kidney stone
Everything you need to know about kidney stones and their symptoms and treatment
Passing stones can be very painful, but the damage is usually not permanent. Depending on the location and condition of the stone, you may not need to do much to remove your stone. Sometimes it is enough to drink a lot of fluids and painkillers to finally expel the stone. In some other situations, surgery may be required due to stone deposition and complications in the urinary system.
If you are at risk of developing kidney stones again, your doctor may give you recommendations to prevent them from forming again.
Low amount of urine during the day is the biggest risk factor for the formation of kidney stones. For this reason, the formation of kidney stones in premature babies with kidney problems is common. However, kidney stones are more likely to form in people between the ages of 20 and 50.
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Various factors play a role in increasing the risk of kidney stones. White people are more likely to develop kidney stones than black people.
Gender also plays a role in this. A higher percentage of men develop kidney stones than women.
A family history of kidney stones can also increase your risk.
Other effective factors in increasing the risk of kidney stone formation are:
Dehydration
obesity
A diet with a high level of protein, salt or glucose
Hyperparathyroid disease
Gastric bypass surgery
Inflammatory bowel diseases that increase calcium absorption
Taking drugs such as the diuretic Triamerene, anticonvulsant drugs and calcium-based antacids
signs
Kidney stones often cause severe pain. Kidney stone symptoms may not appear until the stone begins to move through the urethra. This severe pain is called renal colic. In such a situation, you may feel pain on one side of your back or abdomen.
In men, this pain may spread to the groin area. Renal colic pain is often intermittent but can be very severe. People with renal colic are restless.
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Severe pain in the same side and back, under the ribs
Pain radiating to the lower abdomen and groin
Pain during urination
Pink, red or brown urine
.nausea and vomiting
Constant need to urinate
Urinating more than usual
Fever and chills (in case of infection)
Decreased amount of urine
If the kidney stone is small, it may not have pain or symptoms because the small stone is able to pass through your urinary tract.
The pain caused by kidney stones may change. For example, the location of the pain, the intensity of the pain may change as the stone moves.
Urinary-genital system stones
When to see a doctor?
See your doctor immediately if you experience any of the following symptoms:
.The pain is so intense that you cannot sit
Pain with nausea and vomiting
Pain with fever and chills
The presence of blood in the urine
Difficulty urinating
reasons
Kidney stones often have no definite cause, but a set of factors increase the incidence of kidney stones.
Stones are formed in the kidney when the amount of crystalline materials in the kidney such as calcium, oxalate and uric acid exceeds the amount of liquid materials.
Knowing the type of kidney stones makes it possible to prevent the formation of kidney stones by observing certain conditions. The types of kidney stones include:
Calcium stones
Asteroid stones
Uric acid stones
Cysteine stones
Other stones
Why can kidney stones be a problem?
Stones do not always remain in the kidney. Sometimes they move from the kidney to the urethra. The urethra is small and delicate, and these stones may be too large to move smoothly from the urethra to the bladder.
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Stone passing through the urethra can lead to spasm and burning of the ureter and eventually blood in the urine.
Sometimes stones block the flow of urine. This condition is called urinary obstruction, which may lead to kidney infection and kidney damage.
risk factors
Things that increase the risk of forming stones in your kidney include:
Personal or family history. If someone in your family has kidney stones, you are more likely to develop kidney stones than the average person. And if you already have one or more kidney stones, you are at risk for other stones.
Dehydration. Drinking water daily can reduce the risk of kidney stones. People who live in hot climates and those who sweat a lot may be at higher risk than others.
Special diets. Eating a diet high in protein, sodium, and sugar may increase your risk of developing some types of kidney stones. This is especially true with a high sodium diet. Too much sodium in your diet increases the amount of calcium that must be filtered by the kidneys and significantly increases the risk of developing kidney stones.
Obesity. A high body mass index (BMI), large waist size, and weight gain are associated with an increased risk of developing kidney stones.
Gastrointestinal diseases and surgeries. Gastric bypass surgery, inflammatory bowel disease or chronic diarrhea can cause changes in the digestive process to absorb calcium and water and increase the risk of kidney stones.
Other medical conditions. Diseases and conditions that may increase the risk of developing kidney stones include: renal acidosis, cystinuria, hyperparathyroidism, some medications, and some urinary tract infections.
Preparing to see a doctor
Small kidney stones that do not block or cause other problems can be treated by a family doctor. But if your kidney stone is big or you suffer many complications, your doctor may refer you to a urologist (kidney and urinary tract specialist).
Here are some sample questions to ask your doctor:
Do I have kidney stones?
How big is my kidney stone?
Where is the kidney stone located?
What is my kidney stone?
Do I need medical treatment to get rid of stones?
