Kidney stones are a quite common urologic disorder. It is a hard mass that developed in the collecting system of the kidney. It usually starts in the microscopic tubules collecting urine from the renal pyramid and forms a nucleus of crystallization that attracts more and more crystals of either uric acid or oxalates. In time a small nucleus increases in size. It is called the Randall’s plaque that with time becomes bigger, it may detach and grow in size to form an urinary calculus. Calculi less than 3 mm in diameter may pass spontaneously through the urinary system causing little discomfort.
If the calculus increases in size bigger than 4 mm it may start to travel outside the collecting system of the kidney and cause an acute obstruction to the urine flow.
That in turn causes an extremely painful colicky pain that usually brings the patient to the Emergency Room for help. If there is a high fever the patient has to be admitted to the hospital and treated for urosepsis, a severe, life threatening form of urinary infection.
The diagnosis of urinary calculus and to find its location is done by performing a plain (non contrast) CT scan of the abdomen and pelvis. To find out it’s possible chemical composition by performing a KUB- plain x ray of the abdomen.
Calcified stones most likely built of oxalates cannot be dissolved with medications; stones built of uric acid can be treated with oral medication that can dissolve it after the obstruction of the urine flow was relieved.
Urinary stones that cause obstruction, bleeding, or infection need to be removed from the urinary system after relieving the obstruction and controlling the infection with antibiotics.
Relieving the obstruction:
Can be accomplished by passing a tube (stent) into the ureter (tube connecting the bladder to the kidney) via cystourethroscopy under general anesthesia.
Can also be accomplished by puncturing the kidney under local anesthesia to gain access and drain the obstructed collecting system. That procedure is performed if the above procedure fails or is impossible to perform.
Removing a urinary calculus:
ESWL: extracorporeal shock wave lithotrypsy, crushing the stone, is done using a special technology that generates shock waves that crush the stone placed in focal point of the waves.
There is no bodily invasion; the stone fragments are eliminated with the patient’s urine.
Stones up to 2 cm in diameter can be treated that way.
PCNL: For larger stones it is preferable to undergo direct stone access (contact) Lithotrypsy. This method prevents dissemination of stone fragments all over the kidney. It is done in steps: first by gaining access to the kidney by puncture under local anesthesia and then dilating the access tract under general anesthesia in the Operating Room. After creating an access accommodating a nephroscope the stone is crushed under visual control and the fragments vacuumed out through the instrument. (Swiss Lithoclast).
Ureteroscopy and Lithotrypsy: this technology permits removal of stones impacted in the ureter, the tube that connects the bladder to the kidney. If the stone is small and not embedded in the lining (mucosa) it can be caught in a basket. Otherwise it can be crushed with a laser and the fragments will be eliminated with patient’s urine. All this is done under general anesthesia in the Operating Room.
Open surgery: is reserved for patients with extremely large stones where any of the above mentioned technologies is not capable, alone or in combination, to render the patient stone free. More over repetitious treatments may worsen the patient’s kidney function and/or cause renal hypertention adding to the patient’s health problems. Although open surgery nowadays is a rarity Dr. Plawner developed a vast experience in open surgery for urinary calculi before the advent of the above mentioned technologies.
Prevention of Urinary Lithiasis:
It is one of the most important steps after the initial treatment. It consists of analyzing the stone composition, patient’s dietary habits and examining the patient’s metabolic profile.
It is done by highly specialized labs with clear and understandable instructions to the patients willing to be enrolled in stone prevention programs.
For more information, contact Dr. Plawner by calling (212) 737-2330 for a consultation.