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Overview | 10 ways preventions | Clinical features | Stages of stone formation | Investigations | Complications | Treatment

Did you know that kidney stones, which are hard mineral deposits that form inside the kidney, affect approximately one in ten people during their lifetime? If you’re not familiar with ways to prevent kidney stones, it’s important to learn about them. Kidney stone disease, also known as renal stone disease, is common and can occur in people of all countries. It is more prevalent in males, with 90% of kidney stones being radio-opaque (in contrast to gallstones, which are more common in females and 90% of them being radiolucent). In the UK, the prevalence of kidney stones is around 1.2%, with a lifetime risk of developing a renal stone by age 60-70 estimated at approximately 7% in men. However, in some regions, such as Saudi Arabia, the risk is higher, with a lifetime risk of developing a kidney stone in men aged 60-70 being just over 20%.

1. Stay hydrated

Staying properly hydrated by drinking enough water is crucial in preventing kidney stones, as it helps dilute urine and prevents minerals and salts from clumping together to form stones. When urine contains higher fluid levels, it is less likely to promote stone formation. In contrast, inadequate water intake can result in less urine output, leading to more concentrated urine that is prone to crystallizing and forming kidney stones.

In addition to water, citrus fruits like lemon and orange can also be beneficial in preventing kidney stones. They are rich in citrate, a compound that inhibits stone formation. It is generally recommended to drink at least 8 glasses (2 liters) of water per day, although for optimal kidney health, increasing water intake to 12 glasses per day is advisable.

Monitoring the color of your urine can also serve as an indicator of hydration levels. Ideally, urine should be clear or pale in color, which indicates adequate fluid intake. If your urine appears dark or different in color, it may be a sign of dehydration and a prompt to increase your water consumption.

To ensure that you are drinking pure and clean water, it is essential to use a quality water purifier that removes impurities and contaminants. Healthline recommends a minimum daily intake of 2 liters of water, but it’s always best to consult with your healthcare provider to determine the right amount of water intake for your individual needs. Remember, staying properly hydrated by drinking sufficient water is a simple yet effective way to prevent kidney stones and maintain good overall health.

According to Healthline, you should drink at least 2 liters of water daily. Also, It is important to drink pure and clean water and make sure you drink water from a quality water purifier.

2. Reduce salt intake

Sodium and salt can contribute to water retention, which can lead to dehydration. It is recommended that adults limit their daily salt intake to no more than 2300 milligrams, equivalent to approximately one tablespoon.

Here are some examples of high-salt foods to watch out for:

1. Potato chips
2. Smoked meats
3. Canned soups
4. Most canned fish
5. Prepared meals
6. Lunch meat
7. Condiments
8. Ready-made noodles

It’s important to note that sodium can also be found in other forms in food, such as sodium bicarbonate, disodium phosphate, monosodium glutamate (MSG), and baking powder, among others. Monitoring your intake of these sodium-containing ingredients can also help in managing your overall salt intake and preventing water retention that can lead to dehydration. Consulting with a healthcare professional or a registered dietitian can provide personalized recommendations on managing salt intake based on individual health needs.

3. Maintain a healthy body weight

Maintaining a healthy body weight is essential in preventing kidney stones. Recent research indicates that obesity or rapid weight gain may increase the risk of developing painful kidney stones, with women being particularly vulnerable to this added risk. Studies have shown that women who weigh more than 100 kg are at a higher likelihood of developing kidney stones. This may be due to the added weight on the kidneys caused by excess body fat.

It is important to note that losing weight rapidly through unhealthy means, such as crash dieting, low-carb diets, or high animal protein-based diets, can also increase the risk of kidney stones. These methods can lead to imbalances in the body, affecting the composition of urine and potentially promoting the formation of kidney stones.

When aiming to maintain a healthy body weight or lose weight, it is crucial to do so through healthy and sustainable approaches, such as a well-balanced diet, regular physical activity, and proper hydration. Consulting with a healthcare professional or a registered dietitian can provide personalized guidance on achieving and maintaining a healthy body weight to reduce the risk of kidney stones and promote overall health.

4. Reduce alcohol intake to prevent kidney stones

Alcohol consumption can increase the risk of kidney stone formation through various mechanisms. Alcohol acts as a diuretic, causing increased fluid output from the body while inhibiting fluid absorption, which can lead to dehydration. Dehydration, in turn, can result in the formation of calcium oxalate stones in the kidneys.

Prolonged intake of alcohol can also damage the kidneys and increase the risk of kidney stones as well as other kidney diseases. By reducing the amount of alcohol consumed, it is possible to lower the risk of kidney stone formation.

It is important to note that maintaining proper hydration by drinking an adequate amount of water and avoiding excessive alcohol consumption is crucial in preventing kidney stones. Drinking water regularly throughout the day can help flush out harmful substances from the kidneys and reduce the risk of stone formation

5. Avoid excessive caffeine consumption

Caffeine, a stimulant found in many beverages, can potentially increase the risk of kidney stone formation through its effects on metabolism and hydration. Caffeine has been shown to speed up metabolism, which can lead to increased fluid loss and potentially dehydration. Additionally, caffeine acts as a diuretic, causing increased urine production and further fluid loss, which may also contribute to dehydration.

Some healthcare professionals may recommend drinking tea, depending on the type of kidney stones formed, although this is a controversial topic. Green tea is often considered as one of the herbal remedies for kidney health, while black tea, which contains oxalates, may potentially increase the risk of kidney stone formation.

