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HOW TO LOWER KIDNEY STONES? WHAT CAUSES KIDNEY STONES?
Explaining the curious issues related to kidney stones, Prof. Dr. he explained the treatment process and the steps that need to be taken after it. Awareness of the fact that on average one out of every 7 people has kidney disease in Turkey. Emphasizing its importance, experts tell that early treatment affects the healing process. “So why does the human organ, form kidney stones?”
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Turkey Medicals member and Antalya medical-hospital Professor Doctor who made an assessment on the question about, what should be done after occurrence of the disease he described the necessary procedures and unknowns of sound wave therapy.
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So, how does kidney stone pain go away and what are the points to be considered in surgical intervention? Here are the full details.
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WHAT KIND OF ORGAN IS THE KIDNEY?
Kidneys are muscle organs in front of the muscles that make up the back wall of the abdomen, which have a bean-like shape on both sides (right and left). The main function of the kidneys is to filter harmful substances in the blood and urine it is in the form of. It is also responsible for maintaining and maintaining the salt and water balance of the body. Urine is transported from the kidneys to the bladder (bladder) through channels called ureters.
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WHAT CAUSES KIDNEY STONES?
To understand this, you just need to start with the structure and function of the kidneys a little. Imagine that there are a total of two million filters in the right and left kidneys. This is the harmful substances in the blood it is filtered through a strainer together with water. The amount of this liquid per day is about 100 liters, while the filtered water next to the substances passing through the strainer (salts, chemicals) is so much. After straining, a small as this liquid and salts pass through the channels, they are absorbed back into the body in an equilibrium. If this were not for reabsorption, we would have to drink 100 liters of water every day for 100 liters of urine excreted from our body. Here’s one of the tubes, in addition to the liquid absorbed back into the body, salts are also kept in a balance in our body. In total, about 1-2 liters of a liquid called urine per day enters the kidney collector pool with excess substances and salts that are excreted without absorption.
If there is a very high amount of substances in the blood that are taken excessively or formed in the body, or if there is a small amount of urinary fluid due to drinking a little water, these substances are excreted with urine with a higher density (in consultation).
Dense substances crystallize when they reach a certain threshold density value, and in these crystals they stick together to form sands and stones that merge.
Kidney stones are of various types depending on their content. But most often, kidney stones are stones that consist of a combination of calcium and oxalate (Calcium-Oxalate). In addition, uric acid, calcium phosphate, cystine and infectious stones are also observed.
There must be several reasons for the formation of stones in the collecting system of the kidneys, either alone or together, so that dense substances crystallize in the kidney and merge to form stones. These reasons can be listed as follows:
1- A high amount of this substance is taken by mouth, and its amount in the blood increases a lot, and therefore the urine passes a lot,
2- In the organ that metabolizes the substance, the substance is overproduced and released into the blood too much, and therefore too Tue to the urine,
3- A small amount of urine is formed in the urine, which will cause condensation of the substance (for example, drinking a little water, losing a lot of water),
4- A preservative that prevents substances from sticking together in the urine and, consequently, the formation of stones very low content of substances.
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WHAT ARE THE SYMPTOMS OF KIDNEY STONES?
The most common symptom of kidney stones is pain in the area where the kidney is located. This pain is sometimes mild, and sometimes it can be in the form of a very severe crisis. The most severe that can be experienced, described by patients it is one of the pains. In addition, because the stone is a foreign body, it can cause kidney inflammation by infecting it in the urine and therefore causing a high fever. If there is no inflammation in the kidney and it is only in the way of urination if an infection occurs, this can also cause burning when urinating.
It can cause bleeding here due to playing in the kidney pool (pelvis) or ureter canal, causing bleeding in the urine. Symptoms of kidney stones include pain, fever, or burning and bleeding when urinating they can be one by one, as well as together. Sometimes, during sudden and severe pains, the gastrointestinal muscle may also spasm reflexively, and nausea or even vomiting may occur due to this.
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WHY IS THERE SEVERE PAIN IN THE KIDNEY STONE?
A stone in the kidney pool enters the urinary tract (ureter) or blocks the channel at the exit of the kidney in the pool behind it, due to the incoming urine, because the production of urine from the kidney continues, there is a high water pressure occurs. This pressure causes a sudden and severe stretching of the capsule that surrounds the kidney, this stretching causes severe kidney pain.
