RENAL STONES | ASSOCIATE PROF. CENK ACAR
RENAL STONES








What is a renal stone and why does is happen?
The renal stone disease is the presence of a stone in anywhere in the urinary tract (kidneys, internal urinary canal (ureter), bladder or external urinary canal (urethra)). Stones can cause obstruction and distension in the urinary tracts and swelling of the kidney and can result in the loss of renal functions if not treated in time.

What are signs of renal stones?
Mostly flank pain and blood in urine are seen in adults. If the stones obstruct the urinary tract, nausea and vomiting, loss of appetite and fatigue can be added to these signs. Furthermore, fever can be seen if urinary tract infections accompany the renal stones. In small children however, restlessness or vomiting that are not unique for stone disease can be seen at presentation.

How is renal stone diagnosed?
Patients with stones obstructing the urinary tracts are generally evaluated in emergency rooms initially. Following the history and physical examination of patients, urinalysis and whole blood count is performed, and presence and amount of stones is determined with imaging methods. Ultrasonography and plain abdominal x-ray must be the first choices as the imaging methods. However, with the help of the technologic advancements, the non-contrast (without administering drugs intravenously) with spiral computerized tomography for determining all the features of the stone in stone patients and showing all their anatomic features have dominated other imaging methods.

What are the treatment methods for renal stones?
The first objective for the patients applying to the emergency room is to diagnose the stone and to determine whether emergency treatment is required. Particularly for the small stones, spontaneous falling of the stone from kidney through the bladder is mostly seen. For this patients, the pain must be stopped effectively and intravenous fluid therapy is administered to increase the urinary output. Then the patients are followed up for 7 to 14 days under drugs that will help to excrete the stone. Failure of medical excretion of the stone within this period shows that an interventional treatment is required. If the stone is excreted, it is very important to determine the stone type for preventing formation of further stones. A metabolic evaluation is required in patients with recurring stone disease. Particularly 70% of the pediatric patients have a metabolic problem, and drug treatments to be prescribed aiming at the removal of the causes can reduce the formation of new stones, and can even dissolve the existing stone for some stone types.

What is Extracorporeal Shock Wave Lithotripsy (ESWL)?
This is the method of breaking the stone by focusing the shock waves created by a device (magnetic or piezoelectric) onto the stone. It can be performed under general anesthesia in small children and with local anesthesia in adults. Success of this procedure depends on the number of stones, sizes, locations, type, and anatomical structure of the urinary tracts. It is known that this procedure causes no permanent damage on kidneys. It is particularly very effective on the small renal stones, smaller than 1 cm, and that have located at pelvis of the kidney. However, redness or bruises at the site of application, pain during the excretion of the broken parts, urinary bleeding, obstruction of the urinary tracts by the broken pieces and fever can be seen.

How is the renal stone surgery performed?
While the patients were treated only with open surgery in the past, most of the stone treatments are performed endoscopically (closed surgical techniques) owing to the technological advancements today. The surgical modality is determined based on the number, size, location and type of the stones, anatomical structure of the urinary tracts and preference of the patient.
URS (Ureteroendoscopy) is the procedure that thin and flexible endoscopic instruments are entered from the external urinary tract (urethra) to bladder and the upper urinary tract (ureter) in order to fragment the stone with LASER (Holmium: YAG) and remove it. No incision or scar is left. Success rate is very high. Patient can return to his/her normal daily life one day later.
PNL (Percutaneous Nephrolithotomy) is the procedure that stones are fragmented through a sheath of about 1cm placed in the kidney through the skin. It requires a hospital stay of 2 to 3 days after the procedure. The patient will have a very small wound in the kidney area, which can heal very rapidly. Success rate is high particularly for large kidney stones.