Kidney and Ureteral Stones Kidney and ureteral stones are commonly observed worldwide. There is a 5-10% chance of developing urinary system stones in every individual throughout their lifetime. The reasons for this are attributed to a diet rich in animal protein and salt, obesity, certain genetic diseases, and lifestyle changes. Kidney stones can sometimes cause no discomfort at all, but they are often among the reasons for hospital admissions due to severe pain.
What is a Stone? A stone is a solid, hard mass that can form in various organs of the body, such as the gallbladder, bladder, and kidneys. Each stone has a different molecular composition despite its location in the body. Stones can form due to an underlying pathology and can be treated in different ways. Kidney stones form when minerals or acid salts in your urine later crystallize into stones.
Kidney and Ureteral Stones
Symptoms of Kidney Stones In humans, kidney and ureteral stones often lead to complaints of pain. However, symptoms can vary from severe, constant pain to intermittent discomfort depending on the size, shape, and location of the stone.
Severe pain (renal colic)
Severe pain (renal colic) When a stone falls into the ureter (urinary canal) and obstructs the flow of urine, it causes severe pain known as renal colic. This pain is characterized by a sharp pain in the lower back and flank area (the side of the abdomen from the ribs to the hip). This pain results from a sudden increase in pressure in the urinary tract and the ureter's wall. The pain comes in waves and does not subside when changing positions. Some patients describe this pain as the most severe they have ever experienced in their lives. If the stone is in the ureter rather than the kidney, it can cause pain in the groin and an urge to urinate. In men, ureteral stones can even cause pain in the testicles.
Other symptoms that may accompany renal colic include:
- - Nausea
- - Vomiting
- - Blood in the urine (urine appears pink or red)
- - Painful urination
Fever Renal colic is an emergency, and you should seek immediate medical attention to relieve the pain and undergo further evaluation. If you have a high fever (≥38.5°C or 101.3°F), you should seek medical help immediately.
Diagnosis of Kidney Stones Initially, when you go to the hospital, your medical history will be reviewed, and a physical examination will be conducted to approach the diagnosis. Subsequently, various imaging methods and, if necessary, additional tests may be requested. Kidney and Ureteral Stones
Imaging Tests To diagnose urinary system stone disease, the internal organs need to be imaged. These imaging methods can range from ultrasound that uses high-frequency sound waves to low-dose computed tomography. These scans clearly reveal the location and size of the stone.
ESWL (Extracorporeal Shockwave Lithotripsy) ESWL is a method used for the treatment of stones in the kidney, ureter, or bladder. The procedure is performed by focusing shockwaves generated externally on the stones using a device. These shockwaves have enough intensity to break the stones into smaller pieces, which can then be passed through the urinary tract.
ESWL is typically performed without pain, and in many cases, it does not require hospitalization. The duration of the procedure can vary depending on the size and number of stones but generally takes 30-60 minutes.
ESWL treatment is an ideal option for stones under 2 cm that are not suitable for other treatment methods or require surgical intervention. However, in some cases, multiple sessions may be required, and potential side effects of the procedure include post-treatment bleeding, pain, infection, or blockage by stone fragments. Therefore, it is important to consult your doctor before undergoing the ESWL procedure to obtain detailed information about its advantages and disadvantages. Kidney and Ureteral Stones
RIRS(Retrograde Intrarenal Surgery-Flexible URS)
RIRS (Retrograde Intrarenal Surgery - Flexible URS) RIRS stands for "Retrograde Intrarenal Surgery," and it is a minimally invasive surgical method used in urology for the treatment of kidney conditions such as kidney stones.
RIRS is performed without making any surgical incisions by inserting a special endoscope and fiber-optic camera into the kidney through natural body cavities. During this procedure, the patient is usually under general anesthesia, and the endoscope's tip is used to break and remove the stones in the kidney using a laser or ultrasonic energy source.
This minimally invasive method speeds up the patient's recovery process and minimizes postoperative pain. RIRS surgery is often a preferred treatment method because it is less risky and less invasive compared to other traditional methods such as open surgery or endoscopic stone removal.
PNL(Perkütan nefrolitotomi)
PNL (Percutaneous Nephrolithotomy) Percutaneous nephrolithotomy is a surgical procedure used to remove large stones (2 cm) located within the kidney. The term "percutaneous" means "through the skin," and the procedure is performed by creating a hole in the skin.
This procedure is required when other treatment options (such as medication or shock wave therapy) have failed or for very large stones. Percutaneous nephrolithotomy can be an effective and safe procedure for most patients, but like any surgical procedure, it carries some risks. These risks may include complications such as infection, bleeding, and kidney damage.
For appropriate stones, less invasive methods such as mini-PNL and micro-PNL have been developed.
After the procedure, the patient typically stays in the hospital for a few days and should follow the doctor's recommendations to complete the recovery process.
Stone Analysis and Other Tests In the case of renal colic, urine and blood tests may be requested to determine if you have an infection or if there is a decrease in your kidney function. If the stone is expected to be passed through urination, you may be asked to strain your urine. The dropped stone should be analyzed using appropriate methods to understand what type of stone it is. Stone analysis guides in preventing the recurrence of stones and helps select the appropriate preventive treatment. If you are in a high-risk group for stone formation, a 24-hour urine analysis and metabolic evaluation would be suitable for assessing your current urine composition.
General Lifestyle Recommendations to Prevent Stones Even if your risk of forming another stone is low, making certain lifestyle changes can help prevent stone formation. The following fluid intake and dietary recommendations are for adult patients with any type of stone:
• Ensure you drink 2.5-3 liters of fluid every day. Distribute your fluid intake evenly throughout the day. Choose pH-neutral beverages like water or milk. If you live in a hot climate or engage in vigorous physical exercise, you may need to increase your fluid intake even further.
• Maintain a balanced and varied diet. Avoid excessive intake of vitamin supplements. Consume plenty of vegetables, fiber, and fruits. Be cautious about calcium supplements, and do not use calcium supplements without consulting your doctor. Reduce the amount of salt in your diet (it should not exceed 3 to 5 grams per day). Avoid excessive consumption of animal protein (0.6 g/kg). Maintain a healthy weight (your Body Mass Index should be between 18-25 kg/m²).
• Aim to exercise 2 or 3 times a week. Avoid stress.