It is important to be mindful of caffeine intake and stay within the recommended upper limit for adults, which is 400 mg per day, equivalent to approximately 4 cups of coffee. Monitoring caffeine consumption from various sources, including coffee, tea, energy drinks, and other beverages or foods containing caffeine, can help reduce the risk of kidney stone formation and maintain proper hydration levels. Consulting with a healthcare professional or a registered dietitian can provide personalized recommendations on caffeine intake and its potential impact on kidney health. Additionally, staying well-hydrated by drinking enough water alongside moderate caffeine consumption can help mitigate the risks associated with caffeine and promote kidney health.

Source: Mayoclinic

6. Avoid sugary drink to prevent kidney stones

Consuming high amounts of sugar, particularly in the form of high-fructose corn syrup commonly found in sugary drinks, can increase the risk of kidney stone formation. High sugar intake can also contribute to dehydration, as it can cause increased urine production and fluid loss.

Research has shown that individuals who consume one or more servings of sugar-sweetened soda per day have a 23% higher risk of developing kidney stones compared to those who consume less than one serving of soda per week. This risk is also applicable to other sugary beverages, such as apple cider and other sweetened drinks. Therefore, reducing sugar consumption can be beneficial in preventing the formation of kidney stones.

It is important to be mindful of the amount of added sugars in beverages and foods, and opt for healthier alternatives such as water, unsweetened tea, or naturally flavored water to stay hydrated without the added sugar.

7. Get enough dietary calcium

Calcium oxalate is a common compound found in kidney stones. While it’s true that excess calcium intake can contribute to kidney stone formation, it’s important to note that adequate dietary calcium can actually help reduce the risk of kidney stones.

Many dairy products, such as milk, yogurt, and cheese, are excellent sources of calcium. In addition, some other foods that contain calcium include orange juice, soy sauce, canned fish with bones (such as sardines or salmon), tofu, and certain cereals.

It’s crucial to ensure that you’re getting enough dietary calcium to help prevent kidney stones. When calcium intake is insufficient, the body may leach calcium from the bones, which can actually increase the risk of kidney stone formation. Therefore, it’s important to maintain a balanced diet that includes appropriate amounts of calcium from various food sources to support overall kidney health and reduce the risk of kidney stone formation.

8. Avoid Vitamin C supplements to prevent kidney stones

High doses of vitamin C supplements, particularly in the form of ascorbic acid, have been associated with an increased risk of kidney stone formation, particularly in men. One study found that men who took high doses of vitamin C supplements doubled their risk of developing kidney stones compared to those who did not take vitamin C supplements.

The reason behind this increased risk is that vitamin C is metabolized in the body to oxalate, which is a component of many types of kidney stones, including calcium oxalate stones, the most common type. When oxalate levels in the urine become too high, it can combine with calcium to form crystals, which can then accumulate and form kidney stones.

It’s important to note that this increased risk appears to be associated with high doses of vitamin C supplements that exceed the recommended dietary allowance (RDA) and not with vitamin C obtained from whole foods. In fact, most studies suggest that vitamin C intake from foods, such as fruits and vegetables, does not increase the risk of kidney stones and may even have a protective effect against stone formation, likely due to the presence of other beneficial compounds in these foods.

9. Increase your magnesium intake

Magnesium is indeed an essential mineral that plays a critical role in numerous metabolic reactions in the body, including energy production and muscle movements. It is also believed to have a potential role in preventing calcium oxalate kidney stone formation.

Research suggests that adequate magnesium intake may help reduce the risk of calcium oxalate kidney stones. Magnesium can bind to oxalate in the intestines, forming insoluble crystals that are excreted in the feces, preventing oxalate from being absorbed into the bloodstream and ultimately reducing the amount of oxalate that can be excreted in the urine. This can help lower the risk of oxalate-based kidney stone formation.

Furthermore, magnesium has also been shown to inhibit the formation of calcium crystals in the urine, which can further contribute to the prevention of kidney stone formation.

It’s important to note that magnesium intake should be balanced and should not exceed the recommended dietary allowance (RDA) for your age and gender, as excessive magnesium intake can also have adverse effects on health. The best way to obtain magnesium is through a balanced diet that includes magnesium-rich foods, such as nuts and seeds, whole grains, legumes, leafy green vegetables, and dairy products.

10. Explore herbal remedies

Chanca Piedra, also known as “stone breaker,” is a popular herbal remedy that has been traditionally used in some cultures to prevent kidney stones. It is believed to have properties that can help prevent the formation of calcium oxalate stones, which are the most common type of kidney stones. Additionally, some proponents of Chanca Piedra claim that it can help reduce the size of existing kidney stones, making them easier to pass.

However, it’s important to note that the scientific evidence supporting the use of Chanca Piedra for kidney stone prevention is limited and inconclusive. While there are some studies that suggest potential benefits of Chanca Piedra in preventing kidney stones, the evidence is not robust, and more research is needed to establish its efficacy and safety.

It’s also worth mentioning that herbal remedies, including Chanca Piedra, are not regulated by the FDA in the same way as pharmaceutical drugs, and their safety and effectiveness may vary widely depending on the quality and preparation of the product. Herbal remedies can also interact with other medications or have potential side effects, and their long-term safety is often not well understood.

Therefore, it’s crucial to use herbal remedies with caution and consult with a qualified healthcare provider before using them, especially if you have any underlying health conditions or are taking medications.