Sometimes, not only in the kidney pool, the stones in the small chalice (calyx) play and block the channel of this small pool (chalice pool), and only in the chalice in this area is caused by high pressure and again severe it causes pain. This pain is so severe that the intestinal Muscle suddenly spasm, and nausea or even vomiting can also accompany this pain.
By the way, what should I do as a treatment for this severe pain?
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HOW DOES KIDNEY STONE PAIN PASS?
Because there may be nausea or vomiting accompanied by severe kidney stone pain, oral painkillers may not work very well. Therefore, in the initial plan, it is necessary to contact the emergency department or a Urological clinic intravenously or it is recommended to reduce or relieve pain with painkillers that will be made from the hip. For the reduction of spasm in the urinary canal due to stretching in the kidney capsule, hot application will be relaxing. This spasm if it decreases, because some urine will drain down around the stone, the water pressure in the kidney pool decreases, and the tension of the kidney capsule decreases, which can lead to a decrease in pain.
If the pain persists consecutively, despite taking painkillers, or intervention on a stone that has fallen into the emergency channel may occur. Or enter it endoscopically through the urinary tract to ensure the drainage of urine into the urinary canal a temporary tube (stent) is inserted. Prof. Dr. in this approach recommended by, especially if there is a high fever accompanied by pain, a stent should be placed to drain this infected urine in absolute terms. Infection treatment of systemic infection and fever caused by urine with microbes that contain and accumulate in the kidney due to blocking the stone, penetrate into the kidney tissues and blood with high pressure, but with the help of a stent in addition to ensuring the drainage of urine and removing infected urine from the kidney, it is possible with intensive antibiotic therapy. Infection control is possible only with antibiotic therapy without draining the urine with a stent is not possible.
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HOW DOES THE STONE IN THE URINARY TRACT (URETER) FALL OUT?
Stones that form in the kidney pool and fall into the urinary canal called the ureter are called ureteral stones. The most necessary diagnostic method used today for the diagnosis of ureteral stones is intravenous drug-free (non-contrast) urinary it is a computed tomography aimed at the system. The simplest method of diagnosis is a complete urinalysis, after which severe pain in a patient admitted for severe reasons is removed with painkillers. A high amount of blood in the urinalysis in the case of cells (erythrocytes), Prof. Dr. the first diagnostic method proposed by the is not an ultrasound of the urinary system, but the above-mentioned computed tomography. There are several reasons for this.
1- An ultrasound scan can only see stones in the presence of kidney stones or, with careful observation, at the point where the urinary canal opens into the bladder. It may also indicate an enlargement of the kidney pool. Ureteral duct he cannot see the stones in it because they are behind the intestines, the area of the pelvis and intestinal gases are blocked. In kidney pain presenting with severe pain, most often the stone has fallen into the ureteral canal because it is, ultrasound is insufficient to show this stone.
2- Ultrasonographic evaluation may differ in its interpretation according to the experience of the person performing it.
3- In a urinary tract computed tomography taken without medication (i.e. without intravenous contrast media), the beam to the forehead is very low and is taken very quickly (less than 1 minute) because it is taken according to the stone protocol.
4- Kidney, the ureter also shows the presence of stones in the bladder and other kidneys and ureters of a homogeneous nature, regardless of who is pulling it.
5- By measuring not only the presence of a stone in the ureter, but also the size of the stone and even the calcium density of the stone, “how likely can a stone be lowered with medication, is there no possibility of falling with medication, crushing a stone – so it can be broken by sound waves?” it also allows us to have information about such issues and guide our patient more qualitatively. If a ureteral stone is detected with this technique, it is treated with medication can it be lowered by itself? for the planning of this, attention should be paid to some features. These are: a. If the size of the stone (especially its transverse size) is 6 mm and below, it can be removed spontaneously within 15 days with the help of drug therapy the probability of its fall is about 65-70%. b. If there is an intense thickening of the ureter wall (urinary canal wall) due to edema in the place where the stone sits in the ureteral canal, and the transverse diameter of the stone is 7 mm and larger with drug therapy, the probability that it will fall or break with a sound wave is much reduced.
If the transverse diameter of the stone detected in the ureter is about 6 mm and there is no severe edema in the ureteral canal, oral painkillers, urine-lubricating drugs and drugs that prevent and even relax spasm of the ureter muscle are prescribed self-medication is followed by its fall over time. Warm application during this period will be very helpful in relaxing the muscle of the ureter wall. If the expansion of the kidney pool is not too excessive, and if there is no loss of kidney function during the drug treatment period, it is preferable to follow up the spontaneous fall of the stone with drug therapy in this form of ureteral stone.
