Stones of the urinary tract called ureter are very common in the kidney and urine from the kidneys to the urinary bladder. Stone is a hard mass developed by crystals from urine in the urinary tract. It can be found in the kidney or ureter. Kidney and ureteral stones are usually shed without any discomfort, but this disease can become one of the most painful experiences known.
Treatment of kidney and ureteral stones
Factors influencing the choice of treatment:
Not all stones require treatment. If your stone causes discomfort and does not fall naturally from urine, you need treatment. Your doctor may also offer treatment if you already have medical illnesses.
It is usually followed if you have a kidney or ureter stone that does not cause any discomfort. Your doctor will give you a schedule of your regular checks to ensure that your condition is not getting worse.
If your stone is likely to be excreted in the urine, your doctor may prescribe medications that facilitate this period. This is called conservative treatment.
If your stone continues to grow, if it causes frequent and severe pain, you should seek active treatment.
Conservative stone treatment
Most kidney and ureteral stones spontaneously leave the body during voiding. However, depending on the size and location of the stone, it will take a while. You may have renal colic pain when the stone moves. If your stone is too small, it can be self-discarded within 4 weeks with a 95% chance.
Keep in mind:
There are two common preventive treatment options: Medical Expulsive Therapy (BAT) and resolution of urinary acid stones. In both cases, you need medication.
Active stone therapy
Kidney or ureteral stones should be treated if they cause symptoms. There are 3 common ways to remove stones: shock wave stone (ESWL), ureterorenoscopy (URS), and percutaneous nephrolithotomy (PNL).
Which active treatment method is best for you depends on many factors. The most important factor is the symptoms caused by the stone. Your doctor may recommend different treatment options based on whether your stone is present in the kidney or ureter.
If you do not have any medical symptoms, treatment can also be applied if:
Your doctor may recommend removal of the stone in the ureter if:
Conservative stone therapy Medical Expulsive Therapy (MET)
Your doctor may prescribe medications to help you get rid of your stone faster and reduce pain when you move. This is called Medical Expulsive Therapy (BAT) and is most effective in ureteral stones.
During BAT - as often as your doctor recommends - you should be kept under regular doctor supervision.
Unraveling the stone
If you have uric acid stone, it is possible to dissolve it. This is done by increasing the pH of your urine, making it alkaline from acidic state. At the pH-level of 7.0-7.2, the stone shrinks in size and eventually dissolves completely. You can measure your urine pH at home using a simple dipstick.
Extracorporeal Stone crushing with shock waves (ESWL)
ESWL is made with a machine that breaks stones from outside the body. To break the stone, focused shock waves (high-energy sound waves with short signals) are transmitted from the skin to the stone. The stone absorbs the energy of the shock waves and breaks up into small pieces. The particles are then excreted in the urine.
The ESWL method is suitable for the majority of patients. However, the success of the method depends on several factors, such as stone qualities and body structure.
During the procedure you will hear the sound of the shock waves resembling a small burst sound. You do not need anesthesia for this procedure, but you will receive pain medication to avoid pain during the procedure. SWL operation depends on the location and size of the stone in the session.
If your stone is large, you may need to have several sessions to break your entire stone.
In which cases ESWL is not recommended?
ESWL should not be applied in some cases regarding your physical condition or stone structure
ESWL is not recommended in the following cases:
ESWL post condition:
ESWL breaks down your stones into small pieces. These particles are discarded without intervention on the days or weeks following ESWL. You can get BAT to discard the stone particles.
Things to do before ESWL
It will explain in detail what you need to do in preparation for the process. If you are taking an anticoagulant medication, you may need to discontinue the medication, so consult your doctor. Do not eat anything for 4 hours before the procedure.
In general, you can return to your daily life immediately after treatment. However, it is necessary to rest as much as possible on the day of the procedure.
If you do not have any pain, it is very important that you consume more liquid than normal to remove the stone particles. Try to consume more than 2 liters of liquid per day.
It is important to collect the resulting stones for stone analysis.
Inform your doctor immediately if:
Percutaneous Nephrolithotomy (PCNL)
PCNL is a surgery where large stones are removed directly from your kidney. The biggest advantage is that even very large stones can be removed in a single operation. PCNL is performed under general anesthesia.
However, compared to ESWL and URS, the risk of complications is higher. The most common complication of PCNL is bleeding and high fever.
When is PCNL considered?
PCNL should be considered when your stone is too large (greater than 2cm) and has not yet passed to the ureter. PCNL can also offer you as a treatment option in the following cases:
PCNL construction
PCNL is performed under general anesthesia. Depending on the size of the stone, it is either removed as a whole piece or first cut into small pieces. At this point all the stone particles are removed.
Cases where PCNL should not be performed
PCNL is an effective and reliable procedure, but there are some contraindications since the stone is accessed directly from the skin. If you are taking blood thinners, you should stop using them prior to the procedure, PNL is not recommended if you are pregnant or have a physical condition that prevents access to the kidney.
You stay in the hospital for a few days with PCNL. If you have a tube, you will be discharged by the doctor or nurse after the tube has been removed. Your urine may be slightly bloody for the first few days. Do not exercise in the first two weeks after the operation.