Do I need surgery or another method to remove stones?
How likely is it that my other kidney will also form stones?
How can I prevent the formation of kidney stones in the future?
Do I need to follow up for this stone?
If you have any other questions, be sure to ask your doctor
What should you expect from your doctor?
Questions that the doctor may ask you:
How did your symptoms start?
Was your symptom continuous or occasional?
How do your symptoms worsen?
What things improve your symptoms?
Does anyone else in your family have kidney stones?
Tests and diagnosis
If your doctor suspects kidney stones, he may order the following tests:
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blood test. Blood tests may show too much calcium or high uric acid in your blood. Blood test results may be based on other aspects of your health.
Urinalysis. A 24-hour urine collection may show excessive excretion of minerals from your urine.
Imaging methods. Imaging methods such as X-ray and for smaller stones CT scan are very useful. Sometimes ultrasound is the first imaging step in kidney stones due to its uncomplicated nature.
Urinary stone analysis. By using a strainer while urinating, you can hold your stone and give it to the laboratory for stone analysis. This can help you decide what steps to take to prevent stones.
treatment
Kidney stone treatment varies depending on the type of stone and its cause.
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Small stones
These stones often do not require aggressive measures. You will be able to remove these stones by:
Drinking water. Drinking 2 to 3 liters of water daily can wash your kidneys well and prevent the formation of new stones.
Painkillers. Passing kidney stones is usually painful, and the doctor will give you painkillers such as (acetaminophen, ibuprofen, etc.) to reduce this pain.
Other treatments. Your doctor may use drugs such as alpha blockers. These drugs relax the muscles of the ureter and facilitate the passage of stones.
Big stones
If your stone is large and cannot be removed with the above, the doctor may use the following at his discretion:
Sound waves to break rocks
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Closed surgery, also known as PCNL.
It is a method to remove kidney stones. In this method, a camera is inserted into the kidney by making a small hole in the side, and after crushing the stones, we remove them.
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TUL method
In cases of ureteral stones, the TUL method, in which by inserting a camera through the urinary tract, crushes it until it comes out.
If a person has an overactive parathyroid gland, which causes the formation of calcium stones, the surgery of this gland will be necessary.
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Advantages of closed kidney stone surgery compared to open surgery
The importance and special feature of the Riers surgery method compared to other stone crushing and kidney surgery methods is that the patient does not need to remove the large pieces of the stone. Since during this surgery (Reer’s surgery) the stone is placed directly in front of the stone by the ureteroscope and multiple blows are made on the stone with the holmium laser fiber, the surgeon can easily see the stone and with sufficient skill can It is to hit the stone with a laser and crush it and completely pulverize it. These pieces are so small that they will be easily removed without suffering pain and other complications when the patient urinates. In other methods of kidney stone operation, the stones are broken into 4-5 and even bigger than 6 mm chambers, which the patient has to endure a lot of pain and many problems to remove them.
Another advantage of the Riers surgery method is that this type of stone crushing and pulverization (Reers surgery) does not require the discontinuation of anticoagulants. For example, heart patients who take aspirin or Plavix and have to stop taking these drugs for a while for every surgery will not need to stop taking their drugs by doing this surgery (reversal surgery). Many patients over the age of 50 are forced to take permanent and unstoppable drugs such as aspirin, plavix, warfarin… and suffer from stroke and heart attack due to stopping these drugs.
In other methods of stone crushing and open kidney stone surgery and lateral puncture method (PCNL), the patient must stop taking these drugs for a week or more, and there is a risk for the patient to have heart and brain attacks. But in a new, modern and advanced stone crushing method
RIRS surgery, the patient will not need to stop any of these drugs, and the stone will be broken easily without the slightest abnormal bleeding during the surgery, and the patient will not be disabled or have any special problems, and will be discharged on the same day of the operation or the day after the operation. This can be an important advantage and feature for a person, especially in the current conditions of the society and the world (the conditions of the spread of the Covid-19 virus and the possibility of contracting the corona virus), where it is better for patients not to be in close contact with each other. Rear surgery) which is performed in the morning and the patient will be discharged in the evening or night of the same day of surgery with a prescription can be very beneficial for the patient and his family.
Another very important advantage and feature of the Rears surgery method is the absence of body piercing or surgical incision for the patient. In this method, it enters the patient’s kidney system through the urethra and the natural holes of the urethra, and there is no need to pierce or cut the patient’s body, and it easily enters the bladder, ureter, and all the calyces of the kidney through the urethra. It is done as needed. This surgery (reversal surgery) is a highly specialized surgical method that a limited number of endourology subspecialists in the country have the skills and expertise to perform this surgery (reversal surgery) and there are restrictions for performing reversal surgery in the country. There are few skilled endo-urologist surgeons who have the necessary skills to use the flexible ureteroscope device in our country and they are limited to less than ten skilled endo-urologists in this field in the whole country.