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But in some cases, treatment with medication due to the fact that there are repeated bouts of severe pain even while walking, the quality of life can drop very much, and in this case it is unnecessary to wait for the stone to fall out by itself. By endoscopic and laser through the urinary canal treatment should be carried out by intervention.
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WHAT IS TREATMENT FOR A URETERAL STONE THAT DOES NOT FALL OR CANNOT BE LOWERED?
A stone that has fallen into the urinary tract, that is, into the ureter, may not fall for several reasons. The most important reason for this is that the diameter of the stone is large and it is inserted into the ureter. Another reason is that the ureter is inserted into the duct with edema formed by the stone on the wall of the ureteral canal, the lumen narrows and compresses the stone even more. Sometimes, due to the fact that the stone is notched, it can also be inserted into the ureteral canal, although this is rare. Move insertion in the ureteral canal is most often at the exit of the renal pool or just below the exit, or due to narrowing of the lumen, where the ureter passes over (crosses) the large vessels in the pelvis the result. In addition, at the lower end, where the ureter opens into the bladder, it is often encountered that the stone cannot be inserted and lowered. The most effective treatment for stones left in the ureteral canal is endoscopic urination it is a stone that gets out of the way and breaks into sand or 1-2 mm pieces with a laser. For this purpose, a very thin endoscopic device is inserted into the ureter under general anesthesia and the stone is seen and cut into pieces with laser energy are separated. An endoscopic device that does not curl (rigid), especially in the lower parts of the ureteral canal, while an endoscopic device that can curl (flexible) is more often used for stones in the upper part of the ureter. The name of the basket used to be these stones when treating a given catcher by grasping and pulling it into the wire, the basket method is rarely used today. This is for the collection of parts after the large stone is broken into pieces by the laser the basket device can be used as an October. However, pulling the stone with a basket without breaking the stone can cause unwanted injuries to the ureteral canal.
The stone is passed through the endoscopic device in the ureteral duct during laser fracture, the stone can escape up or even into the kidney under the influence of the crushing force. Prof. Dr. especially in recent years and during the laser fracture of the stone, materials that prevent it from escaping back escape back he advises you not to have problems. With the application of an endoscopic laser, the stone is divided into sand or 1-2 millimeter pieces and after pouring, the process is stopped. But be sure to move to another it is checked that there is no left. Severe pain after surgery, October the trauma caused by a stone in the ureter, and in addition, the edema on the wall of the ureter canal, which is increased by traumas during laser crushing, will narrow the lumen a temporary tube called a stent can be inserted into the ureter to prevent an attack. This stent helps both the drainage of urine and prevents pain attacks after surgery, as if dropping a stone it prevents its occurrence, as well as allows the edema on the ureter wall to heal faster. Since there will be no pain, the patient can easily return to work or social life within 1-2 days.
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HOW TO BREAK A STONE WITH SOUND WAVES SENT FROM OUTSIDE THE BODY?
In the ESWL stone crushing mechanism, which means crushing stones with shock waves from outside the body (Extracorporeal Shock Wave Lithotripsy), it is important that the stone is necessarily contained in the liquid. This fluid is also urine. Body the waves sent to the urine by a loud sound wave from outside are focused on the stone by an X-ray machine or ultrasound. Sound waves that hit the stone floating in the urine are small air bubbles on the surface of the stone however, with a successive sound wave, this air bubble bursts, and the stone surface cracks and the piece begins to break off. A new air bubble is formed, and then the incoming sound wave also explodes these bubbles. So, move to ESWL in order for it to break, there must be urine around the stone. A stone that is stuck in the ureter canal, unfortunately, does not have urine around it. For this reason, it can become very difficult to break with ESWL. ESWL below 2 cm it is a more applicable method for kidney pool stones.
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IS THERE ANOTHER METHOD OF SURGICAL TREATMENT OF URETERAL STONES?
In the past, ureteral stones were removed by open surgery. Nowadays, with the development of optical and endoscopic technology, the practice of open surgery is almost nonexistent now. But sometimes very large ureteral stones, especially he may have been stuck in the big vein neighborhood and grew up there. These stones may not be reached endoscopically due to edema, as well as a stent may not be inserted. In this case, with laparoscopic technique by cutting the ureter wall with optical and fine laparoscopic surgical instruments sent into the body through 3 small holes drilled into the body, the stone is removed from the ureter and the wall is sutured again. With this method, your patient will be 1-2 days he doesn’t stay in the hospital much.