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Clinical features

• Renal pain is felt over renal angle, hypochondrium, and lumbar region.
• Pain can be severe, radiating to groin and testis in males, and worsens with movements.
• Vomiting may occur due to pylorospasm.
• Haematuria (blood in urine) is common.
• Pyuria (pus in urine) may be present.
• Fever may be present.
• Tenderness in renal angle, often with a palpable mass in the loin due to hydronephritis.
• The mass in the loin moves with respiration and is bimanually palpable, ballotable, smooth, and soft, resembling a urinary tract infection.
• Incidental findings of kidney issues may occur during diagnostic tests for other conditions.
• Hypertension (high blood pressure) is often associated with kidney problems.
• Foods rich in oxalates, such as spinach, tea, cola, alcohol, and citrus fruits, should be noted as they may contribute to kidney stone formation.

Stages of stone formation

1. Supersaturation: Urine becomes oversaturated with substances that can form crystals, such as calcium, oxalate, and uric acid. This can occur due to various factors, such as diet, genetics, and medical conditions, leading to an increased concentration of these substances in the urine.
2. Nucleus formation: Crystals start to form in the urine, acting as a nucleus for stone formation. These tiny crystals can adhere to the lining of the urinary tract, providing a starting point for stone development.
3. Crystallization: The crystals grow in size and begin to aggregate, forming larger solid particles in the urine. The type of crystal formed depends on the composition of the supersaturated urine, with common types being calcium oxalate, calcium phosphate, and uric acid crystals.
4. Aggregation: The crystals continue to aggregate, forming larger clumps or aggregates. This process can be facilitated by factors such as urinary stasis, where urine flow is slowed or obstructed, allowing the crystals to come into contact and stick together.
5. Matrix formation: A matrix or framework of organic materials, such as proteins or mucoproteins, may develop around the aggregated crystals. The matrix can help bind the crystals together and promote stone formation.
6. Stone formation: Over time, the aggregated crystals and matrix may form a solid stone, which can vary in size, shape, and composition. Once the stone reaches a certain size, it may become lodged in the urinary tract, causing symptoms such as pain, hematuria, and urinary tract infections.

It’s important to note that not all individuals who have supersaturation of urine or crystal formation will develop kidney stones. Other factors, such as urinary tract anatomy, urinary pH, and presence of inhibitors or promoters of stone formation, also play a role in determining whether or not a stone will form.

Investigations

Blood tests:

1. Erythrocyte sedimentation rate (ESR): To assess for inflammation, which may be elevated in the presence of infection or other conditions related to kidney stones.
2. Serum calcium, phosphate, creatinine, blood urea, uric acid, and parathyroid hormone (PTH) levels: To evaluate the levels of these chemicals in the blood, which can provide information about the metabolism of calcium, phosphate, and uric acid, as well as kidney function and possible hormonal imbalances related to stone formation.

Urine tests:

1. Urine calcium, urate, cystine (if suspected), pH, and specific gravity: To assess the levels of these substances in the urine, which can help determine the risk factors for stone formation and identify the type of stone (e.g., calcium, uric acid, cystine).
2. Urine analysis and culture/sensitivity (C/S): To identify any signs of infection in the urinary tract, such as the presence of bacteria, white blood cells, or red blood cells in the urine.

Imaging tests:

1. Plain X-ray or KUB (kidneys, ureters, bladder) X-ray: To visualize the kidneys, ureters, and bladder for the presence of stones, which may appear as opaque structures on X-ray (about 90% of kidney stones are visible on X-ray).
2. Intravenous urography (IVU): To assess the structure and function of the kidneys and urinary tract using a contrast dye injected intravenously, which can help detect stones and evaluate kidney function.
3. Retrograde pyelography (RGP): If needed, this test involves injecting a contrast dye directly into the ureters to visualize the urinary tract and locate any stones.
4. Ultrasound abdomen: To detect even radiolucent stones (stones that are not visible on X-ray) and assess for any changes in the renal parenchyma, such as swelling or damage.

Advanced imaging:

1. Computed tomography (CT) scan: To identify small stones that may be missed on X-ray or other imaging tests, and to provide detailed information about the size, location, and composition of stones. CT scan is considered the gold standard for imaging kidney stones.

These investigations can help in diagnosing kidney stones, determining their size, location, and composition, assessing kidney function, identifying possible risk factors, and guiding appropriate treatment strategies.

Complications

1. Sepsis: In severe cases, kidney stones can lead to infection in the urinary tract or the kidneys, which can progress to sepsis, a life-threatening condition characterized by a widespread infection throughout the body.
2. Urinary tract infections (UTIs): Kidney stones can increase the risk of developing UTIs, as the stones can obstruct the normal flow of urine and provide a breeding ground for bacteria, leading to infection in the urinary tract.
3. Blocked ureter: Kidney stones that are large in size or located in a certain position can block the ureter, the tube that connects the kidney to the bladder, preventing the normal passage of urine and causing pain, discomfort, and potentially leading to infection or kidney damage.
4. Injury to the ureter: During surgical interventions to remove or treat kidney stones, there is a risk of injuring the ureter, which can lead to complications such as bleeding, infection, or scarring.
5. Bleeding during surgery: Surgical procedures to remove or treat kidney stones can sometimes result in bleeding, either during the procedure or postoperatively, which may require additional interventions or blood transfusion.
6. Pain: Kidney stones can cause severe pain, known as renal colic, which can be debilitating and require medical intervention for relief.

