Kidney and Ureteral Stones Treatment by Dr M Gopichand at #kimshospitals

 

Diagnosis 

If your doctor suspects that you have a kidney stone, you may have diagnostic tests and procedures, such as:

• Blood testing. Blood tests may reveal too much calcium or uric acid and CREATININE in your blood. Blood test results help monitor the health of your kidneys and may lead your doctor to check for other medical conditions.
• Urine testing. The 24-hour urine collection test may show that you're excreting too many stone-forming minerals or too few stone-preventing substances. For this test, your doctor may request that you perform two urine collections over two consecutive days.

• Imaging. Imaging tests may show kidney stones in your urinary tract. High-speed or dual energy computerized tomography (CT) may reveal even tiny stones. Simple abdominal X-rays are used less frequently because this kind of imaging test can miss small kidney stones.

  Ultrasound, a noninvasive test that is quick and easy to perform, is another imaging option to diagnose kidney stones.

• Analysis of passed stones. You may be asked to urinate through a strainer to catch stones that you pass. Lab analysis will reveal the makeup of your kidney stones. Your doctor uses this information to determine what's causing your kidney stones and to form a plan to prevent more kidney stones.

Treatment

Treatment for kidney stones varies, depending on the type of stone and the cause.

Small stones less than 5 mm with minimal symptoms

Most small kidney stones won't require invasive treatment. You may be able to pass a small stone by:

• Drinking water. Drinking as much as 1.8 to 3.6 liters a day will keep your urine dilute and may prevent stones from forming. Unless your doctor tells you otherwise, drink enough fluid — ideally mostly water — to produce clear or nearly clear urine.
• Pain relievers. Passing a small stone can cause some discomfort. To relieve mild pain, your doctor may recommend pain relievers such as ibuprofen or diclofenac 
• Medical therapy. Your doctor may give you a medication to help pass your kidney stone. This type of medication, known as an alpha blocker, relaxes the muscles in your ureter, helping you pass the kidney stone more quickly and with less pain
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• Large stones More than 5 mm and  Those which cause symptoms 
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  Kidney stones that are too large to pass on their own or cause bleeding, kidney damage or ongoing urinary tract infections may require more-extensive treatment. Procedures may include:
  
  
  
  

  • Using sound waves to break up stones. For certain kidney stones — depending on size and location — your doctor may recommend a procedure called extracorporeal shock wave lithotripsy (ESWL).It has high failure rates especially with hard stones 

    ESWL can cause blood in the urine, bruising on the back or abdomen, bleeding around the kidney and other adjacent organs, and discomfort as the stone fragments pass through the urinary tract.

  • Surgery to remove very large stones in the kidney. A procedure called percutaneous nephrolithotomy  involves surgically removing a kidney stone using small telescopes and instruments inserted through a small incision in your back.

    You will receive general anesthesia during the surgery and be in the hospital for o3 to 5 days while you recover. 

  • Using a scope to remove stones. To remove a smaller stone in your ureter or kidney, your doctor may pass a thin lighted tube (ureteroscope) BOTH RIGID AND FLEXIBLE  equipped with a camera through your urethra and bladder to your ureter.

    Once the stone is located, special tools can snare the stone or break it into pieces that will pass in your urine. Your doctor may then place a small tube (stent) in the ureter to relieve swelling and promote healing. You may need general or local anesthesia during this procedure. 

    
    

    #RIRS (retrograde intrarenal surgery): Retrograde intrarenal surgery (RIRS) is a procedure for doing surgery within the kidney using a viewing tube called a fiberoptic endoscope. 

    In RIRS the scope is placed through the urethra (the urinary opening) into the bladder and then through the ureter into the urine-collecting part of the kidney. The scope thus is moved retrograde (up the urinary tract system) to within the kidney (intrarenal). 

    RIRS may be done to remove a stone. The stone is seen through the scope and can then be manipulated and evaporated by a laser probe or grabbed by small forceps, etc. 

    RIRS is performed by a specialist, an urologist (endourologist) with special expertise in RIRS. The procedure is usually done under general or spinal anesthesia. 

    The advantages of RIRS over open surgery include a quicker solution of the problem, the elimination of prolonged pain after surgery, and much faster recovery.

    
    

    Prevention

    Prevention of kidney stones may include a combination of lifestyle changes and medications.

    Lifestyle changes

    You may reduce your risk of kidney stones if you:

    • Drink water throughout the day. For people with a history of kidney stones, doctors usually recommend drinking enough fluids to pass about 2  of urine a day. Your doctor may ask that you measure your urine output to make sure that you're drinking enough water.

      If you live in a hot, dry climate or you exercise frequently, you may need to drink even more water to produce enough urine. If your urine is light and clear, you're likely drinking enough water.

    • Eat fewer oxalate-rich foods. If you tend to form calcium oxalate stones, your doctor may recommend restricting foods rich in oxalates. These include beets, okra, spinach, sweet potatoes, nuts, tea, chocolate, black pepper and soy products.
    • Choose a diet low in salt and animal protein. Reduce the amount of salt you eat and choose nonanimal protein sources, such as legumes.

    • Continue eating calcium-rich foods, but use caution with calcium supplements. Calcium in food doesn't have an effect on your risk of kidney stones. Continue eating calcium-rich foods unless your doctor advises otherwise.

      Ask your doctor before taking calcium supplements, as these have been linked to increased risk of kidney stones. You may reduce the risk by taking supplements with meals. Diets low in calcium can increase kidney stone formation in some people.

      
      

    Medications

    Medications can control the amount of minerals and salts in the urine and may be helpful in people who form certain kinds of stones. The type of medication your doctor prescribes will depend on the kind of kidney stones you have. Here are some examples:

    • Calcium stones. To help prevent calcium stones from forming, your doctor may prescribe a thiazide diuretic or a phosphate-containing preparation.
    • Uric acid stones. Your doctor may prescribe allopurinol to reduce uric acid levels in your blood and urine and a medicine to keep your urine alkaline. In some cases, allopurinol and an alkalizing agent may dissolve the uric acid stones.
    • Struvite stones. To prevent struvite stones, your doctor may recommend strategies to keep your urine free of bacteria that cause infection, including drinking fluids to maintain good urine flow and frequent voiding. In rare cases long-term use of antibiotics in small or intermittent doses may help achieve this goal. For instance, your doctor may recommend an antibiotic before and for a while after surgery to treat your kidney stones.
    • Cystine stones. Along with suggesting a diet lower in salt and protein, your doctor may recommend that you drink more fluids so that you produce a lot more urine,..