The cost of closed kidney stone surgery
An important point in the surgery method is the expensive equipment and thus the high cost of this surgery. The flexible ureteroscope required for rear surgery costs about four hundred million tomans, and maybe after about a hundred surgeries or even less, the ureteroscope’s efficiency may be lost and it can no longer be used. In addition to the ureteroscope, a laser device is needed to crush and pulverize the stone for the ureteral surgery. These laser devices are not domestically produced and are at They have a high visitation fee in the world, and it is necessary to import it into the country, and when they enter the country, they will have a very high visitation fee of about two billion tomans, and this cost cannot be paid for most of the country’s medical centers, even in Tehran. There are few medical centers that have the ability to buy these devices, and with the growth and fluctuations of the currency, the ability to buy these two or three surgical centers will decrease, on the other hand, the repair, service and maintenance of these devices are very expensive and high cost for the medical centers. has it.
prevention
To prevent the formation of urinary stones, the following will help:
Drinking water during the day. Drinking 2 to 3 liters of liquids, especially water, can prevent the formation of new stones.
If you live in a hot area or exercise a lot, you may even need more water.
Eat foods with less oxalate. If your kidney tends to form calcium oxalate stones, your doctor may limit foods rich in oxalate. These foods include: rhubarb, beets, okra, spinach, beet leaves, sweet potatoes, nuts, tea, chocolate and Soy products.
Choose a diet low in protein (animal) and low in salt.
In some kidney stones, such as calcium oxalate, consuming more calcium prevents the formation of new stones. But in some other cases, calcium may increase the formation of kidney stones, so be sure to consult your doctor about this.
If you are not allowed to take calcium supplements, ask your doctor about taking calcium supplements.
Frequently asked questions before and after kidney stone surgery:
1- Which method of breaking kidney stones is better?
It depends on the size of the stone, but in general, the least dangerous stone breaking method for kidney stones is the laser method, i.e. RIRS.
2- What is the difference between extra-organ and intra-organ stone crushing in kidney stones?
In extra-organ stone breaking, that is, ESWL, the stone is broken through the skin with ultrasound waves, but in the intra-organ method, we enter the kidney with a camera from inside the duct and use a laser beam to pulverize the stone, the name of this closed surgery method is RIRS.
3- What is the advantage of Rears compared to other kidney stone surgeries?
There is no damage to the kidney tissue in the resurgence method, while in the PCNL and ESWL method, some of the kidney tissue is always destroyed. When the patient undergoes stone crushing several times with non-resurgence methods, the kidney will be destroyed over time.
4- Do we stay hospitalized for kidney stones after rear surgery?
Generally, patients are discharged on the same day of surgery and can take care of their daily activities.
5- What is the purpose of the double J that we put after the rears?
Double J is a delicate stent that is placed inside the ureter so that urine does not accumulate in the kidney and stones are removed from it easily and painlessly. Also, if there is a stricture of the ureter, it expands with Double J.
6- I have pain, burning and bleeding after putting double g, is it normal?
Double G is associated with flank pain in all patients, especially at the end of urinating. Also, burning in urination and blood in the urine are completely normal until the day a person has Double G.
7- What should I do to reduce the pain and burning of double J?
Painkillers such as diclofenac suppositories or ketorolac ampoules can be used. Also, some specialized drugs may be added to the treatment with the opinion of the patient’s surgeon.
8- What will happen if we take out the double J early?
We need to see why the surgeon used the double J. For example, if it was inserted to prevent ureteral stricture, if it is removed early, the ureter will be narrowed.
9- What is the difference between Rears and Tul?
In the RIRS method, the stone is pulverized using a Holmium laser, and it is used for any stone anywhere in the ureter and kidney, because it is done with a flexible camera, but in the TUL method, the stone is crushed with a pneumatic crusher, and if it is above the ureter, it goes inside If the kidney is thrown, it will come out of the surgeon’s crosshairs, and the person will have to perform extra-organ stone crushing again.
10- What diet should we have for less stone formation?
The general diet for stone patients includes less salt and red meat consumption and more fluids
11- Should those who are prone to stone formation eat dairy products?
Yes, stone patients must consume dairy products in their meals to avoid kidney stones.
12- Can you exercise after kidney stone surgery?
If the patient does not have double J, he is completely free to do any kind of exercise, but if the patient has double J, he should not do intense sports until it is removed.
13- How many days after stone operation should I rest and not go to work?
Usually, patients can easily return to the workplace the day after the surgery and can take care of their daily tasks