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The treatment of kidney stones

Posted Mar 14 2012 4:45am

This article discusses the treatment of kidneyOne of two bean-shaped organs that are located on either side of the body, below the ribcage. The main role of the kidneys is to filter out waste products from the blood. stones, from lifestyle changes such as drinking plenty of water, to surgical intervention.

Fortunately, surgery is not usually necessary. Most kidney stones can pass through the urinary system with plenty of water two to three litres a day to help move the stone along. Often, the patient can stay home during this process, drinking fluids and taking pain medication as needed. The doctor usually asks the patient to save the passed stone(s) for testing. It can be caught in a cup or tea strainer used only for this purpose.

The treatment of kidney stones

A simple and most important lifestyle change to prevent stones is to drink more liquids water is best. Someone who tends to form stones should try to drink enough liquids throughout the day to produce at least two litres of urine in every 24-hour period.

In the past, people who form calcium stones were told to avoid dairy products and other foods with high calcium content. Recent studies have shown that foods high in calcium, including dairy products, may help prevent calcium stones. Taking calcium as a supplement in pill form, however, may increase the risk of developing stones.

Patients may be told to avoid food with added vitaminEssential substances that cannot be produced by the body and so must be acquired from the diet. D and certain types of antacids that have a calcium base. Someone who has highly acidic urine may need to eat less meat, fish, and poultry as these foods increase the amount of acid in the urine.

To prevent cystine stones, a person should drink enough water each day to dilute the concentration of cystine that escapes into the urine, which may be difficult. More than four litres of water may be needed every 24 hours, and a third of that must be drunk during the night.

During the acuteHas a sudden onset. renal colic Spasms of severe pain in one side of the back usually caused by a kidney stone passing down the ureter. phase, painkillers including non-steroidal anti-inflammatory drugsA group of drugs that give pain relief and reduce inflammation. (NSAIDnon-steroidal anti-inflammatory drug) such as diclofenac, or opiatesAny drug derived from or chemically similar to opium. are recommended.

Calcium and uric acid stones

A doctor may prescribe certain medications to help prevent calcium and uric acid stones. These medicines control the amount of acid or alkali in the urine which are key factors in crystal formation. The medicine allopurinol may also be useful in some cases of hyperuricosuriaA medical condition whereby there are excessive amounts of uric acid present in the urine..

Doctors usually try to control hypercalciuriaA condition whereby there are excessive amounts of calcium in the urine., and thus prevent calcium stones, by prescribing certain diureticsDrugs that help to remove excess water from the body by increasing the amount lost in urine., such as hydrochlorothiazide. These medicines decrease the amount of calcium released by the kidneys into the urine by favouring calcium retention in bone. They work best when sodiumOne of the chemical components of salt (sodium chloride) and an important blood chemical. intake is low.

Rarely, patients with hypercalciuria are given the medicine sodium cellulose phosphate, which binds calcium in the intestinesThe major part of the digestive tract. and prevents it from leaking into the urine.

People with hyperparathyroidismExcessive secretion of parathyroid hormone from the parathyroid glands. sometimes develop calcium stones. In these cases, surgery is usually required to remove the parathyroid glands, which are located in the neck. In most cases, only one of the glands is enlarged. Removing the glands cures the patient’s problem with hyperparathyroidism and kidney stones.

Cystine and struvite stones

If cystine stones cannot be controlled by drinking more fluids, a doctor may prescribe medicines such as tiopronin and penicillamine, which help to reduce the amount of cystine in the urine.

For struvite stones that have been totally removed, the first line of prevention is to keep the urine free of bacteriaA group of organisms too small to be seen with the naked eye, which are usually made up of just a single cell. that can cause infectionInvasion by organisms that may be harmful, for example bacteria or parasites.. A patient’s urine will be tested regularly to ensure no bacteria are present.

If struvite stones cannot be removed, a doctor may prescribe a medicine called acetohydroxamic acid (AHA). AHA is used with long-term antibiotic medicines to prevent the infection that leads to stone growth.

The treatment of kidney stones

A meta-analysis of nine randomised controlled trialsStudies comparing the outcomes between one or more different treatments for a disease (or in some instances, preventive measures against that disease) and no active treatment at all (the placebo group). Study participants are allocated to the various groups on a random basis. May be abbreviated to RCT. suggests that treatment with a calcium channel blocker or an alpha blocker improves the chance of the spontaneous expulsion of small distal urinary stones, which would spare patients from surgery.

