Lecturer in Urology (UWI)
Symptoms of kidney stones
Stones form in the kidneys and can move into the kidney tubes called the ureters. They can cause severe pain. The pain usually starts in the back and can move as the stone moves. It can be felt in the tummy. The pain is colicky and comes and goes – during episodes patients often say that lying still does not help and describe pacing while trying to cope. There may be blood in the urine, vomiting and even urgency to go to the bathroom. A blocked kidney may lead to infection and even loss of a kidney if not dealt with in time.
Treatment options –
who needs treatment
The treatment option for kidney stones depends on several factors including stone size, hardness and location. It also depends on several patient-related factors such as patient preference, comorbidities and body type. Additionally, some kidney stones cause issues such as blockage and infection and may require emergency treatment in the form of a stent or tube drainage. Some stones may even dissolve with medication over time and some may just require observation. Some will inevitable fail observation. This article briefly reviews the most common management options for stones.
As mentioned above, stones form in the kidney and can then move or migrate into the ureter. Sometimes a stone becomes stuck in this tube and can be extremely painful. They can cause the kidney to become infected and may lead to sepsis. If left untreated, a stone blocking the ureter can lead to death of that kidney.
In some patients we may be able to use medication to help the kidney stones pass. These drugs work by relaxing the ureter and this treatment is called Medical Expulsive Therapy. This is appropriate for stones less than 1 cm and in a patient who has no signs of infection or kidney damage and in whom the pain has settled. It is very helpful for stones which have moved close to the bladder.
If the stone is causing a blockage and infection, the patient will require relief of the blockage and antibiotics.
Definitive treatment of the stone is postponed until the infection has settled. Relief of the obstruction will require a stent or a tube placed into the kidney through the back called a nephrostomy tube. The stent is a plastic tube placed via the urine passage with no cuts and spans the entire tube from the kidney to the bladder – it bypasses the stone and allows urine to drain. Stents may cause some bleeding and discomfort and is not a treatment for the stone but merely buys us time and prevents kidney damage until the stone can be treated. The stent should not stay in place for lengthy periods as sometimes stones can form around the stent itself.
What are the surgical options?
If the stone is too large or otherwise unsuitable for observation, surgery may be required. Fortunately, we have a number of options for kidney stones in Trinidad and large cuts for stones are becoming much less frequent.
– During ureteroscopy a long thin camera/scope is passed into the urine tube and even into the kidney. There are different types of scopes including rigid and flexible ones and the procedure is done with the patient asleep. We can therefore see the stone and break it up with a laser. Many times this can be done as a same day procedure.
2. Extracorporeal shockwave lithotripsy (ESWL)
– During this procedure the patient is placed on a machine which generates shockwaves. The machine uses X-rays or ultrasound to find the stone and take aim. These shockwaves travel through the patient’s body and break stones without needing a cut. This is a same day procedure and you do not need to go to sleep but may require some sedation. Once the stone breaks up, fragments are passed into the urine. Sometimes several sessions are needed to break the stones. This procedure is available to the public in San Fernando.
Percutaneous Nephrolithotomy (PCNL)
– This is a procedure done for larger stones in the kidney. A needle is used to puncture the kidney using x-ray or ultrasound as a guide and a small wire is placed into the kidney. This pathway into the kidney is then gradually enlarged to about a half of an inch or less and instruments are passed into the kidney to crush and remove the stones. If the stones are very large additional punctures may be needed. You will need blood donors for this procedure as bleeding is a risk.