It’s important to note that not all cases of kidney stones will result in complications, and the risks vary depending on the size, location, and composition of the stones, as well as individual factors. Prompt medical attention and appropriate management can help minimize the risk of complications associated with kidney stones.

Treatment

1. Nephrolithotomy (PCNL):

Indications for PCNL:

1. Stone size: PCNL is typically considered for stones larger than 2.5 cm in size that cannot be effectively treated with other minimally invasive techniques such as Extracorporeal Shock Wave Lithotripsy (ESWL).
2. Multiple stones: PCNL may also be indicated for patients with multiple stones in the kidney or renal pelvis.
3. Stones not responding to ESWL: PCNL may be recommended when ESWL has been attempted but failed to effectively fragment and clear the kidney stones.

Procedure for PCNL:

1. Preoperative Preparation: The patient is prepared for the procedure with appropriate preoperative evaluation and imaging. The procedure is typically performed under general anesthesia.
2. Cystoscopy and Ureteric Stent/Catheter Placement: Initially, a cystoscopy is performed to visualize the bladder and urethra. A ureteric stent or catheter is then placed to ensure proper drainage of urine from the kidney during the procedure.
3. Renal Access: The renal pelvicalyceal system is identified using fluoroscopy (C-arm) or ultrasound guidance. A needle puncture is made percutaneously through the loin, guided by imaging.
4. Guidewire Placement: Once access to the renal pelvicalyceal system is established, a guidewire is passed through the needle and into the kidney to provide a pathway for subsequent dilators and instruments.
5. Graduated Dilatation: Graduated dilators are passed over the guidewire to widen the access tract, allowing for passage of the nephroscope.
6. Nephroscopy and Stone Fragmentation: A nephroscope, a thin tube with a light source and camera, is passed through the access tract into the kidney. The stones are visualized, and various methods such as laser (Holmium), pneumatic, ultrasonic, or electrohydraulic techniques are used to fragment the stones into smaller pieces.
7. Stone Removal: Once the stones are adequately fragmented, they are removed using specialized instruments or suction.
8. Postoperative Care: After the procedure, the patient is monitored closely for any complications, and a follow-up plan is established for continued stone management.

Additional Information:

1. PCNL is considered a minimally invasive procedure for the treatment of kidney stones, as it avoids the need for a large incision and allows for faster recovery compared to open surgery.
2. PCNL may be performed as a primary treatment option for large or complex kidney stones, or as a salvage procedure when other treatments have failed.
3. PCNL has a high success rate in achieving stone clearance, with lower recurrence rates compared to other techniques.
4. PCNL may be associated with potential risks and complications, such as bleeding, infection, injury to surrounding organs or structures, and postoperative pain. However, these risks are generally low and can be managed with proper surgical expertise and postoperative care.

It’s important to note that the specific indications, technique, and postoperative care for PCNL may vary depending on the patient’s individual condition and the surgeon’s preference.

Complications of Percutaneous Nephrolithotomy (PCNL):

1. Hemorrhage: One of the potential complications of PCNL is bleeding, which can occur during the procedure or postoperatively. Hemorrhage may result from injury to blood vessels during needle puncture, dilatation, or stone fragmentation. In rare cases, it may require blood transfusion or other interventions to control the bleeding.
2. Perforation of collecting duct causing extravasation of irrigation fluid: During the creation of the access tract or during stone fragmentation, there is a risk of unintentional perforation of the collecting duct, which can lead to extravasation of irrigation fluid into the surrounding tissue. This can cause discomfort, infection, and delayed healing of the tract.
3. Injury to colon or pleura while creating an initial track for nephroscope: The initial puncture for PCNL, which is made percutaneously through the loin, carries a risk of injuring nearby organs such as the colon or pleura (lining of the lungs). This risk can be minimized by careful placement of the puncture needle under imaging guidance, but in rare cases, injury may occur, leading to complications such as infection or pneumothorax (accumulation of air in the pleural cavity).
4. Infection: Like any surgical procedure, PCNL carries a risk of infection. This can occur in the kidney, surrounding tissues, or at the access site. Infections may require antibiotics, drainage, or other interventions for management.
5. Urinary Tract Injuries: PCNL involves manipulation of the urinary tract, including the renal pelvis and calyces. Inadvertent injury to these structures can occur during needle puncture, dilatation, or stone removal, which may require further intervention and management.
6. Postoperative Pain: Following PCNL, patients may experience postoperative pain, which can be managed with appropriate pain medications. However, in some cases, severe or prolonged pain may require further evaluation and management.
7. Other potential complications: Other possible complications of PCNL include fluid overload, electrolyte imbalances, allergic reactions to medications or contrast agents, and complications related to anesthesia.

It’s important to note that complications from PCNL are generally rare and can be minimized with proper surgical technique, careful patient selection, and postoperative care. Close monitoring during and after the procedure, as well as prompt recognition and management of any potential complications, is essential for ensuring a safe and successful outcome.

2. ESWL (extracorporeal shock wave lithotripsy)

Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive medical procedure used to treat kidney stones and other types of urinary stones. It involves using shock waves generated outside the body to break up the stones into smaller fragments that can be easily passed out of the body through the urinary tract.

During ESWL, shock waves are delivered to the stone through the skin and body tissues without making any incisions. The shock waves are typically generated using either piezo-ceramic or electromagnetic technology, and they are focused on the targeted stone using fluoroscopy (C-arm) or ultrasound guidance.