Surgery may be needed to remove a kidney stone if it:

  • Does not pass after a reasonable period of time and causes constant pain.
  • Is too large to pass on its own or is caught in a difficult place.
  • Blocks the flow of urine.
  • Causes an ongoing urinary tractThe channels that carry urine from the kidneys to the outside of the body. infection.
  • Damages kidney tissueA group of cells with a similar structure and a specialised function. or causes constant bleeding.
  • Has grown larger, as seen on follow-up imaging.

Until twenty years ago, open surgery was necessary to remove a stone. The surgery required a recovery time of four to six weeks. Today, treatment for these stones is greatly improved, and many options do not require major open surgery and can be performed using minimally invasive techniques requiring only a few hours hospital stay.

Extracorporeal Shock Wave Lithotripsy (ESWL) is the most frequently used procedure for the treatment of small kidney stones. In ESWL, shockwaves that are created outside the body travel through the skin and body tissues and target the denser stones. The stones break down into small particles and are easily passed through the urinary tract in the urine.

Several types of ESWL devices exist. Most devices use either x-rays or ultrasoundA diagnostic method in which very high frequency sound waves are passed into the body and the reflective echoes analysed to build a picture of the internal organs – or of the foetus in the uterus. to help the urologistA specialist in the treatment of diseases of the urinary tract, the channels that carry urine from the kidneys to the outside of the body. pinpoint the stone during treatment. For most types of ESWL procedures, anaesthesia is not required.

In many cases, ESWL may be done on an outpatient basis. Recovery time is relatively short, and most people can resume normal activities the next day.
Complications may occur with ESWL. Some patients have bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. in their urine for a few days after treatment. Bruising and minor discomfort in the back or abdomenThe part of the body that contains the stomach, intestines, liver, gallbladder and other organs. from the shockwaves can occur. To reduce the risk of complications, we would usually tell patients to avoid taking aspirinOne of the most used medicines. and other medicines that affect blood clotting for two weeks before treatment.

Sometimes, the shattered stone particles can cause a minor blockage as they pass through the urinary tract and cause discomfort. In some cases, the doctor will insert a small tube called a stentA tube placed inside a tubular structure in the body, to keep it patent, that is, open. through the bladderThe organ that stores urine. into the ureter under general anaestheticAny agent that reduces or abolishes sensation, affecting the whole body. to help these fragments pass. Sometimes the stone is not completely shattered with one treatment, and additional treatments may be needed.

As with any interventional, surgical procedure, potential risks and complications will be discussed with the urologist before making a treatment decision.

Sometimes a procedure called percutaneous nephrolithotomy (PCNL) is recommended to remove a kidney stone. This treatment is often used when the stone is quite large or in a location that does not allow effective use of ESWL or flexible ureterorenoscopy (an endoscopic examination of the ureter).
In this procedure, the urologist makes a one inch incision in the back and creates a tunnel directly into the kidney. Using an instrument called a nephroscope, the urologist locates and removes the stone. For large stones, the Swiss LithoClast® Master, which produces simultaneous ultrasonic and pneumatic lithotripsy, may be needed to break the stone into small pieces. Often, patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the hospital stay.

A major advantage of percutaneous nephrolithotomy is that the urologist can remove all of the stone fragments directly instead of relying solely on their natural passage from the kidney.

Although some stones in the uretersTwo tubes that carry urine from the kidneys to the bladder, where it is stored. can be treated with ESWL, ureteroscopy may be needed for mid- and lower-ureter stones and a flexible ureterorenoscopy for small kidney stones not amenable to ESWL. No incision is made in this procedure. Instead, the urologist passes the ureteroscope, a small fiberoptic instrument, through the urethraThe tube that carries urine from the bladder, and in men also carries semen during ejaculation. and bladder into the ureter. The urologist then locates the stone and either removes it with a basket-like device or shatters it with Holmium laser, a special instrument that vaporises the stone into sand particles with minimal traumaA physical injury or emotionally painful event. to the wall of the ureter or kidney.

Blood in urine is a very common feature as a result of treatment. It is often transient and settles rapidly.

Urine infection may occur, as stones are often full of bacteria. The urologist tends to give a large dose of antibioticsMedication to treat infections caused by microbes (organisms that can't be seen with the naked eye), such as bacteria. in theatre and often send patients home on antibiotics.

Discomfort or pain - Stents can cause discomfort or pain, commonly in the bladder and kidney area, but sometimes in other areas such as the groin, urethra and genitals. The discomfort or pain may be more noticeable after physical activities and after passing urine.

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