Kidney & Ureteric Stones

Kidney Stones

The kidneys are two bean-shaped organs that help in the removal of wastes from the body.

As the kidneys filter blood of impurities, minerals and acid salts can accumulate and harden over time. These solid crystalline deposits are called kidney stones and can form in one or both kidneys. The stones can travel down the urinary tract and block the flow of urine, causing pain and bleeding.

Kidney stone formation is a common urinary system disorder that can form in any individual. However, men, and overweight people are at a higher risk of developing them.

Causes

Kidney stones form when certain salts and minerals in the urine become highly concentrated and build up. This can happen due to

  • Insufficient water intake
  • Treatments for kidney diseases and cancer
  • Certain medications
  • Family history
  • Intestinal disease such as Crohn’s disease
  • Single functional kidney

Signs and Symptoms

Symptoms of kidney stone formation may not manifest until the stone moves around the kidney or down into the urinary tract. Symptoms may include

  • Severe pain below the ribs, back, sides, lower abdomen, groin and during urination
  • Pain that fluctuates in intensity
  • Frequent urge to urinate
  • Pink, brown or red urine that is cloudy or foul smelling

You should call your doctor if you find it difficult to pass urine, or the pain increases and is accompanied with fever, chills, vomiting and nausea.

Diagnosis

When kidney stones are suspected, your doctor may order blood, urine and imaging tests (X-ray, CT scans) to diagnose the condition. You may also be asked to urinate through a sieve to collect and test the kidney stones that pass in the lab. The results will help your doctor to determine the cause and formulate an appropriate plan for treatment.

Conservative treatment

Treatment depends on the type of stone and its underlying cause. Small kidney stones can be flushed out by drinking plenty of water every day or through medication. Additionally, your doctor may prescribe medication to relieve pain.

Treatment options

For larger stones, your doctor may suggest certain procedures based on the location and size of the kidney stones.

A noninvasive procedure called Extracorporeal shock wave lithotripsy may be recommended to break down large stones. Your surgeon will administer sedatives or local anaesthesia to keep you comfortable. The location of the stones is determined with the help of ultrasound or X-rays. Using a device called a lithotripter, high energy sound waves are passed over the area to be treated from outside the body. The shock waves will vibrate and break the stones down without harming the rest of the body. The stone fragments can now easily pass out through the urine.

Sometimes, your surgeon may use insert a stent or tube before or after the procedure through the bladder or the back into the kidney to hold the urinary tube open, preventing the pieces from blocking the tube.

Another alternative procedure your doctor may suggest is ureteroscopy. This can be used for stones in the urinary tract closer to the bladder. A thin lighted tube called an ureteroscope is inserted through your urinary tract opening, so no incisions are needed for the procedure. Once the stone is located, tiny forceps or a basket shaped instrument at the end of the scope grabs and removes the stones. Larger stones are first broken down with a laser before excision.

Sometimes, a more invasive procedure called percutaneous nephrolithotomy may be performed. Your surgeon will make an incision in your back under general, regional or spinal anaesthesia. A hollow tube with a probe is inserted into the incision. Your surgeon can either remove the stones directly or break them into fragments before excising them.

Prevention

Kidney stones can be prevented by making some lifestyle changes like drinking more water and reducing the intake of excess salt and animal proteins.

Ureteric Stones

The urinary system, comprised of the kidneys, ureters, bladder, and urethra, purifies the blood by removing waste substances and excretes them from the body in the form of urine. Urine is produced in the kidneys and passes through tube-like structures called ureters to reach the bladder. A urinary tract stone is formed by crystallisation of substances (mostly calcium) in the urine. As the kidneys filter blood of impurities, minerals and acid salts can accumulate and harden over time. These solid crystalline deposits or kidney stones can form in one or both kidneys and may get lodged in the ureters (called ureteric stones). The ureteric stones block the flow of urine and can cause severe pain in the flank, lower abdomen and groin. Other symptoms may include blood-stained or foul-smelling urine, frequent urination, and/or fevers. If fevers occur, this can represent a life-threatening emergency and you should present to the emergency department of your nearest hospital straight away.

When ureteric stones are suspected, your doctor may order blood, urine, and imaging tests such as a low radiation dose CT scan to diagnose the condition. A stone analysis may be carried out to determine the cause of the stone formation. This involves straining the urine for stone particles which are then examined in the laboratory.

Treatment of a ureteric stone depends on its size, location, and symptoms. Small stones (under 4 mm) can be assisted to pass by certain medications and drinking fluids in many instances. Additionally, your doctor may prescribe analgesic medication to relieve pain in waiting for the stone to pass. For larger stones, your doctor may suggest certain procedures based on the location and size of the stone. When stones are larger or fail to progress, a ureteric stent maybe inserted to temporarily relieve the obstruction.

Definitive treatment your doctor may suggest include performing either shock wave lithotripsy or undergoing an ureteroscopy. With this latter procedure, a thin lighted tube called a ureteroscope is inserted through the urinary passage. Once the stone is located, it can be fragmented using a laser fibre and the fragments removed using basket shaped instruments at the end of the scope.