The shock waves create high-energy pressure waves that pass through the body and converge at the stone, causing it to break up into smaller pieces. These smaller stone fragments are then naturally eliminated from the body through the urinary tract during urination.

ESWL is typically used to treat stones that are less than 2.5 cm in size, located in the kidney, ureter, or bladder, and composed of certain types of stones, such as calcium-based stones or uric acid stones. It is considered a relatively safe and effective treatment option for suitable patients, and it is often performed as an outpatient procedure without the need for general anesthesia.

ESWL has several advantages, including being non-invasive, not requiring incisions, no or minimal anesthesia, minimal recovery time, and the ability to repeat the procedure if needed.

Advantages of ESWL:

1. Non-invasive: ESWL is a non-invasive procedure that does not require any incisions or surgical instruments to be inserted into the body. It is performed externally, using either piezo-ceramic or electromagnetic shock waves that are passed through a water bath or water cushion, which act as a medium to deliver the shock waves to the stone. This makes it a relatively safer option compared to invasive procedures like PCNL.
2. No anesthesia required: ESWL can be performed without the need for general anesthesia in most cases. It can be done as an outpatient procedure or with minimal sedation, which reduces the risks and complications associated with anesthesia.
3. Outpatient procedure: ESWL can often be done as an outpatient procedure, meaning that the patient can go home on the same day of the procedure. This eliminates the need for a hospital stay and allows for a faster recovery and return to normal activities.
4. Effective for stones less than 2.5 cm: ESWL is highly effective for treating stones that are less than 2.5 cm in size. The shock waves can fragment the stones into smaller pieces that can be easily passed out of the body through the urinary tract.
5. Suitable for different types of stones: ESWL is effective in treating various types of stones, including hard stones and oxalate stones. It can be used for stones located in the kidney, ureter, or bladder.
6. Repeatable: ESWL can be repeated if needed, in different settings or sessions, to achieve complete stone clearance. This makes it a versatile option for managing stones that may require multiple treatments.
7. Alternative to invasive procedures: If ESWL is not successful in fragmenting the stone completely, it can serve as a stepping stone to more invasive procedures like PCNL. It can be used as a first-line treatment, and if needed, PCNL can be performed as a secondary option.
8. Minimal recovery time: ESWL typically has a shorter recovery time compared to invasive procedures like PCNL. Most patients can resume their normal activities within a few days after the procedure.

It’s important to note that the suitability of ESWL depends on various factors, such as the size, location, and composition of the stone, as well as the overall health and condition of the patient.

Complications

1. Renal hematoma: ESWL uses high-energy shock waves to fragment kidney stones, and these shock waves can sometimes cause bleeding within the kidney, leading to the formation of a hematoma or a collection of blood. The risk of renal hematoma is higher in patients with larger stones, multiple stones, or those with a history of bleeding disorders.
2. Severe hematuria: ESWL can cause bleeding in the urinary tract, resulting in blood in the urine. While mild hematuria is common after ESWL and usually resolves on its own, severe hematuria can occur in some cases, requiring further medical intervention such as blood transfusion or additional procedures to control the bleeding.
3. Injury to adjacent structures: The shock waves used in ESWL can potentially cause injury to nearby structures, such as the surrounding organs (e.g., liver, spleen) or blood vessels. This can result in complications such as bleeding, organ damage, or other injuries.
4. Fragmented stone retention in the ureter: After the stone is fragmented by the shock waves, the smaller stone fragments may not pass easily through the urinary tract and can get lodged in the ureter, leading to pain, obstruction, or infection. This may require additional procedures, such as ureteroscopy or stent placement, to help clear the fragments and prevent complications.
5. Incomplete stone clearance: ESWL may not always completely fragment and eliminate the entire stone, especially in cases of larger or harder stones. Some stone fragments may remain in the kidney or ureter, requiring additional treatments or procedures to clear them, and in some cases, repeat ESWL sessions may be needed.
6. Pain or discomfort: ESWL can cause temporary discomfort or pain during the procedure, including pain in the back, abdomen, or groin area. Most patients tolerate the procedure well with pain medications, but in some cases, the pain may persist or require additional management.

Contraindications

1. Pregnancy: ESWL is generally contraindicated in pregnant women due to potential risks to the developing fetus from the shock waves. The high-energy shock waves used in ESWL can potentially cause harm to the fetus, including risk of fetal injury or premature labor. Pregnant women with kidney stones may require alternative treatment options that are safe for pregnancy, and the decision should be made in consultation with a healthcare provider.
2. Bleeding disorder: Patients with bleeding disorders, such as hemophilia or other clotting disorders, may be at an increased risk of bleeding complications during or after ESWL. The shock waves used in ESWL can potentially cause bleeding in the urinary tract or other areas, and patients with bleeding disorders may require alternative treatment options or additional precautions to manage the risk of bleeding.
3. Patients with abdominal aneurysms: ESWL is contraindicated in patients with known abdominal aortic aneurysms or other vascular abnormalities in the treatment area. The high-energy shock waves used in ESWL can potentially cause injury or rupture of the blood vessels, leading to life-threatening bleeding or other vascular complications. Prior imaging studies, such as CT scan or ultrasound, should be performed to screen for potential vascular abnormalities before considering ESWL.
4. Sepsis and renal failure (serum creatinine more than 3 mg%): ESWL may not be suitable for patients with severe sepsis or renal failure, as the procedure may pose additional risks in these cases. Sepsis is a severe infection that can affect multiple organs in the body, and ESWL may further stress the body and worsen the infection. Similarly, patients with renal failure, indicated by elevated serum creatinine levels of more than 3 mg%, may have compromised kidney function, and ESWL may not be appropriate or may require special precautions.

