Kidney Stones Surgery & Treatments

Kidney stones, scientifically known as “Renal Calculi” is a condition characterized by the presence of hard mineral and salt crystals in one or both kidneys. The causes range from genetics and diet to medications and metabolic diseases. Kidney stones vary in size as well as shape. The smaller ones may pass on their own while passing urine with little or no pain, but those that are larger may get obstructed, leading to severe pain and bleeding. On experiencing any symptoms, one must seek care from a doctor or urologist to avoid any further complications.

The causes of kidney stones are multifactorial. It forms due to an excess amount of the minerals and salts in the urine that crystallize and stick together, becoming more in composition than the fluid in the urine can dilute. 
Kidney stones can be made up of different types of crystals depending upon their composition. Identifying it helps determine the course of treatment and prevents its reoccurrence. The various types are:
 

• Calcium Stones: They are the most common type of kidney stones. Calcium stones are formed when there is an excess of calcium in the urine, which combines with oxalate or phosphate to form a hard stone. Factors that can contribute to the formation of calcium stones include a high-salt diet, low fluid intake, and certain medical conditions such as hyperparathyroidism and Crohn's disease.
• Uric Acid Stones: They account for around 10% of all kidney stones. Uric acid stones are formed when there is too much uric acid in the urine, which can occur due to a variety of factors such as a diet high in purines (which are found in certain meats and seafood), dehydration, and medical conditions such as gout and metabolic disorders.
• Struvite Stones: They account for around 10-15% of all kidney stones. These are found mostly in women with Urinary Tract Infections (UTIs) and cause urinary obstruction due to their larger size. Treating the underlying infection helps prevent its occurrence.
• Cystine stones: Cystine stones are a rare type of kidney stone that is formed from cystine, an amino acid that is found in the urine. These stones account for less than 1% of all kidney stones. Cystine stones are formed when there is an excess of cystine in the urine, which can occur due to a genetic disorder called cystinuria.

There are several risk factors that can increase a person's chances of developing kidney stones. These include:

• Family history: People with a family history of kidney stones are more likely to develop them.
• Age and gender: Men are more likely to develop kidney stones than women, and people over the age of 40 are at a higher risk.
• Dehydration: Low fluid intake can cause concentrated urine, which increases the risk of kidney stones.
• Diet: A diet high in salt, sugar, and animal protein, and low in calcium, can increase the risk of kidney stones.
• Medical conditions: Certain medical conditions, such as gout, hyperparathyroidism, and inflammatory bowel disease, can increase the risk of kidney stones.
• Medications: Some medications, such as diuretics and antacids, can increase the risk of kidney stones.
• Obesity: Obesity increases the risk of kidney stones by increasing the levels of certain substances in the urine that promote stone formation.
• Immobility: People who are bedridden or have limited mobility are at a higher risk of developing kidney stones due to reduced urinary flow.

It is important to note that having one or more of these risk factors does not necessarily mean that a person will develop kidney stones, but it does increase the likelihood.

The following medical conditions that could also lead to kidney stones:

• Renal tubular acidosis
• Cystinuria
• Hyperparathyroidism
• If you are facing constant urinary tract infections, you might be at an increased risk of developing kidney stones.
• Long-term and excessive use of vitamin C, dietary supplements, laxatives, calcium-based antacids, triamterene diuretics (often called water pills), anti-seizure medication, and certain medications used to treat migraines and depression.

A patient with kidney stones may be asymptomatic unless the stones move through the urinary tract, with the most common symptom being, severe abdominal pain (known as renal colic) associated with nausea and vomiting.

Gastrointestinal symptoms include:

• Pain type: Severe, sharp pain that comes in waves and fluctuates in intensity and may shift to a different location as the stone moves through the urinary tract.
• Pain areas: In the side and back, below the ribs that may radiate to the lower abdomen and groin.

Urinary signs and symptoms of kidney stones:

• Burning sensation while urinating.
• A persistent need to urinate.
• Frequent urination in small amounts. 
• Blood in the urine (Pink, red, or brown urine).
• Cloudy or foul-smelling urine
• If an infection is present the patient may experience fever and chills

Complications that arise from leaving kidney stones untreated are:

• Urinary Tract Infections (UTIs)
• More intense over time
• Urinary tract infections
• Damage to the kidney
• Recurrent kidney stones

In rare cases, untreated kidney stones can lead to serious complications, such as sepsis, a potentially life-threatening infection that can spread throughout the body.

Kidney stones can be diagnosed using the following:

• A complete health history assessment.
• A physical exam.
• Tests, including blood tests for calcium, phosphorus, uric acid, and electrolytes.
• Blood Urea Nitrogen (BUN) and Creatinine to assess kidney functioning.
• Urine analysis to check for crystals, bacteria, blood, and white cells.
• Examination of passed stones to determine their type

Imaging tests that can help to rule out obstruction are:

• Abdominal X-rays.
• Ultrasound of the kidney (the preferred test).
• Abdominal CT scan.
• Intravenous Pyelogram (IVP).
• Retrograde Pyelogram.
• MRI scan of the abdomen and kidneys.

Note: The contrast dyes used in imaging tests can cause kidney damage in those with impaired kidney function and hence patients must inform about medications that he/she is taking prior to tests being performed.

Treatment depends on the type of kidney stones and intensity of symptoms. The kidney stones which are smaller with minimal symptoms can be treated with pain relievers, by drinking an adequate amount of water, and through medical therapy.

1. Medical Therapy
   Medications known as an alpha-blocker, relax the muscles in the ureter, helping the patient pass the kidney stone more quickly and with less pain. Kidney stones that are larger in size and cause severe pain, and blood in the urine, and those associated with urinary tract infections may require extensive treatment options such as:
2. Extracorporeal Shock Wave Lithotripsy (ESWL) 
   ESWL is a procedure that uses sound waves to break up kidney stones, depending on size and location. It may require sedation or light anesthesia.
3. Ureteroscopy
   This procedure uses a ureteroscope to remove a smaller stone in the ureter or kidney. The scope has a small wire with a camera attached when inserted into the urethra and is passed into the bladder. The doctor then uses an instrument to remove the stone.
4. Retrograde Intrarenal Surgery (RIRS)
   This procedure may require general or spinal anesthesia. An endoscope with fiber optics is inserted in the retrograde fashion i.e. through the urinary tract opening, via the ureter that connects to the kidneys. Once the stones can be accessed, they are subjected to a Holmium laser and fragments may be grabbed by forceps or ancillary devices-stone baskets.
5. Percutaneous Nephrolithotomy
   This surgery uses a small incision on the back that removes the larger stones in the kidney under general anesthesia. The doctor may recommend this surgery if ESWL is unsuccessful.
6. Parathyroid Gland Surgery
   Parathyroid gland surgery may be considered as a treatment option for kidney stones if they are caused by hyperparathyroidism, which is a condition characterized by overactive parathyroid glands that produce too much parathyroid hormone (PTH). PTH regulates calcium levels in the blood, and when the levels are too high, it can lead to the formation of calcium-based kidney stones. In such cases, surgery to remove the affected parathyroid gland(s) may help to normalize calcium levels and prevent further stone formation.

Kidney stones can be prevented with a combination of medications and lifestyle changes.

Lifestyle changes to reduce the risk of kidney stones:

• Drinking plenty of water throughout the day
• Eating fewer foods that are oxalate-rich
• Consuming a diet that’s low in animal protein and salt
• Being cautious with calcium supplements while eating foods rich in calcium.

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