SURGERY & REMOVAL
Kidney stone surgery is the procedure of surgically removing the stones that are crystallized in the kidneys of the patient. Kidney stone surgery, which is performed considering the size and location of the stone in the kidney, is performed endoscopically, that is, closed.
WHAT IS KIDNEY STONE?
Kidney stones are hard deposits of minerals and salts. Most of the time, when the urine becomes concentrated, the minerals crystallize and stick together and this causes the formation of stones. Kidney stones can occur in any part of the urinary tract, from the kidneys to the bladder.
Kidney stones can cause very uncomfortable symptoms for the person, but when the stones are diagnosed in time, they usually do not cause permanent damage. Depending on the situation, the person may not need to do anything other than pain relievers and drinking plenty of water in the treatment of kidney stones. However, if kidney stones remain in the urinary tract or if there is a urinary tract infection, surgical procedures may be required.
Kidney stones may not cause any symptoms until they cause a blockage in the urinary tract. Symptoms in case of obstruction include severe pain in the back and under the ribs, pain radiating to the lower abdomen and groin, burning and pain during urination, change in urine color, foul-smelling urine, nausea and vomiting, and urinating more often than usual. The pain caused by the kidney stone may differ according to the position it takes while passing through the urinary tract. When symptoms become severe, a doctor should be consulted as soon as possible.
WHAT ARE THE TYPES OF KIDNEY STONES?
Most kidney stones are usually calcium oxalate stones. Oxalate is a naturally occurring substance in food and is also produced daily by the liver. Some fruits and vegetables, as well as nuts and chocolate, have high oxalate content. Dietary factors, high doses of vitamin D, intestinal bypass surgery, or various metabolic disorders can cause an increased amount of calcium or oxalate in the urine. Calcium stones can also form in the form of calcium phosphate in some cases. These stones may occur due to the drugs taken for migraine pain.
Struvite stones occur as a result of infection such as urinary tract infection. In some cases, these stones can grow rapidly with very few symptoms.
Uric Acid Stones
Uric acid stones are more likely to occur in people who do not drink enough or lose too much fluid, who are on a high protein diet, or who have gout.
Cystinuria and Cystine Stones
These stones occur in people who have an inherited disorder that causes the kidneys to secrete too much of certain amino acids (cystinuria).
WHAT ARE THE RISK FACTORS ?
If a person has a family history of kidney stones, it is more likely to occur in the person. In addition, if the person already has one or more kidney stones, there is an increase in the likelihood of another stone occurring.
Not drinking enough water during the day can increase the likelihood of kidney stones. People who live in hot climates and sweat a lot are at higher risk than others. Following a diet rich in protein, sodium (salt) and sugar may increase the likelihood of some types of kidney stones. This is especially true for high sodium diets. Too much salt in a person's diet can lead to kidney stones, as it increases the amount of calcium the kidneys need to filter.
High body mass index, wide waist circumference and sudden weight gain increase the likelihood of kidney stones.
Digestive Diseases and Surgery
Gastric bypass surgery, inflammatory bowel diseases, or chronic diarrhea can affect calcium and water absorption, which can cause changes in the digestive process.
HOW IS KIDNEY STONE TREATED?
First of all, the stone must be cleared from the kidney and/or urinary tract. Then, it is aimed to investigate the reasons for the formation of the stone and to prevent its re-occurrence.
In the treatment of stones, especially for stones smaller than 5 mm that fall into the urinary canal, medical treatment with drugs is preferred. For this purpose, in addition to some drugs that will expand the urinary channels so that the stone can pass more easily, painkillers and antibiotics are given to prevent pain and infection, and the patient is expected to drop the stone by drinking plenty of water. If the stone does not fall despite this treatment or if there is a larger stone, there are options to break the stone with extra-body shock waves (ESWL) or to remove the stone by surgery.
HOW IS KIDNEY STONE SURGERY PERFORMED?
Stone surgeries have started to be performed completely closed (endoscopically) with today's technology.
The choice of method in stone surgery is completely planned according to the size of the stone, the location of the stone (in the kidney or in the urinary tract), and whether the stone causes obstruction or not.