Conservative treatment:

1. Flush therapy: Flush therapy, also known as “watchful waiting” or “expectant management,” is a conservative approach that may be used for lower ureteric stones. This approach involves close monitoring of the stone’s progress and allowing it to pass naturally without any active intervention, especially if the stone is small and causing minimal symptoms. Patients may be advised to drink plenty of fluids, such as water, to promote urine flow and flush out the stone from the urinary tract.
2. IV fluids: Intravenous (IV) fluids may be administered as part of conservative treatment for kidney stones. IV fluids help to maintain hydration and increase urine production, which can facilitate the passage of stones by flushing them out through the urinary tract. Adequate hydration is essential to promote natural stone passage and reduce the risk of complications associated with dehydration.
3. Inj Frusemide: Frusemide, also known as furosemide, is a loop diuretic that may be administered intravenously in certain cases of kidney stones. It works by increasing urine production and promoting diuresis, which can help to flush out the stone from the urinary tract. The dosage of frusemide may vary depending on the patient’s condition and response to treatment, and it is typically administered under the supervision of a healthcare provider.
4. Anti-inflammatory and antispasmodic agents: Anti-inflammatory and antispasmodic agents may be prescribed as part of conservative treatment for kidney stones to relieve pain and discomfort associated with stone passage. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may help to reduce inflammation and relieve pain. Antispasmodic medications, such as oxybutynin or hyoscine, may help to relax the smooth muscles of the urinary tract, reducing spasms and easing the passage of the stone.

 Surgery for kidney stones

Presently most of the renal stones can be removed without open surgery (PCNL< ESWL< URS). But limiting factors are cost availability.

1. Pyelolithotomy

Pyelolithotomy is a surgical procedure used for the removal of kidney stones that are located in the extrarenal pelvis, which is the portion of the renal pelvis that extends outside the kidney.

Indications: Pyelolithotomy may be considered in cases where the kidney stone is located in the extrarenal pelvis, which is the portion of the renal pelvis that extends outside the kidney. It may also be considered when other less invasive treatment options, such as ESWL or ureteroscopy, are not feasible or unsuccessful.

Procedure: Pyelolithotomy is typically performed through a loin (posterior subcostal) incision, which is an incision made in the back, just below the ribcage. The kidney is approached through this incision, and the renal pelvis, which is the part of the kidney that collects urine, is opened. The stone is then removed from the renal pelvis. Depending on the size and location of the stone, different techniques may be used to remove it, such as forceps, scoops, or baskets. Once the stone is removed, the renal pelvis is closed using sutures or staples. A drain may be placed to allow any excess fluid to drain out, and the wound is closed with sutures or staples.

Recovery: After Pyelolithotomy, the patient may need to stay in the hospital for a few days for postoperative monitoring and recovery. Pain medications may be prescribed to manage postoperative pain, and antibiotics may be given to prevent infection. The drain, if placed, will be removed once the drainage slows down. The patient may be advised to avoid heavy lifting or strenuous activities for several weeks to allow for proper healing of the incision. Follow-up appointments with the healthcare provider may be scheduled to monitor the recovery process and assess the success of the procedure in eliminating the stone.

Complications: As with any surgical procedure, Pyelolithotomy carries potential risks and complications. These may include bleeding, infection, damage to adjacent structures such as blood vessels, ureter or surrounding organs, urine leakage, and scarring. It’s important to discuss the potential risks and benefits of Pyelolithotomy with a healthcare provider before undergoing the procedure.

Pyelolithotomy is a surgical option for the removal of kidney stones in the extrarenal pelvis, and it may be considered in certain cases where other treatment options are not feasible or unsuccessful.

2. Extended pyelolithotomy (Gil-Vernet)

Extended pyelolithotomy, also known as Gil-Vernet pyelolithotomy, is a surgical procedure used for the removal of large renal pelvic stones or complex kidney stones that cannot be effectively managed by standard pyelolithotomy techniques. It is a more extensive approach that involves a larger incision and a more thorough exploration and removal of stones from the renal pelvis.

Indications: Extended pyelolithotomy may be considered in cases where the kidney stone is large, complex, or located deep within the renal pelvis, and standard pyelolithotomy techniques are not feasible or unsuccessful. It may also be considered when other less invasive treatment options, such as ESWL or ureteroscopy, are not suitable for the management of the stone.

Procedure: Extended pyelolithotomy is typically performed through a loin (posterior subcostal) incision, which is a larger incision made in the back, just below the ribcage. The kidney is approached through this incision, and the renal pelvis is carefully opened to expose the stone. The stone(s) are then removed from the renal pelvis using various techniques, such as forceps, scoops, or baskets, depending on the size and location of the stone(s). In some cases, additional procedures may be performed during extended pyelolithotomy, such as ureteroscopy or fluoroscopy to ensure complete removal of the stones. Once the stones are removed, the renal pelvis is closed using sutures or staples, and a drain may be placed to allow any excess fluid to drain out. The wound is then closed with sutures or staples.

