Kidney Stone Treatment And Management (in Sharjah)
Kidney stones, aka renal calculi or urolithiasis, are hard deposits of minerals and salts that accumulate and solidify in the passages of the urinary system. The most common sites of stone formation are the calyx and the pelvis of the kidney and the urinary bladder. Kidney stones occur in 2% -3 % of the population. Find out more about Kidney Stone Treatment and causes below.
Types of Kidney Stones
- Calcium oxalate stones – 85% of the stones
Commonly seen in patients with primary hyperparathyroidism with hyper-calciuria (presence of calcium in the urine) and hyper-calcemia (presence of calcium in blood above the standard limit). Hyperparathyroidism causes blood Calcium levels to increase. This extra calcium is excreted through the kidneys where they accumulate to form sold deposits called kidney stones.
- Struvite (staghorn calculi) – 2% -20%
Struvite kidney stones can grow large enough to fill the whole collecting system. Struvite stones are composed of magnesium, phosphate, and/or ammonium. Struvite stones are formed in the setting of a urinary tract infection by urease producing bacteria such as Proteus and Staphylococci, which are capable of covering urea into ammonium and carbon dioxide.
- Uric acid stones – 5%- 10%
Uric acid stones are observed in patients with diseases such as Gout and Myeloproliferative Disorders such as leukemia.
- Cystine and xanthene – rare.
Causes of Kidney Stones
- Idiopathic – 70%-80% of kidney stones have no underlying pathology and are classified idiopathic.
- Hyperparathyroidism- leading to hyper-calcemia and hyper-calciuria which causes the deposition of calcium oxalate stones.
- Myeloproliferative disorders such as leukemias
- Cystine metabolism defects (hereditary defects) – cystine defects
- Urinary tract infection – causes the formation of struvite stones
- Enzyme disorders like – primary hyperoxaluria, xanthuria, cystinuria.
- Diet – increased protein intake, increased sodium consumption, low Vit A intake.
- Dehydration, hot climate,
Signs and symptoms
- Pain – Severe, sharp pain in the side, back, and below the ribs. The pain can radiate to the lower abdomen and groin.
- Hematuria – the presence of blood in the urine ( but this is usually microscopic)
- Asymptomatic – some stones such as struvite stones can be asymptomatic till late stages.
- Pyuria – urine containing pus or white blood cells.
Complications of Untreated Kidney Stones
- Obstruction of renal passages.
- Ulceration or damage to the renal passages.
- Predisposition to renal infection.
What Investigations are Performed to Confirm the Diagnosis
- X-ray of the kidney, ureter, and bladder –
Most kidney stones are radio-opaque (visible on radiographs). Calcium oxalate, struvite and phosphate stones can be visualized on an X-ray film, where are uric acid stones which are radiolucent cannot be visualized.
- Intravenous Urography – IVU
Renal function tests must be performed to make sure it is safe to perform IVU. A contrast agent is sent through an intravenous line, and its passage is visualized on radiography to assess the structures of the renal tract.
- Ultrasonography – USG
Most of the stones can be diagnosed on USG.
- Non-Contrast Enhanced Helical CT KUB – NCCT
This is currently the best method of investigation for kidney stones. It can accurately identify all types of stones including radiolucent stones which are usually not visualized on an X-ray.
Successful management of kidney stones includes treating the stone and preventing recurrence. Treatment options vary depending on the size, site, and the composition of the stone. Most of the stones can be managed conservatively ( without surgery and other invasive procedures).
- Observation –
90% of the stores that are less than 5 mm in size, usually pass out spontaneously. Pain-killers, antibiotics (if infected), and plenty of water (up to 3 liters per day) are recommended.
- Medical expulsive therapy (MET)
- 70% of the stones that are 6-8 mm in diameter can pass with medication.
- Tamsulosin capsules are given once a night. Tamsulosin causes the dilation of the lower ureter and bladder neck to allow the stone to pass.
- Analgesics for pain.
- Plenty of fluids should also be taken.
- Extracorporeal Shock Wave Lithotripsy (ESWL)
- It’s a non-surgical modality of treatment, where the stone is focused and bombarded with shock waves that disintegrate the stones into fragments. These fragments then pass out with urine.
- ESWL is considered when – the kidney stones are less than 2cm or when the kidney stones greater than 2 cm are lodged in the lower pole and have a less chance of clearance or if they are ureteric stones less than 1 cm in size.
- Contraindications (the procedure is not considered )
- Uncontrolled bleeding diathesis( an inherited predisposition to a disease)
- Uncontrolled hypertension
- Urinary tract infection with fever
- Urinary tract obstruction distal to the stone
- Very obese patients in which the shock waves cannot reach the stones.
- Percutaneous nephrolithotomy (PCNL)
It is a minimally invasive procedure to remove stones through a small puncture wound through the skin. It is usually done under general or spinal anesthesia.
- < 2 cm stones have a 90% clearance.
- > 2 cm stones have an 80% clearance.
This method is used for
- Staghorn calculi
- Large renal stones
- Failed ESWL procedures
The complications include
- Urinary fistula
- Perforation of the colon or pleural cavity during placement of the nephrostomy tract
- Retrograde Intra-Renal Surgery (RIRS)
This is an endoscopic method of treating renal stones. A standard ureteroscope is used to enter the ureter and the pelvis. The tip of the stereoscope can be deflated to enter the affected calyx of the kidney. The stones are visualized and fragmented or vaporized with the red light laser.
- Open surgery
Due to the advent of endoscopic and laser surgeries, open surgeries are rarely used in developed countries.
- Open surgery is considered when
- Very large stones occupying many calyces.
- Failure if PCNL and ESWL
- Morbidly obese patients can make the tract puncture hazardous that it can injure the renal hilum and vessels.
Types of open surgeries
- Extended Pyelolithotomy – it is indicated for staghorn stones.
- Anatrophic Nephrolithotomy – its indicated if there is a large complex stone fully branching into the peripheral calyces.
- Partial Nephrectomy– indicated when there are multiple stones at the lower pole and non-functioning lower pole. Also indicated in severe infections like xanthogranulomatous pyelonephritis.
Frequently asked questions
- What to do if bilateral (both kidneys) stones are present?
In that case, the kidney which is better functioning (on DTPA scan ) or symptomatic, or which is infected should be treated first.
- How to prevent recurrent stone formation?
- Do a complete metabolic workup on –
- serum calcium,
- serum uric acid.
- 24 hr urinary urates calcium and phosphate.
- Prevent excessive intake of milk in case of calcium stones.
- Patients with hyperuricemia should be treated with allopurinol and should avoid red meat offal and fish
- Sulfur-containing protein (egg/meat/fish) should be restricted in cystinuria
- Idiopathic hypercalciuria is treated with bendroflumethiazide
Kidney Stone Removal Price in Sharjah
Al Saha Al Shifa Hospital Sharjah has cost-effective treatment for kidney stone related diseases and it can be treated by consulting our Specialist Urologist. Our consultation charges are 200 AED.