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Non-Surgical Treatment for Urinary Stones

Kidney stone is a hard, crystalline mineral stone sometimes also called renal calculi which is formed within the kidney or urinary tract. It often cause blood in the urine (hematuria) and intolerable pain in the abdomen, sides or groin. Kidney stones can also lead to other infections in the urinary tract and bladder. Anyone may develop these stones within the age group of 20 to 50. Uric acid kidney stones are more common in the people with high level of uric acid in their blood (hyperuricemai) including stones formed from magnesium ammonium phosphate and calcium stones.

There are various factors that may cause the formation of kidney stones including:

• Inadequate intake of water

• Obstruction in the urine

• Increased uric acid

• High calcium in the urine (hypercalciuria)

• Hyperparathyroidism

• Renal tubular acidosis

• Metabolic conditions such as cystinuria and hyperoxaluria

• Chronic diseases like diabetes, high blood pressure (hypertension)

• Some medications like diuretics, calcium containing antacids

• Excessive intake of animal protein, salt, sugar and vitamin D supplements

People with kidney stones often experience sudden severe pain or cramps in their lower back, side, groin or abdomen. They may feel nauseated, difficulty in urinating, uncomfortable feeling of urinary urgency, penile pain or testicular pain.

Treatment for kidney stones can vary depending on the size and location of the stone and patient’s overall health. A small stone with minimal symptoms can be treated by less or non invasive methods such as increased water or fluid intake to flush out the stone, medications to help in the expulsion of the stone quickly with less pain.

There are other treatment options for removing stones from the kidney that include:

• Extracorporeal shock wave lithotripsy (ESWL) – This procedure uses shock waves that break a kidney stone into small pieces to let them pass out easily through the urinary tract. Patient will lie down on a water filled cushion and will be given sedative or local anesthesia. Surgeon will perform some tests like Ultrasound or X-rays to know the exact location of the stone and then will pass high energy sound waves through the body without any injury and break the stone into small pieces which will come out from the urinary tract easily. This procedure can be done within an hour. If patient has large stone then surgeon may use a stent that holds the ureter open to let the small stone pieces to pass without blocking the ureter. Stone fragments usually pass in the urine for few days and may cause mild pain or discomfort after ESWL procedure. Patient can go back home the same day.

Pregnant women, people with bleeding disorder, has pacemaker, kidney infection, kidney cancer, urinary tract infection, abnormal kidney structure or function should avoid undergoing this treatment method.

There are also some risks involved in ESWL:

• Pain while passing out the stone pieces

• Obstructive/ blocked urine flow due to stone fragments stuck in the urinary tract that may need to be removed with a ureteroscope

• Infection in urinary tract

• Bleeding around the outside of the kidney

ESWL is a safe procedure that can be done on children as well but may not treat cystine kidney stones successfully as they do not break easily.

• Laser lithotripsy – laser lithotripsy is done to break the kidney stones in the urinary tract with the help of ureteroscope which is passed into the tubes of urinary tract. The laser breaks the stone into sand like particles which are then flushed out in the urine. This procedure doesn’t require any incision and patient can go back home within 24 hours. This procedure is done when other non-surgical treatments have failed or if kidney stones are too large to pass, irregular in shape or causing bleeding or damage the surrounding tissue. There are also some risks or complications involved in this procedure such as increased bleeding in the urine, injury to urinary tract, stent may move out of position or infection. Doctor may prescribe some pain killers and antibiotics after the surgery.

• Percutaneous nephrolithotomy – PCNL, a minimal invasive procedure done under general anesthesia for removing larger kidney stones from the patient’s urinary tract with the help of nephroscope (thin hollow tube) which is passed into the kidney through a small incision made in the patient’s back. This treatment procedure is done under general anesthesia or spinal anesthesia and uses an ultrasonic or laser probe to break large stones and pass them out through suction. Patient may require staying at the hospital for 2-3 days and can return to his/her work soon. There might be mild discomfort or pain after the surgery. Doctor may prescribe some pain medications or antibiotics for preventing infection and faster recovery. Patient should inform doctor in case of fever, chills or heavy bleeding in urine and should follow up with doctor weekly or till the time he/she gets recovered.

Kidney stone patient should take care of their diet or medications to prevent a recurrence of the kidney stone.

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