Urinary System Stone Disease and Surgical Treatment in Adults
What is urinary system stone disease?
Stone disease is one of the most common diseases in urology practice. It is seen in roughly 15 out of every 100 people in Turkey.
How are stones formed in the kidneys?
The formation of stones in the kidney is caused by the combination of many factors. The amount of urine formed and excreted in the kidneys is very important, and the excretion of some chemical substances through the urine increases with the effect of some factors, and these substances easily precipitate in the urine, which may decrease depending on the amount of fluid taken, leading to the formation of small crystals. After these crystals are formed, they quickly combine to form kidney stones.
Who is at risk?
Kidney stones are formed 2-3 times more often in men than in women. It occurs more frequently in hot climates (especially in the south and southeast regions of our country), due to sweating and insufficient fluid intake in summer. Certain foods and beverages are known to lead to the formation of stones. Apart from all these, individuals with a family history of stone disease are also at significant risk for stone disease.
What are the symptoms of urinary system stone disease?
Flank pain on the side of the stone is the most important symptom. The pain can be severe, stabbing, and sometimes long-lasting and enduring side pains. Especially the stones that come out of the kidney and enter the urinary canal called the ureter cause much more severe pain. The intensity of the pain may increase or decrease from time to time. In addition, bleeding in the urine, burning, nausea and vomiting can also be seen. Sometimes, the diagnosis of stone disease can be made with random imaging methods that do not cause any symptoms.
How is the diagnosis of urinary system stone disease?
The most used examination method is ultrasonography. It is a simple and practical application that does not pose any application difficulties to the patients. Diagnosis can also be made by radiological methods such as blank or medicated kidney film (IVP), computed tomography in the stone protocol. The treatment plan varies depending on the location of the stones, their number, and the diameter of the stones.
How is urinary system stone disease treated?
The location and size of the stone are the most important criteria in treatment planning. The size of the stone is important in the stones that have entered the canal between the kidney and the urinary bladder, which we call the ureter. If these stones are less than 6 mm, they may fall spontaneously with some medical treatments and plenty of fluid consumption. It may be necessary to intervene in stones that do not fall spontaneously within 2 weeks or stones larger than 6 mm. Almost all the stones stuck in the ureter can be treated with the endoscopic method (ureterorenoscopy). During the procedure, the stone is reached by entering the urinary canal where the stone is located, with a special lighted instrument (not bendable, rigid ureterorenoscope).
Today, in the treatment of stones in the upper ureter or kidney, extracorporeal shock wave therapy (SWL) and endoscopic method can generally be chosen. Flexible (bendable, flexible) ureterorenoscopes are used in the endoscopic method. Here, the stone is grinded with a laser by entering through the urinary canal. This method is also called retrograde intrarenal surgery (RIRS). Percutaneous stone surgery (percutaneous nephrolithotomy) can be selected for large stones with a size of more than 2 cm in the kidney. Today, the rate of open surgical interventions has decreased to 1-2% due to both the endoscopic (closed) procedures that are widely applied with technological developments and the detection and treatment of stones when they are smaller. This method can be chosen in cases where there are large and complex stones that fill almost all the cavities of the kidneys and there is a narrowing in the lower part of the stones that will prevent them from falling after the treatment. The technique applied and the devices used in this regard are explained in detail in the section "Surgical Treatment of Stone Disease in Children".
How to protect from urinary system stone disease?
It is especially important to increase water consumption. It is important to drink at least 2.5 liters of water per day. Reducing salt consumption, animal protein intake, beverages that increase urinary excretion such as tea, coffee, and carbonated beverages; Increasing daily physical activity and consumption of lemons and oranges containing citric acid, which prevents stone formation, is beneficial for our protection from disease. It is also important to have regular kidney checks.