Dr Satyen­dra Per­saud

DM (Urol) FRCS (Eng)

Con­sul­tant Urol­o­gist/

Lec­tur­er in Urol­o­gy (UWI)

Symp­toms of kid­ney stones

Stones form in the kid­neys and can move in­to the kid­ney tubes called the ureters. They can cause se­vere pain. The pain usu­al­ly starts in the back and can move as the stone moves. It can be felt in the tum­my. The pain is col­icky and comes and goes – dur­ing episodes pa­tients of­ten say that ly­ing still does not help and de­scribe pac­ing while try­ing to cope. There may be blood in the urine, vom­it­ing and even ur­gency to go to the bath­room. A blocked kid­ney may lead to in­fec­tion and even loss of a kid­ney if not dealt with in time.

Treat­ment op­tions –

who needs treat­ment

The treat­ment op­tion for kid­ney stones de­pends on sev­er­al fac­tors in­clud­ing stone size, hard­ness and lo­ca­tion. It al­so de­pends on sev­er­al pa­tient-re­lat­ed fac­tors such as pa­tient pref­er­ence, co­mor­bidi­ties and body type. Ad­di­tion­al­ly, some kid­ney stones cause is­sues such as block­age and in­fec­tion and may re­quire emer­gency treat­ment in the form of a stent or tube drainage. Some stones may even dis­solve with med­ica­tion over time and some may just re­quire ob­ser­va­tion. Some will in­evitable fail ob­ser­va­tion. This ar­ti­cle briefly re­views the most com­mon man­age­ment op­tions for stones.

As men­tioned above, stones form in the kid­ney and can then move or mi­grate in­to the ureter. Some­times a stone be­comes stuck in this tube and can be ex­treme­ly painful. They can cause the kid­ney to be­come in­fect­ed and may lead to sep­sis. If left un­treat­ed, a stone block­ing the ureter can lead to death of that kid­ney.

In some pa­tients we may be able to use med­ica­tion to help the kid­ney stones pass. These drugs work by re­lax­ing the ureter and this treat­ment is called Med­ical Ex­pul­sive Ther­a­py. This is ap­pro­pri­ate for stones less than 1 cm and in a pa­tient who has no signs of in­fec­tion or kid­ney dam­age and in whom the pain has set­tled. It is very help­ful for stones which have moved close to the blad­der.

If the stone is caus­ing a block­age and in­fec­tion, the pa­tient will re­quire re­lief of the block­age and an­tibi­otics.

De­fin­i­tive treat­ment of the stone is post­poned un­til the in­fec­tion has set­tled. Re­lief of the ob­struc­tion will re­quire a stent or a tube placed in­to the kid­ney through the back called a nephros­to­my tube. The stent is a plas­tic tube placed via the urine pas­sage with no cuts and spans the en­tire tube from the kid­ney to the blad­der – it by­pass­es the stone and al­lows urine to drain. Stents may cause some bleed­ing and dis­com­fort and is not a treat­ment for the stone but mere­ly buys us time and pre­vents kid­ney dam­age un­til the stone can be treat­ed. The stent should not stay in place for lengthy pe­ri­ods as some­times stones can form around the stent it­self.

What are the sur­gi­cal op­tions?

If the stone is too large or oth­er­wise un­suit­able for ob­ser­va­tion, surgery may be re­quired. For­tu­nate­ly, we have a num­ber of op­tions for kid­ney stones in Trinidad and large cuts for stones are be­com­ing much less fre­quent.

1. Ureteroscopy

– Dur­ing ureteroscopy a long thin cam­era/scope is passed in­to the urine tube and even in­to the kid­ney. There are dif­fer­ent types of scopes in­clud­ing rigid and flex­i­ble ones and the pro­ce­dure is done with the pa­tient asleep. We can there­fore see the stone and break it up with a laser. Many times this can be done as a same day pro­ce­dure.

2. Ex­tra­cor­po­re­al shock­wave lithotrip­sy (ESWL)

– Dur­ing this pro­ce­dure the pa­tient is placed on a ma­chine which gen­er­ates shock­waves. The ma­chine us­es X-rays or ul­tra­sound to find the stone and take aim. These shock­waves trav­el through the pa­tient’s body and break stones with­out need­ing a cut. This is a same day pro­ce­dure and you do not need to go to sleep but may re­quire some se­da­tion. Once the stone breaks up, frag­ments are passed in­to the urine. Some­times sev­er­al ses­sions are need­ed to break the stones. This pro­ce­dure is avail­able to the pub­lic in San Fer­nan­do.

Per­cu­ta­neous Nephrolitho­to­my (PC­NL)

– This is a pro­ce­dure done for larg­er stones in the kid­ney. A nee­dle is used to punc­ture the kid­ney us­ing x-ray or ul­tra­sound as a guide and a small wire is placed in­to the kid­ney. This path­way in­to the kid­ney is then grad­u­al­ly en­larged to about a half of an inch or less and in­stru­ments are passed in­to the kid­ney to crush and re­move the stones. If the stones are very large ad­di­tion­al punc­tures may be need­ed. You will need blood donors for this pro­ce­dure as bleed­ing is a risk.