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Urology Center for Kidney Disorders (Non-invazive Surgery of kidney and urethral stones, Tumors of kidney) , Incontinence with state of art Video-Urodynamy System for Diagnosis , Bladder Disorders (Bladder stone, Bladder cancer ,Functional disorders of bladder), Scrotum and Testis Disorders (Hydrocele, Varicocele, Spermatocele,Testis tumor) Diseases of Urethra.
Hattat Urinary System Stones Diagnosis & Treatment Center
KIDNEY STONES
Kidney stones (calculi) are hardened mineral deposits that form in the kidney. They originate as microscopic particles and develop into stones over time. The medical term for this condition is nephrolithiasis, or renal stone disease. The kidneys filter waste products from the blood and add them to the urine that the kidneys produce. When waste materials in the urine do not dissolve completely, crystals and kidney stones are likely to form. Small stones can cause some discomfort as they pass out of the body. Regardless of size, stones may pass out of the kidney, become lodged in the tube that carries urine from the kidney to the bladder (ureter), and cause severe pain that begins in the lower back and radiates to the side or groin. A lodged stone can block the flow of urine, causing pressure to build in the affected ureter and kidney. Increased pressure results in stretching and spasm, which cause severe pain.
Stone Formation
Kidney stones form when there is a high level of calcium (hypercalciuria), oxalate (hyperoxaluria), or uric acid (hyperuricosuria) in the urine; a lack of citrate in the urine; or insufficient water in the kidneys to dissolve waste products. The kidneys must maintain an adequate amount of water in the body to remove waste products. If dehydration occurs, high levels of substances that do not dissolve completely (e.g., calcium, oxalate, uric acid) may form crystals that slowly build up into kidney stones. Urine normally contains chemicals—citrate, magnesium, pyrophosphate—that prevent the formation of crystals. Low levels of these inhibitors can contribute to the formation of kidney stones. Of these, citrate is thought to be the most important.
Causes and Risk Factors
Several factors increase the risk for developing kidney stones, including inadequate fluid intake and dehydration, reduced urinary flow and volume, certain chemical levels in the urine that are too high (e.g., calcium, oxalate, uric acid) or too low (e.g., citrate), and several medical conditions. Anything that blocks or reduces the flow of urine (e.g., urinary obstruction, genetic abnormality) also increases the risk.
Chemical risk factors include high levels of the following in the urine:
- Calcium (hypercalciuria)
- Cystine (cystinuria; caused by a genetic disorder)
- Oxalate (hyperoxaluria)
- Uric acid (hyperuricosuria)
- Sodium (hypernatremia)
A low level of citrate is a risk factor for hypocitraturia.
The following medical conditions are also risk factors:
- Congenital kidney defect that may increase urinary calcium loss and stone formation (medullary sponge kidney)
- Excessive parathyroid hormone, which causes calcium loss (hyperparathyroidism)
- Gout (caused by excessive uric acid in the blood)
- High blood pressure (hypertension)
- Inflammation of the colon that causes chronic diarrhea, dehydration, and chemical imbalances (colitis)
- Inherited condition in which the kidneys are unable to excrete acid (renal tubular acidosis)
- Intestinal disorder that causes chronic diarrhea, dehydration, and low citrate (Crohn's disease)
- Painful joint inflammation (arthritis)
- Urinary tract infections (affect kidney function)
Diet plays an important role in the development of kidney stones, especially in patients who are predisposed to the condition. A diet high in sodium, fats, meat, and sugar, and low in fiber, vegetable protein, and unrefined carbohydrates increases the risk for renal stone disease. Recurrent kidney stones may form in patients who are sensitive to the chemical byproducts of animal protein and who consume large amounts of meat.
High doses of vitamin C (i.e., more than 500 mg per day) can result in high levels of oxalate in the urine (hyperoxaluria) and increase the risk for kidney stones. Oxalate is found in berries, vegetables (e.g., green beans, beets, spinach, squash, tomatoes), nuts, chocolate, and tea. Stone formers should limit their intake of cranberries, which contain a moderate amount of oxalate.
Signs and Symptoms
Small, smooth kidney stones may remain in the kidney or pass without causing pain (called "silent" stones). Stones that lodge in the tube that carries urine from the kidneys to the bladder (ureter) cause the urinary system to spasm and produce pain. The pain is unrelated to the size of the stone and often radiates from the lower back to the side or groin.
A "small" stone (usually 4 mm in diameter or less) has a 90% chance of spontaneous passage. Stones that are 8 mm in diameter or larger usually require medical intervention.
Other symptoms of kidney stones may include the following:
- Blood in the urine (hematuria)
- Increased frequency of urination
- Nausea and vomiting
- Pain during urination (stinging, burning)
- Tenderness in the abdomen and kidney region
- Urinary tract infection (fever, chills, loss of appetite)
Diagnosis
Diagnosis of renal stone disease involves a medical history, physical examination, laboratory evaluation, and imaging tests. Laboratory tests include urinalysis to detect the presence of blood (hematuria) and bacteria (bacteriuria) in the urine. Other tests include blood tests for creatinine (to evaluate kidney function), BUN and electrolytes (to detect dehydration), calcium (to detect hyperparathyroidism), and a complete blood count (CBC; to detect infection).
