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HOW KIDNEY STONE ARE FORMED ?

Everyone will have lot of mineral in the blood and urine, which in few people when produced in large quantity tend to circulate in blood, filter in the kidney. This excess quantity of minerals get deposited on filters of kidney ( papilla ) [when kidney filter the blood to form urine ] ,they are called as stone promoters which form crystals that gradually enlarge in size , form stones in kidneys. Promoters are minerals like calcium, phosphorous, uric acid, oxalate, cysteine.

Inhibitors - this are the chemicals that inhibitors the stone formation like citrate, magnesium pyrophosphates. So stone formation is basically an imbalance between stone promoters and inhibitors, that occur due to genetic cause, lifestyle habits are other factors .Transformation of crystals to stone needs super saturation, that is crystal aggregate in large quantity when less urine is formed.



STONE IN KIDNEY

If there are stones inside your kidney, you will not pain , unless it become large enough to produce dull aching pain .sometimes you may notice blood in the urine . rarely you develope high fever , subsequent testing will reveal stones in kidney .


STONE IN URETER

If stone moves from kidney to ureter ( the tube that passes from kidney to urinary bladder ) , thereby blocking the urine flow , so urine collect inside the kidney, then kidney get swollen which leads to classical severe pain of stone which doctors call it as ureteric colic .



STONES IN URINARY BLADDER

If stones are inside your urinary bladder . (organ that stores urine after receiving it from both kidney),you might experience symptoms like burning sensation while urination with increased frequency of urination with passage of blood in the urine .

TREATEMENT OPTIONS:

There are two method of treatments by which your urologist will manage.

(A) MEDICAL TREATMENT

For stones inside kidney that is less than 10 mm , urologist will usually advice you to drink plenty of oral fluid along with some medication which may prevent stone formation in future. There is a type of stone called as pure uric acid stone , which can be completely dissolved when your urine is alkalinized with some medication , but unfortunately this type of stone occur together with other type of stone like calcium stone which will not dissolve with medication .

SURGICAL MANAGEMENT


(B) ESWL ( Extracorporeal shockwave lithotripsy )

In this procedure , stone upto 1.5cm inside the kidney or in the upper portion of ureter can be broken down with a machine . this is usually done as daycare procedure . no need for anaesthesia. You can get discharged in same day evening. The main disadvantage of this procedure is not all type of stones can be broken with this procedure and even if broken there may be delay in passage of broken pieces there by your pain will persist upto weeks. Sometimes if these procedure fails to clear the stone, then you may need additional procedure to remove the stones

PCNL ( Percutaneous nephrolithotomy )

In this procedure stone inside the kidney are removed by making a small keyhole in your back. Stone are removed by rigid instrument called as nephroscopy,by which even large stone upto 4 cm can be broken into pieces , removed . you can get discharge with in three days . major complication of this procedure is bleeding that may require blood transfusion and rarely you may require renal angioembolization ( a coil placed in the ruptured blood vessel to arrest bleeding )

RIRS & LASERTRIPSY ( Retrograde intrarenal surgery with laser fragmentation )

In this method , stone in the kidney , upper ureter can be removed by passing a flexible scope through the normal urinary passage. stones upto 2.5 cm can be broken down to dust with help of laser . there is no hole made anywhere . no chance of bleeding like PCNL , you get discharged on very next day . however the procedure is bit expensive

URS ( Semi rigid ureteroscopy )

Here stone in the ureter is removed by passing a rigid scope via the natural urinary passage you can get discharged on the next day & resume your routine work in another one day . complication of this procedure is injury to ureter.

In URS,RIRS,PCNL your urologist may place a tube inside ureter called as Stent .Purpose is allow normal flow of urine from kidney to bladder and to allow a small broken stone pieces to pass out . this stent need to be removed after 2–3weeks that is usually done under local anaesthesia . stent usually will produce some discomfort like burning sensation on urination, blood in urine and pain on the back and lower abdomen while urination . you need to get it removed as per urologist advice . Incase if you forget to get it remove at stipulated time and left it inside for long period , then crystals form along the entire length of ureter which subsequently form stones along the entire length of the stent , which then make its removal a complicated procedure .

CYSTOLITHOTRIPY

Stones inside the urinary bladder are removed by passing the rigid scope called cystoscope via natural urinary passage and broken into small pieces then removed . you will get discharged on next day.