excessive use of unknown medicines & unorganized health care. One can usually see the helplessness in my eyes as I finish examining & analyzing these patients in my office as I can not treat these Kidney Stones & these Kidney Stone patients because the patient is left with no kidney tissue & there is no way to regenerate this precious Kidney tissue. And I have seen them in hundreds during the last 40 years I have been treating Kidney stones.

70 to 80 % of Kidney Stones pass out spontaneously and do not need any surgical intervention. These are smaller stones of up to 5 mm in size. As the size grows, the chances of spontaneous passage decrease. Small Kidney Stones are notorious to cause sudden, severe & agonizing pain which not only is a temporary dreaded condition but puts the whole family on tenterhooks. The patient is rushed in an emergency to family physicians or specialists where pain killer injections are given to the patient. Usually, it takes several hours before the patient can get relief. The best injectable in Kidney Stone pain is Diclofenac Sodium usually in combination with other analgesic injections. Many such stones can, fortunately, be treated later for spontaneous passage. Only a few of them need surgical intervention. The indication for emergency surgical intervention in small kidney stones usually arises in UV junction stones with persistent pain unrelieved by several injectable analgesics. There are several other indications for surgical removal of small kidney stones to be discussed separately. How to speed up the spontaneous passage of small Kidney Stones is a very common question asked to me in my office by patients of Kidney stones as well as by their relatives & friends. The best thing to do in such cases is to take plenty of fluids.

Drink Plenty of
Fluids to Stay
away from
Kidney Stones

As the small Kidney stone finds its way into the ureter, it starts troubling the patient. The stone usually gets stuck up at UV Junction, where the ureter joins the urinary bladder. The reason for this is the narrowing of the ureter in the bladder wall. The diameter of ureter outside urinary bladder is approximately 3 to 5 mm but it reduces to almost half when it passes through the bladder wall & that is the reason why the majority of these small stones get stuck here. In an attempt to pass out, these small Kidney stones because of their movement cause mild to severe pain in the lower abdomen on the side which is harbouring the kidney stone. This pain is usually referred to back (Lumbar region) because of distention of kidney & stretching of Kidney Capsule. However, we must remember that more common cause of back pain is a disease of the muscles or spine & not the Kidney Stones.

A word of caution in this situation is to avoid plenty of fluids in severe pain as that may increase pain. Some drugs may also help in spontaneous passage of small kidney stones. These include alpha-blockers which may relax the smooth muscle of lower ureter & facilitate the spontaneous passage of small kidney stones. Spontaneous passage of kidney stones through normal urinary passage could be quite painful.

Kidney or Renal stones or calculi are solid masses of crystals. Almost all primary Urinary stones form in Kidneys & then travel to the ureter, Urinary bladder or urethra. Kidney stones are more likely to occur in Men than Women, more common in the age group of 20 to 40 years, in people having a positive family history of kidney stones, in people who give a history of stone formation in the past, in people who give a history of dehydration, in obese people, in patients of hyperparathyroidism, in non-vegetarian men & women or those who consume high protein diet, in several diseases like post gastric bypass surgery, inflammatory bowel disease, renal tubular acidosis, cystinuria, certain medications & sometimes because of urinary tract infections.

The Images Below are of Kidney Stones taken as snapshots from the video recording of RIRS Surgery done at our hospital with Digital Flexible Ureteroscopes, Flex XC and Flex XC S.

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