You must return to the hospital immediately if:
Ureterorenoscopy (URS)
URS is a type of surgery performed with a small diameter endoscope instrument. URS is common and the success level is high and the risk of complications is low. URS is performed under general anesthesia. During surgery, without any incision in your body, the endoscope is entered into the bladder through the urethra and the stone is removed.
URS considerations
For those with obstructive stones, the complete occlusion period should be considered if the pain tolerance of the patient is very low or if the patient has more than 3 weeks.
When is URS not recommended?
There are very few cases where URS shows contraindication. If your condition is suitable for anesthesia and you do not have an untreated urinary tract infection, URS can be applied to almost any patient. It is always important to discuss your personal situation with your doctor.
Preparation for surgery
Although the details will be explained to you by your doctor, it is forbidden to eat, drink or smoke within 6-8 hours before the operation in terms of preparation for anesthesia.
You can usually be discharged 1 day after surgery and return to your daily activities that do not require heavy physical exercise and activity. Your urine may come bloody for a few days. If a tube is inserted during the procedure, your doctor will remove it when your urine flow returns to normal.
You should immediately return to the hospital if:
Causes of kidney and ureteral stones
What causes kidney stones?
Everybody, whether men or women, can have stones during their lifetime. A stone may form if there is an imbalance in the way your body produces urine. This may be related to the amount of fluid you drink and the presence of stone-inducing substances in your urine.
There are other reasons for stone formation.
Some people are more likely to create stones.
You are in a high risk group if you:
Some urological conditions increase the risk of stone disease:
Some other conditions are associated with stone disease. These:
Stone formation is also associated with many drugs. Please do not stop using any prescribed medication without your doctor's advice.
Symptoms of kidney and ureteral stones
Renal and ureteral stones are generally thought to cause pain. However, depending on the size, shape, location of the urinary tract, the symptoms may vary between severe pain and painless.
Severe pain (renal colic)
If the stone blocks normal urine flow through the ureter, you will experience severe pain, known as spasm-induced renal colic, to rhythmically throw stones in the urinary tract. This is a sharp pain in the area extending from the waist and flank to the hip. If the stone is in your ureter and not in your kidney, you may feel pain in your groin and thigh. Men may also have pain in the ovaries.
Renal colic develops as a result of sudden pressure increase in urinary tract and ureter wall. Pain comes in waves and does not diminish when you change your position. It is described as one of the most painful situations you can experience and is likened to labor.
Other symptoms associated with renal colic include:
Renal colic is an important condition in terms of pain, and urgency increases if you have high fever.
Stones can also cause recurrent, relentless pain in your flank area. This type of pain may also be a sign of other diseases, so you will need to have some medical tests to determine if you have kidney or ureteral stones.
Some stones do not cause any discomfort. They are called asymptomatic and are usually small. Asymptomatic stones are usually detected during X-ray or other imaging procedures for other diseases.
Diagnosis of kidney and ureteral stones
Your doctor will perform a number of tests to understand the cause of your symptoms. This is called a diagnosis. After questioning your history and familial history, imaging and biochemical tests are performed.
Imaging techniques
To determine where your stone is located, your kidneys should be imaged. USG, X-ray, noncontrast computed tomography (CT), magnetic resonance imaging (MRI) and medicated kidney film (IVP) can be used. These scans clearly reveal the size, shape and thickness of the stone.
In case of renal colic, urine and blood tests are performed to see if there is infection or renal failure.
If your stone is expected to be excreted in the urine, your doctor may recommend that you drain your urine to collect it. Your doctor may ask you to analyze what type of stone you have. This information is important because it helps to choose the best preventive and therapeutic method.
Obstructed and infected kidney
If you have fever with renal colic, or if you experience unusual fatigue, you should immediately consult your urology doctor or a hospital. Blood and urine tests are performed to check for renal obstruction and infection. Depending on the severity of the obstruction, your doctor will establish a treatment protocol, then you will receive antibiotics to relieve the infection. Treatment to remove your stone can only be done after the infection has been removed.
Prevention of stone formation
Some stone patients may have more stone formation in the future. After your stone has been dropped or removed with treatment, your doctor will determine if there is a high risk of stone formation again. For this he will need to analyze your stone. The results of your blood and urine tests before treatment will also be evaluated by your doctor. In such cases, stone analysis, metabolism tests and familial factors are important.
Recommendations for the prevention of stone formation
Your doctor will advise you to make some lifestyle changes even if you have a low risk of another stone formation. These measures reduce the risk of creating another stone and improve your overall health.
Recommendations for adults.
Consume more liquid
DIET
Depending on your personal situation, your doctor may advise you on adapting your diet. It is important to discuss this first with your doctor.
Healthy habits
Adopting a healthy lifestyle is always a good idea.
Metabolic evaluation for urolithiasis
If you have a high risk of stone formation, your doctor will perform a metabolic evaluation. This is a series of blood and urine tests that determine which additional treatment you may need.
According to the results of the tests you can receive medication. Drug treatment usually has no side effects or very few side effects. It also helps you consider your lifestyle changes
As part of your metabolic assessment, your doctor will ask you to collect urine during 2 different 24-hour periods. This is done approximately 3 weeks after the stone has spontaneously dropped or removed with treatment. The amount of urine is measured along with the amount of different substances in your urine.
The substances in your urine include calcium, acid.
Your doctor will take another urine sample to adjust the dose of the medication 2-3 months after starting the medication.
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