Imaging tests
Abdominal X-ray. An abdominal X-ray can visualize most kidney stones and can help to judge changes in the size of a stone over.
Ultrasound Ultrasound can detect a dilated (stretched) upper urinary tract and kidney caused by a stone lodged in the ureter, but usually cannot detect small stones, especially those located outside the kidney. It is the preferred imaging method for kidney stone patients who are pregnant.
Intravenous Pyelogram (IVP) This test involves taking a series of x-rays after injecting a contrast agent (dye) into a vein. The contrast agent flows through the veins, is excreted by the kidneys, and improves the x-ray images of the kidneys and ureters. If a kidney stone is blocking a ureter, the contrast agent builds up in the affected kidney and is excreted more slowly. Most kidney stones (e.g., calcium stones) can be precisely located using this procedure.
Retrograde Pyelogram A cystoscopy (i.e., a procedure in which a telescopic instrument is inserted into the urethra) is performed to locate the opening from the ureter to the bladder. The contrast agent is injected directly into this opening and an x-ray is taken to locate the kidney stone.
Computerized tomography This test uses a scanner and a computer to create images of the urinary system. It is performed quickly but may have difficulty detecting small stones located near the bladder. CT scan can also help identify medical conditions (e.g., ruptured appendix, bowel obstruction) that cause symptoms similar to kidney stones.
How are they treated?
For most stones, your doctor will suggest drinking 8 to 10 glasses of water a day to help flush them out. You may also need to take pain medicine. You can do this at home.
If a stone is too large to pass on its own, or if it gets stuck in the urinary tract, you may need treatment. This happens in only 1 or 2 out of 10 people with kidney stones.1
The most common medical treatment is extracorporeal shock wave lithotripsy (ESWL). This uses sound waves to break a kidney stone into small pieces. The bits can pass out of your body in your urine. Other times, a doctor will need to remove the stone or place a small metal tube in the ureter to keep it open while stones pass.
Surgical treatment at Hattat Hospital
In most cases, less invasive treatments are successful rather than open surgery.
Lithotripsy This procedure is effective for stones in the kidney or upper ureter. It uses an instrument, machine, or probe to break the stone into tiny particles that can pass naturally. Lithotripsy is not appropriate for patients with very large stones or other medical conditions.
Percutaneous Nephrostolithotomy (PCN) This surgical procedure is performed under local anesthesia and intravenous sedation. Percutaneous (i.e., through the skin) removal of kidney stones (lithotomy) is accomplished through the most direct route to stones through the kidney. A needle and guidewire are used to access the stones. The surgeon then threads various catheters over the guidewire and into the kidney and manipulates surgical instruments through the catheters to fragment and remove kidney stones. This procedure achieves a better stone-free outcome in the treatment of medium and large stones than shock wave lithrotripsy. This procedure usually requires hospitalization, and most patients resume normal activity within 2 weeks.
Ureteroscopic Stone Removal This procedure is performed under general anesthesia to treat stones located in the middle and lower ureter. A small, fiberoptic instrument (ureteroscope) is passed through the urethra and bladder and into the ureter. Small stones are removed and large stones are fragmented using a laser or similar device. A small tube (or stent) may be left in the ureter for a few days after treatment to promote healing and prevent blockage from swelling or spasm.
Open Surgery This procedure requires general anesthesia. An incision is made in the patient's back and the stone is extracted through an incision in the ureter or kidney. Most patients require prolonged hospitalization and recovery takes several weeks. This procedure is now rarely used for kidney stones.
BLADDER and URETERAL STONES
Bladder stones are hard buildups of mineral that form in the urinary bladder. Bladder stones typically form when urine stagnates in the bladder due to poor emptying of the bladder (urinary stasis). This causes minerals and other substances to form crystals on the inner surfaces of the bladder. Over time, these crystals may combine to form a stone. Men are three times more likely to develop bladder stones than women. The chances of stones forming increases with age. Most people are over 45 when the stones are discovered.
A urethral stone is a kidney stone that has moved down into the ureter. Most stones enter the ureter when they are still small enough to move down into the bladder. From there, they pass out of the body with urination. Some stones, however, have grown larger by the time they leave the kidney. They may become lodged in a narrow part of the ureter, causing pain and possibly blocking the flow of urine. These stones may need to be treated.
The surgical treatment is the same as Kidney Stones.
Symptoms
- Frequent urge to urinate
- Interruption of urine stream
- Nausea and vomiting
- Difficulty urinating
- Blood in the urine
- Abdominal pain or pressure
- Bladder infections
Diagnosis
Diagnosis of urinary stone disease involves a medical history, physical examination, laboratory evaluation, and imaging tests such as : Abdominal X-ray, Ultrasound ,Intravenous Pyelogram (IVP) Retrograde Pyelogram and Computerized tomography.
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