Kidney stone disease, which is one of the kidney diseases and is frequently encountered, can lead to kidney loss and kidney failure if it is not treated with the formation of stones in the inner part of the kidney where the urine is filtered.
Therefore, timely diagnosis and treatment is very important. Factors that increase the risk of kidney stone formation are as follows: Obesity Recurrent urinary tract infections Having previously had kidney stones Insufficient physical activity Congenital kidney abnormalities Presence of any other disease in the kidneys Chronic intestinal problems Gout disease Kidney Stone Symptoms The most common symptoms of kidney stone disease are: Severe chest, abdomen, waist and side pains Nausea and vomiting Blood in the urine Burning in the urine Inability to urinate Approximately 75% of all kidney stone cases consist of calcium stones. Uric acid stones: It is a type of kidney stone seen in individuals with gout, who are fed a high protein diet that increases the amount of uric acid in the blood. Cystine stones: It is a rare type of kidney stone caused by metabolic disorders. Citruvite (infection) stones: This type of stone, which is formed due to urinary tract infections, can cause serious kidney damage in a short time due to its very rapid growth. How Is Kidney Stone Diagnosed? In the diagnosis of kidney stones, physical examination and medical history, as well as various laboratory tests, as well as medical imaging techniques are used.
Some of these diagnostic tests are: Ultrasonography Ureteroscopy X-ray Computed tomography (CT) Urine examination and culture Kidney function tests in blood Kidney Stone Treatment The size of the stone and its location in the kidney are the most important factors in the planning of the treatment to be applied after the diagnosis of kidney stone. As the size of the kidney stone increases, the chance of the patient to pass the stone spontaneously or by medical means decreases. In addition, the placement of the stone in the kidney is higher in the upper part of the kidney than in the lower part. In patients with frequently recurring stones, determining the underlying cause of stone formation is very important in terms of reducing the risk of recurrence and treatment. In particular, stone analysis, blood calcium, magnesium, phosphorus, uric acid, vitamin D and parathormone levels, urine pH, urine cystine, uric acid, oxalate levels, and if an underlying metabolic or hormonal cause is detected, they should be treated. It is important in the treatment and prevention of stones. In recurrent kidney stones, drug treatment may vary according to the type of stone.
The aim of medical treatment is to increase the solubility of crystals in the urine and to prevent them from collapsing in the kidney and turning into stones. Treatment Methods Stone Breaking with Sound Waves (ESWL) ESWL (Stone Breaking with Out-of-body Shock Waves Sound waves from a source are transmitted from the skin to the kidney stones with fluoroscopy (X-ray) and small pieces broken by sound waves are excreted through the urinary tract. Many factors affect the number of kidneys, the anatomical structure of the kidney, the skin-kidney distance, etc. Generally, stones smaller than 2 cm are suitable for eswl.The procedure takes 30 - 45 minutes, depending on the location of the stone, its size and the device used.
It can be applied up to 3 sessions when necessary. The most important advantages are that the procedure is performed on an outpatient basis and that it does not require anesthesia, while the most important disadvantage is that the stone cannot be broken, the broken pieces cannot be poured or it causes pain during pouring. It is a closed surgical technique used in the treatment of stones that have passed into the ureter (the urinary canal between the bladder and the kidney) and is performed by entering through the external urinary tract. The procedure can be performed under general or spinal (anesthetized from the waist down) anesthesia. By using rigid or flexible (flexible) endoscopic devices, the stone is reached by entering through the external urinary tract, and then the stone is fragmented with the laser sent through the device. If necessary, the parts are taken out with a basket catheter. Temporary stent can be placed if edema occurs in the ureter after the procedure, if the broken stone is too large, or if there is an injury in the urinary tract.
The stent is usually removed after two weeks. Since there is no incision or piercing during the procedure, the return to normal life is very fast. The chance of success is very high. It can be applied comfortably except for patients with active urinary tract infections. The most important risks; If there is a narrowing in the urinary canal that will prevent the passage of the device, a stent can be placed and the stone can be intervened in 2 sessions. Urinary tract injury There is bleeding in the urine, fever. It is the process of entering the body from the urinary canal to the kidney by means of a flexible thin endoscope, without making any incisions or holes, and breaking or removing the stones there with the help of laser. Specially produced endoscopes (flexible ureterorenoscope) are used for this procedure. The tip of these instruments, which are approximately 3 mm thick and 60-70 cm long, can be controlled by the surgeon from the back of the device. In this way, each chamber of the kidney can be entered and the stones there can be reached and broken with the help of laser. What are the advantages? Since no incision or piercing is done, the patient can be discharged on the same day; The next day, he can return to his normal daily life.
It is a surgical technique with a high chance of success and a low complication (undesirable side effect) rate. It can be safely applied to all patients except for patients with active urinary tract infections. Percutaneous Nephrolithotomy (PCNL) is an endoscopic (closed) surgical technique used for the treatment of kidney stones by entering the kidney with a small hole in the back. It is generally preferred if it is larger than 2-3 cm or if other methods (ESWL, RIRS) are unsuccessful. Under general anesthesia, the kidney is reached by entering through a 1 cm incision from the back and the stones are broken or the smaller ones are taken out as a whole. If necessary after the procedure, a plastic tube can be inserted through the incision for 1-2 days. PCNL surgery can be performed through smaller incisions thanks to the newly developed devices. While the standard method requires 30 fr (1cm) diameter tubes, this has been reduced to 15-18 fr (5-6mm) in mini-PCNL and 12-14 fr (3-4mm) in ultra mini-PCNL. As the thickness of the device used decreases, the risk of side effects such as bleeding decreases and the recovery is faster after the procedure.