Kidney Stones

A stone is a hard, solid mass that can form in the ureter, bladder, and kidneys.

Bladder stones usually develop as a result of bladder outlet obstruction, meaning difficulty in emptying the bladder.

On the other hand, kidney stones form when minerals or acid salts in your urine crystalize. Most stones leave your body while you urinate. However, in some cases the stones may become large, get stuck and need treatment to remove them. Anyone may develop a kidney stone during his or her lifetime. Stones can form if there is an imbalance in the way your body produces urine. This may be connected to how much you drink and whether there are substances in your urine which trigger stone formation.

People often associate kidney and ureteral stones with pain. However, symptoms can vary from severe pain to no pain at all, depending on stone characteristics – such as the size, shape, and location of the stone in the urinary tract.

Usually stones that are in the kidney do not cause pain unless they obstruct the junction between the kidney and ureter called uretero-pelvic junction. Therefore, pain is only experienced whenever there is an obstruction to the flow of urine.

When the stone is in the ureter, it can cause severe pain when it obstructs the ureter and blocks the flow of urine.

Treatment

Treatment can vary from medical to surgical.

Factors that influence the decision include:

  • • The symptoms
  • • Stone characteristics
  • • The medical history
  • • The kind of treatment available at the hospital and the expertise of your doctor
  • • Personal preferences of the patient

If the stone is likely to pass with urine, the doctor can prescribe drugs to ease this process. This is called conservative treatment.

If the stone continues to grow or causes frequent and severe pain, you will get active treatment.

1. Conservative stone treatment

A significant number of kidney or ureteral stones will pass while you urinate. However, depending on the size and location of the stone, it will take some time to pass the stone. You may suffer from renal colic when the stone moves. If you have a very small stone there is a 95% chance of passing this stone within 6 weeks. Two very important factors influence the passage rate:

  • • The closer the stone is to the bladder, the higher the chance of passing it
  • • The bigger the stone, the smaller the chance of passing it There are 2 common conservative treatment options: Medical Expulsive Therapy (MET) and dissolving uric acid stones. In both cases you get medication.

2. Active stone treatment

Kidney or ureteral stones should be treated if they cause symptoms. There are 3 common ways to remove stones: shock-wave lithotripsy , ureteroscopy, and percutaneous nephrolithotomy.

Which active treatment option is best for you depends on many aspects. The most important factor is the symptoms the stone causes. Based on whether the stone is in your kidney or your ureter, the doctor may recommend different treatment options. If you don’t have symptoms you may still get treatment in case:

  • • The stone continues to grow
  • • You are at recurrent stone former
  • • You have an infection
  • • Your stone is significantly large
  • • You prefer active treatment

Flexible ureteroscopy with laser dusting or fragmentation of stone has gained a lot of popularity during the last 10 years because of its high success in yielding stone free kidney or ureter.

It is being performed more and more even for large kidney stones, being less invasive that percutaneous nephrolithotomy, causes less pain and is done without a single scar.

The success of the treatment depends considerably on the material being used and expertise of the doctor carrying the treatment.

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