Recovery: After extended pyelolithotomy, the patient may need to stay in the hospital for a few days for postoperative monitoring and recovery. Pain medications may be prescribed to manage postoperative pain, and antibiotics may be given to prevent infection. The drain, if placed, will be removed once the drainage slows down. The patient may be advised to avoid heavy lifting or strenuous activities for several weeks to allow for proper healing of the incision. Follow-up appointments with the healthcare provider may be scheduled to monitor the recovery process and assess the success of the procedure in eliminating the stone.

Complications: As with any surgical procedure, extended pyelolithotomy carries potential risks and complications. These may include bleeding, infection, damage to adjacent structures such as blood vessels, ureter or surrounding organs, urine leakage, and scarring. Due to the larger incision and more extensive nature of the procedure, there may also be an increased risk of postoperative pain, longer recovery time, and cosmetic concerns. It’s important to discuss the potential risks and benefits of extended pyelolithotomy with a healthcare provider before undergoing the procedure.

3. Nephrolithotomy

Nephrolithotomy is a surgical procedure used for the removal of kidney stones directly from the kidney. It involves making an incision in the kidney to access and remove the stones.

Indications: Nephrolithotomy may be considered in cases where kidney stones are large, complex, or located in a deep part of the kidney that cannot be effectively managed by less invasive techniques, such as ESWL or ureteroscopy. It may also be considered in cases where other treatment options are contraindicated or unsuccessful, and the stones are causing significant symptoms, such as severe pain, infection, or obstruction.

Procedure: Nephrolithotomy is typically performed under general anesthesia. The patient is positioned to allow access to the kidney, and an incision is made in the flank or abdomen to access the kidney directly. The surgeon may use various techniques, such as ultrasound, fluoroscopy, or laparoscopy, to guide the placement of instruments and locate the stones within the kidney. Once the stones are identified, they are carefully removed using forceps, scoops, or baskets. In some cases, additional procedures may be performed during nephrolithotomy, such as pyeloplasty to correct any structural abnormalities or defects in the renal pelvis or ureter. After the stones are removed, the incision in the kidney is closed using sutures or staples, and the wound is closed with sutures or staples.

Recovery: After nephrolithotomy, the patient may need to stay in the hospital for several days for postoperative monitoring and recovery. Pain medications may be prescribed to manage postoperative pain, and antibiotics may be given to prevent infection. The patient may be advised to avoid heavy lifting or strenuous activities for several weeks to allow for proper healing of the incision. Follow-up appointments with the healthcare provider may be scheduled to monitor the recovery process and assess the success of the procedure in eliminating the stones.

Complications: As with any surgical procedure, nephrolithotomy carries potential risks and complications. These may include bleeding, infection, damage to adjacent structures such as blood vessels, ureter, or surrounding organs, urine leakage, scarring, and potential loss of kidney function. It’s important to discuss the potential risks and benefits of nephrolithotomy with a healthcare provider before undergoing the procedure.

4. Nephropyelolithomy

Nephropyelolithotomy is a surgical procedure that involves the removal of kidney stones from both the kidney and the renal pelvis. It is typically used for larger stones that are located in the renal pelvis and extend into the kidney.

Indications: Nephropyelolithotomy may be considered in cases where kidney stones are large and complex, located in both the renal pelvis and the kidney, and cannot be effectively managed by less invasive techniques, such as ESWL or ureteroscopy. It may also be considered in cases where other treatment options are contraindicated or unsuccessful, and the stones are causing significant symptoms, such as severe pain, infection, or obstruction.

Procedure: Nephropyelolithotomy is typically performed under general anesthesia. The patient is positioned to allow access to the kidney and the renal pelvis, and an incision is made in the flank or abdomen to access the kidney and the renal pelvis directly. The surgeon may use various techniques, such as ultrasound, fluoroscopy, or laparoscopy, to guide the placement of instruments and locate the stones within the kidney and the renal pelvis. Once the stones are identified, they are carefully removed using forceps, scoops, or baskets. In some cases, additional procedures may be performed during nephropyelolithotomy, such as pyeloplasty to correct any structural abnormalities or defects in the renal pelvis or ureter. After the stones are removed, the incisions in the kidney and the renal pelvis are closed using sutures or staples, and the wounds are closed with sutures or staples.

Recovery: After nephropyelolithotomy, the patient may need to stay in the hospital for several days for postoperative monitoring and recovery. Pain medications may be prescribed to manage postoperative pain, and antibiotics may be given to prevent infection. The patient may be advised to avoid heavy lifting or strenuous activities for several weeks to allow for proper healing of the incisions. Follow-up appointments with the healthcare provider may be scheduled to monitor the recovery process and assess the success of the procedure in eliminating the stones.

Complications: As with any surgical procedure, nephropyelolithotomy carries potential risks and complications. These may include bleeding, infection, damage to adjacent structures such as blood vessels, ureter, or surrounding organs, urine leakage, scarring, and potential loss of kidney function. It’s important to discuss the potential risks and benefits of nephropyelolithotomy with a healthcare provider before undergoing the procedure.

5. Partial nephrectomy

Partial nephrectomy, also known as kidney-sparing or nephron-sparing surgery, is a surgical procedure that involves the removal of only a portion of the kidney while preserving the remaining healthy kidney tissue. It is typically performed to treat kidney tumors or lesions, while preserving kidney function.

