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Urological stones form through the sticking together (crystallization) of small crystals inside the calyces, renal pelvis or the ureter. They form primarily inside the kidney and then wander downwards to the ureter. The cause of their formation is mainly due to the presence of the ability for stone formation. This is aided by strong (concentrated) urine which permits the coming together of the crystals to form stones.
The small the stone, the more liability for its coming out without interference (spontaneous passage). These spontaneously passable stones are of 2-3 mm in diameter. Larger stones must be treated. The urinary stones are of different composition. They may be Calcium Oxalate, Calcium Phosphate, Urate, Cystine or other substances. They form in adults but also to lesser extent in children.
Diet in form of avoiding chocolate, tomato and spinach (Oxalate), milk (Calcium) may help in rare cases and it is not approved scientifically, So the best way to avoid stones is to drink at least 2 litres of fluids, in particular water, per day. This leads to thinning (dilution ) of the urine to prevent crystallization and stone formation.
The treatment of renal stones is dependant on its size and symptoms. If the stone is small, the best way is to disintegrate it with the machine. This is the so called electromagnetic shock wave lithotrepsy (ESWL).
If the stone is large and branching, then a combination therapy in the form of ESWL and removal through the endoscope per cutaneous litholapaxy (PNL) or even open surgery is recommended. This last modality of treatment is much better, easier and cost effective in comparison to the time consuming mostly non effective and very costy multiple ESWL, which sometimes lasts for many months.
Simple radiograph of renal stones.
The stone is located on the box of the renal pelvis.
Who qualifies for the ESWL?
Patients who have their stones inside the hollow system (calyces, renal pelvis or ureter). The stone must not be casting the whole kidney (staghorn stone) and the way out to the bladder is free.
How does the disintegration (ESWL) work?
The stone is examined by ultrasonography. The patient is positioned either on the back or the abdomen according to the accessibility of the stone. Special water pads are put in contact with his body. The x-ray/energy beamer is positioned on the body. The stone is localised by x-ray and positioned in the middle of the cross at the screen. The stone is shot from outside using a weak energy which is increased to a certain limit. The number of impulses and its frequency are also determined.
The patient becomes a normal physiological salt solution in the veins. Some patients may need pain medication if they experience it during the treatment. Patients may experience red urine after the disintegration which is normal.
How does the extraction (PNL) work?
The stone is reached through a track done through the skin. A metal tube is introduced to the kidney. The way to the calyces and the stone is defined through contrast dye and x-rays.
The endoscope (nephroscope) is inserted and the stone is localized. The stone is fragmented by ultrasonic or laser energy. The fragments are removed or washed out. A tube of silicon is left to drain the kidney.
renal stone
The stone is located in the renal pelvis.
K = kidney / S = stone
Frequently asked questions?
- What is a non invasive treatment of renal stone?
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The non touch disintegration of renal stones is done through a special energy which results from electro hydraulic, electromagnetic or piezoelectric source. It is transferred through water and through the body (high water content) to meet the surface of the stone. The surface of the stone is hard. It can not transfer the energy as it is different from water. The stone reacts through breaking into small fragments.
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- Is ESWL suitable for all types of stones?
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No, it is suitable for stones with less water content. Soft stones do not disintegrate. Also large (casting stones (stag horn stones) are difficult to smatch. They are too big and they need many setting to react
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- Is ESWL painful?
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Mostly not. If the energy meets a part of the chest cage (rib), it may be painful. The capsule of the kidney becomes stretched under the energy, it may result in pain as well.
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- Is it possible to avoid pain during the treatment?
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Yes, if pain is experienced, medications are giving through the veins to stop it. Generally you do not experience agonizing pain during treatment.
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- Shall I become stone free immediately after ESWL?
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No, you need a few days to a few weeks to become stone free. This depends on the size of the stone and the degree of disintegration.
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- Is PNL painful?
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No, it is done under anaesthesia.
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- Shall I become free of stones after PNL?
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Mostly yes. But sometimes it is difficult to reach the minute fragments present in one of the calyces so that we resort to wait and see or to ESWL for final treatment.
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- Why should I have a draining tube inside my kidney after PNL?
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This guarantees drainage of the kidney to preserve its function. It also allows the rest of the fragments of the stone to be washed out of the kidney. This drain allows also contrast dye studies to the kidney and the ureter.
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- Where is this drain connected?
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It is connected to a urine bag which collects both urine and the fragments of the stone.
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- When can I get rid of the drain?
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This is possible when you are stone free. The drain is closed and if you feel no pain, no temperature or leakage, then it is removed. The wound is covered with bandage. It heals within 24 hours.
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- What are the complications of PNL?
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The most important is perforation of the pelvis of the kidney. Others are infection and bleeding. Major affection of the renal tissue is rare.
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- How are the complications treated?
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Perforation is treated by drainage and bed rest. Bleeding is treated by compression bandage and bed rest. In all cases you should administer antibiotics and solutions.
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- How can I help to become stone free?
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You should drink at least 2 litres of fluids, preferably water, and jump or move a lot to help the immigration of the small particles of the stones to travel through the ureter to the bladder and then outside.
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- Should I have medications after the treatment?
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I give some capsules which help the propagation of the particles together with water.
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- How can I avoid stone formation?
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This is achieved through drinking of at least 2 litres of fluids (preferably water) per day. This should be increased in hot countries. Please consult your specialist of internal medicine for the amount of fluid, if you have a heart disease.
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- Is it true that sand and dust are causes of stone formation?
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No, this is not true.
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- Is it true that I can avoid stone formation through certain diets?
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This is a controversy. Most preventive measures are done through the intake of fluids and some medications. There is no need for strict diets except in very special types of stones which are rare.
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