As endoscopic treatment methods in kidney stone surgeries;
Semirigid ureterorenoscopy (URS)
Flexible ureterorenoscopy (Flexible URS)
Percutaneous nephrolithotomy (PNL) methods are available.
Semirigid ureterorenoscopy (URS)
In this method, it is based on breaking the stone by entering the urinary bladder into the urinary canal (ureter) with the help of a thin camera through the urine exit hole. It is carried out without making an additional hole in the patient's body. With URS, only a stone, stenosis or tumor located in the urinary tract (ureter) is observed and can be treated with laser. Stones in the kidneys cannot be intervened.
Flexible ureterorenoscopy (Flexible URS)
It is technically the same as URS. In other words, in this method, without opening an extra hole in the body, it is possible to go to the urinary bladder and from there to the kidneys with a very thin camera system that can be bent in all directions from the urine exit hole. With this method, it is possible to reach all the chambers in the kidney and to break the stones settled in these areas with laser and completely clean them.
Percutaneous nephrolithotomy (PNL)
With this method, a small hole is made on the skin from the waist region and the kidney is reached through this hole. By entering the kidney with special fine instruments, stones and stones are broken and removed to the external environment. In order for this method to be applied, the stone must be larger than 2 cm in the kidney. Since there is no large incision, they feel less pain after the surgery and there is no cosmetically disturbing appearance. The recovery period is very short with the PNL method, which has replaced open kidney stone surgeries today. After the surgery, a thin probe (nephrostomy) is placed through the hole through which the kidney is entered to accelerate the healing process. This probe is easily pulled out 1-2 days after the surgery. With PNL, the stones are completely cleared and the patient is discharged in 2 days on average.
FREQUENTLY ASKED QUESTIONS
Is Kidney Stone Crushing Surgery Risky?
Every surgery and treatment carries a certain amount of risk. The risks of open and closed kidney stone surgeries are the same. The most common complication is bleeding, but there is a 1% to 10% chance of bleeding large enough to require blood supplementation. Another risk is the risk of infection, as in any surgery. For this reason, it is necessary to check whether there is an infection in the urine before the operation and to start preventive antibiotics during the operation.
Do Kidney Stones Recur?
Kidney stones are a recurrent disease. If preventive measures are not taken and lifestyle changes are not made, the risk of recurrence of kidney stones due to environmental and genetic factors is quite high.
Can Kidney Stone Formation Be Prevented?
Some measures can be mentioned to prevent kidney stone formation. The first of these is to drink plenty of fluids. Eating slower meals and giving weight to exercise are also among the measures that experts list to prevent kidney stone formation. It is beneficial to consume foods containing fiber and vegetables and fruits, but it is necessary to avoid foods rich in oxalate such as spinach, cocoa, tea leaves, walnuts, wheat bran. Unless there is a special situation that requires you to take excessive calcium, calcium consumption should also be limited. Studies have shown that lemon juice prevents the formation of some stones. The citrate in lemonade is effective against kidney stones. Therefore, part of the fluid requirement can be taken in the form of lemonade. As with all diseases, early diagnosis with regular health checks at regular intervals is important.
Which Doctor Should Be Seen for Kidney Stones?
Urology doctor should be consulted for kidney stones. What kind of treatment will be applied to the kidney stone is decided after the examination and tests by the urology doctor. Considering that there are surgical methods in the treatment of kidney stones, it is important to choose a urology doctor experienced in kidney stone surgeries and a hospital with a sufficient infrastructure.
What are the foods that will protect the kidneys?
Vitamin B6 (pyroxine) supplements are also effective in preventing stone formation. Kidney bean decoction can be one of the effective herbal treatments to prevent kidney stone problems.
Can kidney stones damage my kidneys?
Kidney stones can cause damage to the kidneys, especially if left untreated for a long time. If recurrent kidney stones cause serious infections, have an obstructive feature, and if treatment is delayed, it can even lead to kidney loss.
When is surgery necessary for kidney stones?
Surgery may not be necessary for every kidney stone. Surgery may come to the fore in kidney and urinary tract stones that do not go away with measures such as increased water consumption and drug therapy.
Kidney stones that cause severe pain and infection
Kidney stones that are too large to pass on their own
kidney stones that cause bleeding
Kidney stones that can cause kidney damage should be operated on.
Full blocking stones