When you need Kidney Stone Surgery

When you need Kidney Stone Surgery ?

Kidney stones develop when crystals accumulate due to elevated mineral levels in the urine. Treatment options for kidney stones depend on various factors, including the size and location of the stones. With advanced technologies such as X-rays, renal ultrasounds, and CT scans, doctors can effectively tailor treatment plans by assessing the stones’ size, location, and the extent of any urine flow obstruction.
Among all the factors, size is the most critical determinant of the treatment approach for kidney stones. Many stones can be managed conservatively with pain relief medications, increased hydration, and medical expulsive therapy. However, larger stones typically require surgical intervention to be removed. Thanks to advancements in medical science, minimally invasive surgical techniques for kidney stone removal have become available, allowing for effective stone extraction with a lower risk of complications.

What is Kidney Stones ?

Medically, kidney stones are defined as solid deposits of minerals that form from the accumulation of minerals, salts, and other substances present in urine. These stones can vary significantly in size and composition, ranging from small particles similar to grains of sand to larger solid masses. The development of kidney stones can be influenced by various factors, including dehydration, dietary habits, genetic predisposition, certain medical conditions, and medications associated with diabetes, obesity, gout, primary hyperparathyroidism, and chronic diarrhea.

Recognizing Kidney Stone Sizes

Accurately determining the size of a kidney stone is essential for selecting the appropriate treatment approach. Physicians have several methods to measure and characterize the size of a stone.
The millimeter (mm) is the most commonly used unit of measurement. Kidney stones smaller than 5 mm can typically be passed from the body with ease, while those larger than 10 mm rarely do so. Instead of providing an exact size, stones may be categorized as “less than” or “greater than” specific size thresholds.
In some cases, particularly when a stone is difficult to visualize on imaging, doctors may use relative terms like “small,” “moderate,” or “large” to describe the stone’s size. This allows patients to gain a general understanding of whether they might require active treatment.
Clinicians utilize imaging techniques such as kidney ultrasounds, CT scans, or X-rays of the kidneys, ureters, and bladder (KUB) to assess stone size. By employing the built-in measuring tools in these images, they can determine the longest diameter of the stone in millimeters. For irregularly shaped stones, multiple dimensions may be recorded.

Surgical Options for Various Types of Kidney Stones

The treatment approach for kidney stones is influenced by several factors, including the type of kidney stone, its size, location, and the symptoms it causes. Below are some common surgical methods used to address different types of kidney stones.

Extracorporeal Shock Wave Lithotripsy (ESWL)

During this procedure, high-energy shock waves are used to fragment kidney stones into smaller pieces, making it easier for them to pass through the urinary tract. ESWL is typically recommended for small to medium-sized stones (usually less than 2 cm) located in the kidney or upper ureter.

Laser Lithotripsy

In this procedure, kidney stones are fragmented into small pieces using a laser fiber, allowing them to be passed naturally or removed through other methods. This treatment is recommended for kidney stones that cannot be eliminated by ESWL, particularly those that are larger or located in the kidney or lower part of the ureter.

Percutaneous Nephrolithotomy (PCNL)

Percutaneous Nephrolithotomy (PCNL) is a minimally invasive surgery for kidney stones, involving a small incision in the back through which laparoscopic instruments insert a tube directly into the kidney to remove or fragment the stone. It is suitable for large stones (typically over 2 cm) or those resistant to standard treatments.

Ureteroscopy (URS)

Ureteroscopy treats stones in the middle and lower ureter. A ureteroscope, a thin tube with a camera, is inserted through the urethra and bladder to locate the stone. The stone is then removed using a basket-like tool or fragmented with a laser.

Open Surgery

Open surgery, though rarely used for kidney stones today, serves as a last resort for complex cases. It is recommended when minimally invasive procedures fail or are unsuitable due to anatomical issues like PUJ obstruction, morbid obesity, renal transplantation, or severe limb contractures.

Kidney Stones : Causes and Symptoms

Kidney stones can affect anyone, but they are more common in males. Typically, males in their 30s and 40s are more likely to experience kidney stones. While the exact causes of kidney stones are unknown, they are usually associated with elevated levels of certain minerals in the urine.
These minerals include calcium, uric acid, and oxalate. Low urine production increases the likelihood of stone formation because it reduces the body’s ability to eliminate the high concentration of minerals. However, understanding the type of kidney stone can assist doctors in analyzing the reasons behind it. There are various types of kidney stones, such as:
  • Calcium Stones: Caused by certain foods (e.g., nuts, chocolate), high vitamin D doses, intestinal bypass surgery, medical conditions like renal tubular acidosis, or medications for migraines/seizures.
  • Struvite Stones: Develop due to urinary tract infections (UTIs).
  • Uric Acid Stones: Result from excessive fluid loss (e.g., chronic diarrhea, malabsorption), high-protein diets, or conditions like diabetes or metabolic syndrome.
  • Cystine Stones: Occur in people with cystinuria, a hereditary disorder causing increased excretion of specific amino acids in the kidneys.

Symptoms of kidney stones include:

  • Severe pain in the abdomen, back, or sides
  • Intense pain during urination
  • Pain that varies in intensity
  • Frequent urination
  • Urine that is red, brown, pink, or cloudy
  • Burning sensation while urinating
  • Nausea and vomiting

Risk Factors for Kidney Stones

Numerous factors can elevate the risk of developing kidney stones. Below is a list of risk factors to be aware of and take steps to prevent stone formation:

  • Family or personal history 
  • Dehydration or drinking less water 
  • Following a diet that’s high in protein, sodium (salt), and sugar 
  • High BMI (Body Mass Index) or obesity 
  • Digestive diseases and surgery, like gastric bypass surgery
  • Medical conditions like renal tubular acidosis, cystinuria, hyperparathyroidism, and frequent UTI
  • Certain medications, like vitamin C, dietary supplements, excessive consumption of laxatives, calcium-based antacids, and certain medications for migraines or depression

Summary -

Kidney stones form for various reasons, but treatment depends on their size and location. Doctors typically recommend conservative approaches, such as medications or therapies, to help pass stones. However, for larger stones, minimally invasive surgeries may be advised. Small stones (<4mm) often pass naturally, while stones >4mm may require procedures like ESWL (Extracorporeal Shock Wave Lithotripsy), URS (Ureteroscopy), or PCNL (Percutaneous Nephrolithotomy) for quick removal without prolonged hospital stays.

Frequently Asked Questions

What is the most effective method to naturally pass a small kidney stone?
Staying well-hydrated by drinking plenty of water and other fluids is essential to dilute urine and aid the passage of small kidney stones. Pain relievers can help manage discomfort for some individuals. Additionally, rest and using heating pads may support the stone’s movement through the urinary tract.
To reduce the risk of recurrent kidney stones, follow a low-sodium, low-oxalate diet, stay well-hydrated with ample daily fluid intake, and take prescribed medications if needed. Maintaining a healthy lifestyle and weight is also crucial for prevention.
Immediate medical attention is necessary for severe pain that persists for several hours, a high fever, difficulty urinating, or signs of dehydration such as confusion. Additionally, if there is blood in the urine, nausea or vomiting, or swelling in the kidneys, it is important to seek evaluation from a physician promptly.