Indications: Partial nephrectomy is indicated in cases where a kidney tumor or lesion is suspected to be malignant or cancerous, and the tumor is located in a favorable location within the kidney that allows for partial removal without compromising the overall function of the kidney. It may also be considered in cases where the patient has a history of kidney disease, renal insufficiency, or other medical conditions that require preservation of as much healthy kidney tissue as possible.

Procedure: Partial nephrectomy is typically performed under general anesthesia. The patient is positioned to allow access to the affected kidney, and an incision is made in the flank or abdomen to expose the kidney. The surgeon may use various techniques, such as open surgery, laparoscopy, or robot-assisted surgery, to remove the tumor or lesion while preserving the healthy kidney tissue. The tumor is carefully dissected from the surrounding kidney tissue, and the blood vessels and ureter are carefully preserved. After the tumor is removed, the incisions in the kidney are closed using sutures or staples, and the wound is closed with sutures or staples.

Recovery: After partial nephrectomy, the patient may need to stay in the hospital for several days for postoperative monitoring and recovery. Pain medications may be prescribed to manage postoperative pain, and antibiotics may be given to prevent infection. The patient may be advised to avoid heavy lifting or strenuous activities for several weeks to allow for proper healing of the incisions. Follow-up appointments with the healthcare provider may be scheduled to monitor the recovery process, assess kidney function, and monitor for recurrence of tumors.

Complications: As with any surgical procedure, partial nephrectomy carries potential risks and complications. These may include bleeding, infection, damage to adjacent structures such as blood vessels or ureter, urine leakage, scarring, loss of kidney function, and potential need for further surgical interventions. It’s important to discuss the potential risks and benefits of partial nephrectomy with a qualified healthcare provider before undergoing the procedure.

6. Bench surgery

Bench surgery for the kidney, also known as ex vivo kidney surgery or kidney bench surgery, is a specialized surgical procedure that involves the removal and manipulation of a kidney outside of the body before it is transplanted back into the recipient’s body. Bench surgery for the kidney is commonly performed in kidney transplantation procedures to optimize the function and viability of the kidney before transplantation.

During bench surgery for the kidney, the donor kidney is carefully removed from the donor’s body and placed on a specialized operating table or “bench”. The surgical team then performs various procedures on the kidney, such as removing tumors or cysts, repairing blood vessels, optimizing blood flow, and ensuring proper anatomical alignment. The kidney may also be preserved or cooled to maintain its viability during the bench surgery process.

Bench surgery for the kidney allows the surgical team to carefully assess and optimize the condition and function of the kidney before transplantation. This may include removing any potential sources of complications, ensuring proper blood supply to the kidney, and addressing any structural or functional abnormalities. By performing these procedures outside of the body, the surgical team can take the time to carefully assess and optimize the kidney’s condition, which can help improve the success and outcomes of the transplantation procedure.

7. Coagulum Pyelolithotomy

Coagulum pyelolithotomy is a surgical procedure that involves the removal of stones from the renal pelvis of the kidney, which are formed as a result of blood clots or coagula. This procedure is typically performed in cases where there is a history of recurrent bleeding or hematuria, and the formation of coagulum stones in the renal pelvis is suspected as the cause.

During coagulum pyelolithotomy, the patient is usually placed under general anesthesia. An incision is made in the loin or flank region, and the kidney is exposed. The renal pelvis is then carefully opened, and the coagulum stones are identified and removed using specialized instruments, such as forceps or stone retrievers. The renal pelvis is then closed using sutures, and a drain may be placed to allow for drainage of any potential fluid or blood.

Coagulum pyelolithotomy is a relatively uncommon procedure and is typically reserved for cases where other treatment options, such as conservative management or less invasive techniques like ESWL, are not effective or appropriate. It is considered a more invasive surgical approach and may be associated with risks and complications, including bleeding, infection, injury to surrounding structures, and postoperative pain. Close monitoring and follow-up care are typically required after coagulum pyelolithotomy to ensure proper healing and recovery.

8. Anatrophic pyelolithotomy

Anatrophic pyelolithotomy is a surgical procedure that involves removing kidney stones by making an incision into the renal pelvis of the kidney and removing the stones, while preserving the normal anatomy of the kidney. It is typically used for larger stones that cannot be effectively treated with less invasive methods, such as ESWL or ureteroscopy.

During anatrophic pyelolithotomy, the patient is usually placed under general anesthesia. An incision is made in the loin or flank region, and the kidney is exposed. The renal pelvis is carefully opened, and the stones are identified and removed using specialized instruments, such as stone retrievers or forceps. The renal pelvis is then closed using sutures, and the kidney is carefully reconstructed to restore its normal anatomical integrity. A drain may be placed to allow for drainage of any potential fluid or blood.

Anatrophic pyelolithotomy is a technically demanding procedure that requires expertise in renal surgery. It is typically performed by urologists who have experience in managing complex kidney stone cases. The procedure aims to remove the stones while preserving as much healthy kidney tissue as possible to maintain the kidney’s normal function.

As with any surgical procedure, anatrophic pyelolithotomy carries risks and potential complications, including bleeding, infection, injury to surrounding structures, and postoperative pain. Close monitoring and follow-up care are necessary after the surgery to ensure proper healing and recovery.

Summary:

Kidney stones are common, but there are prevention methods that may help reduce the risk. Staying hydrated and making dietary changes are the best ways to prevent kidney stones. However, if prevention methods do not work, surgeries may be necessary. If you have conditions that increase the risk of kidney stones, consult with your doctor for management options. It’s important to know the type of kidney stone you have, as it can help in preventing future occurrences.