Kidney Stone
What is Kidney Stone and Why Does It Occur?
Kidney stone disease is the presence of stones anywhere in the urinary tract (kidney, internal urinary tract (ureter), bladder and external urinary tract (urethra). It can cause obstruction, causing enlargement of the urinary tract and swelling in the kidney. If not treated in time, it may result in loss of kidney function.
What are the Symptoms of Kidney Stones?
The most common complaints in adults are flank pain and bleeding in the urine. Nausea-vomiting, loss of appetite and weakness may be added to these symptoms as a result of stones blocking the urinary tract. Additionally, if accompanied by a urinary tract infection, high fever may occur.
In young children, findings that are not specific to stone disease, such as restlessness or vomiting, appear as the first symptom.
How Are Kidney Stones Diagnosed?
Patients with stones blocking the urinary tract are usually first evaluated in the emergency department. Following the history and physical examination of the patients, urine analysis, complete blood count are performed and the presence and amount of stones are determined by imaging methods. As imaging methods, ultrasonography and direct abdominal x-ray should be the first examinations of choice.
However, with the help of technological developments, in recent years, non-contrast (without intravenous drug administration) spiral computed tomography, which is performed to detect all the features of the stone and reveal the anatomy in stone patients, has surpassed other imaging methods.
What are the Kidney Stone Treatment Methods?
The first goal in patients applying to the emergency department is to diagnose stones and determine whether emergency treatment is required. Especially in the treatment of small stones that have passed from the kidney and are approaching the bladder, pain is effectively stopped and intravenous fluid therapy is given to increase urine output.
Then, patients are followed for 7-14 days with drug treatments that help the stone pass. If the stone does not pass within this period, it indicates that invasive treatment is needed.
If the stone falls, determining the type of stone is very important to prevent stone formation again.
Metabolic evaluation is necessary in patients with recurrent stone disease. Especially in at least 70% of pediatric stone patients, there is a metabolic problem, and drug treatments to eliminate these causes can reduce the formation of new stones and, in some stone types, even destroy existing stones.
What is Stone Breaking with Extracorporeal Shock Waves (ESWL)?
It is a crushing process performed by focusing shock waves (magnetic or piezoelectric) created by a device on the stone. It can be performed under anesthesia in young children and with anesthesia in adults. The success of the procedure depends on the number of stones, their size, location, type of stone and the anatomical structure of the urinary tract. It is known that the procedure does not cause permanent damage to the kidney.
It is especially effective in the treatment of small kidney stones and stones smaller than 1 cm located just at the exit of the kidney. However, redness or bruising in the areas where the procedure is applied, pain when the broken pieces fall, bleeding in the urine, broken pieces blocking the urinary tract and fever may occur.
How is Kidney Stone Surgery Done?
While in the past, patients were treated only with open surgery, today, thanks to technological developments, most of the stone treatment is performed with endoscopic (closed surgical methods) techniques. The type of surgery to be performed is decided based on the number, size, location of the stone, type of stone, anatomical structure of the urinary tract and patient preference.
URS (Ureterorenoscopy) is the process of entering the urinary bladder from the external urinary tract (urethra) with thin, rigid or flexible (foldable) endoscopic instruments, and from there reaching the upper urinary tract (ureter) and/or removing the stone in the kidney by breaking it with LASER (Holmium: YAG). There is no incision or scar. The success rate is very high. The patient can return to daily life after one day.
PNL (Percutaneous Nephrolithotomy) is the process of breaking and removing stones through a sheath of approximately 1 cm placed under the skin of the kidney. The patient must stay in the hospital for 2-3 days after the surgery. The patient has a small wound in the kidney area and can heal in a very short time. The success rate is especially high for large kidney stones.