1. What are kidney stones and how are they formed?

The function of kidneys is to excrete waste and fluid from the blood of a person in the form of urine. If the person has consumed less fluid and because of which there is accumulation of wastes which stick inside kidneys. This collection of waste is called kidney stones.

Kidney stones

2. What happens when there are kidney stones?

If the size of kidney stone is small which can easily travel inside the urinary tract, then the patient does not experience any symptoms and these stones generally pass off.

But if the size of stone is moderate to large, then patient may experience any of the symptoms:

  • Pain during micturition
  • Blood during micturition
  • Steep pain in back or lower part of the abdomen
  • Nausea and/or vomiting

3. Treatment

The kidney stone treatment is dependent on the stone size and composition.  Also obstruction due to stone is considered while planning the treatment. 

Investigations:

Kidney stones presence is confirmed by urine test, blood investigations, X-ray KUB (the Kidney, the Ureter and the Bladder) and if required CT scan can be carried out.

If the investigations are suggestive of small size kidney stones, then use of a good amount of fluids and some analgesics may help the patient to relieve from such stones. But if the stone size is big and is obstructing the urinary tract, additional treatment may be necessary.

4. Treatment Options Available

Shock wave lithotripsy: Shock wave lithotripsy: This uses shock waves which fragments stone into pieces of size which easily travel inside the tract and pass out.

Ureteroscopy: It is a procedure that is carried out using a ureteroscope, a long and thin flexible tube attached with a small fiber optic camera that helps to view beyond the bladder into the ureters. It is useful for stones of size from small size to medium size. Generally hospitalization is not required, as it is an OPD procedure, but sometimes looking into other conditions of the patient, hospitalization may be recommended. It takes around 3 hours for the procedure which is done under anesthesia of general type. If the stone is small in size, it is catched in a bag and in case the size of the stone is big or if there is stricture (narrowing) of the ureter, then the stone is fragmented using a laser technology and then these pieces pass off from the body. 

In case the surgeon sees some growth, a biopsy from that area is taken and sent for histopathological examination.

Ureteroscope

Percutaneous nephrolithotomy: In only a very few instances this procedure may be required. A tube is directly inserted into the kidney and stone is removed. 

5. Complications

The patient may experience ureteric swelling for which the surgeon may decide to put a stent which is called an ureteral stent inside the ureter for ensuring proper urine drain from the kidney.

Ureteral stent

6. Advantages of Ureteroscopy

Being flexible, the ureteroscope can reach any region in the kidney and ureter and also gives a very clear view of the urinary tract. Some stones which are not visible on X-ray are also treated using ureteroscopy. It is also helpful in those patients who have failed ESWL or percutaneous nephrolithotomy and also in those patients who need anticoagulants as part of some other disease condition.

7. In whom is ureteroscopy not feasible

Ureteroscopy cannot be performed in those patients who have large stones, as removal of very large fragments is not possible or in patients with previous history of urinary tract reconstruction, as this may alter the anatomy of the region and ureteroscope maneuvering becomes difficult.  

8. Preparation for the procedure:

Not much preparation is required prior to ureteroscopy. The patient needs to go for urination as per the advice of the doctor. Instructions regarding food, fluid intake and medicines will be provided. In case the patient is on anticoagulant therapy, the same needs to be informed during the consultation itself.

9. After the Procedure

After the procedure, it takes around 4 hours to recover from the effects of anesthesia. The patient is advised to drink at least 500 ml of water. The patient may experience pain along with blood during urination for at least 1 day. Antibiotics and analgesics are given to prevent infection. 

10. When to contact your doctor

After discharge if you feel severe pain, or fever with/without chills, inform the doctor immediately. You may be called for examination and prescribed some medication.

Doctor will advise for a follow-up and if any untoward histopathology report, further evaluation will be advised.

The stone removed from the kidney is also sent for its composition analysis and accordingly, the patient is advised for preventive measures for future stones formation.