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IS THERE A SIDE EFFECT OF THE STENT INSERTED INTO THE URETER?
As mentioned earlier, after the stone in the ureter is broken with a laser and its fragments are removed, it will be convenient to place a stent due to small minor hemorrhages and edema on the ureter wall. This stent it is a thin tube made of a material such as soft rubber, and there are holes on it like a pinhole. It is curved at both ends. One curved end will be in the kidney pool, and the other curved end will be in the bladder it is a 26-28 cm tall tube that is inserted into the ureter in the figure. The reason why the two ends are curved is so that when the patient stands up after being inserted, it does not fall from the kidney into the bladder, or the tip in the bladder it is so that it does not escape up to the kidney. If the lower end of the bladder touches the inside of the bladder, there may be tenderness in the bladder. Since this sensitivity varies from person to person, stent-related discomfort also it may differ from patient to patient.
Usually, the stent does not cause any discomfort at all, and a person can easily continue his life, work, and even go on vacation. However, in some people, excessive sensitivity as the lower end of the attached stent touches the urinary bladder, it can describe a feeling of constant urination, a feeling of urination, a feeling of stinging. Some medications may also be given for this feeling of discomfort. Other than that, the lower end is urinating it can cause bleeding that causes pinkness in the urine when it touches the bladder. The only treatment for this is to drink plenty of water and ensure that plenty of urine is formed.
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WHEN AND HOW IS THE STENT INSERTED INTO THE URETER REMOVED?
After the edema on the wall of the ureter or the enlargement due to blockage of the stone in the kidney has passed, it is necessary to remove it from the tip of the bladder bearable. This period is about 2-3 weeks. Some patients may have to spend even longer with a stent due to their work or social life. The stent can easily stay for 3 months. In some patients if the drugs are not enough due to the fact that the stent touches the bladder and the sensitivity it creates, the stent can be removed within a week. In order to withdraw it from the urinary canal with local numbing under office conditions it is entered with a thin endoscope that can be bent, and the tip in the bladder is held and removed from the urinary canal with a long tweezers-like capture device sent through this endoscope. General anesthesia for this procedure it is a simple procedure that does not require, takes less than 1 minute, and is performed after numbing the urine with a gel with local anesthesia. This has the side effect.
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HOW TO LOWER KIDNEY STONES?
Kidney stones if it is of a certain size, it can fall into the ureter. But stones over 1 cm are very rare, especially stones with a diameter of 1.5 cm almost never fall into the canal. Kidney stones below four mm are clinically it is not considered significant. Because even if it falls into the ureteral canal, it is easily lowered without requiring surgical treatment. But stones between 4 and 6 mm can be reduced Dec treatment with a 70% chance, while stones larger than 6 mm are more it is difficult and painful to fall. Unfortunately, when crushing stones with ESWL is applied to stones in the kidney, because stone fragments can break uncontrollably in different sizes, they fall into the ureter more easily after breaking and it can cause severe pain. In some cases, even with a broken stone, they are sequentially lined up in the ureteral canal and form a condition called a stone path. To this is used the term Stein Strasse. Unfortunately, the only remedy in this case is endoscopic surgery is the breaking of stones with a laser by entering them through the urinary canal.
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HOW IS KIDNEY STONE SURGERY PERFORMED?
The treatment of stones in the kidney pool or small pools (we call it calyx) is performed by 3 methods. The most important determining factors in deciding this are, The total size of the stone (if there are several pieces of stone all of them are collected). The number of stones and their location in the kidney. Structural and functional state of the kidney. The surgeon’s experience. The device and its material infrastructure are not more than 20 years ago The whole kidney when treating stones with open surgery, a hole is made in the kidney from outside the body with the help of a percutaneous endoscopy technique developed in the 2005s, and a stone is inserted into the kidney through a pipe inserted into the kidney his endoscopic treatment had improved. This percutaneous method is still an effective technique that is currently preferred for large kidney stones. Currently, thin-long endoscopic devices and lasers that can be curled are used in “Flexible Endoscopic Laser”, which is applied to kidney stones mainly from the urinary canal to the ureter and from there up and into the kidney with development and, of course, experience – in short, Flexible URS it is mentioned that stone crushing treatment is performed with. But in addition to thin endoscopic devices that can curl and reach as far as the kidney, which are very sensitive for this, laser energy power and a lot of auxiliary material and, of course, surgical experience are required.
With experience, even stones measuring 4-5 cm in the kidney can now be treated with this method. Also, if there are stones in both kidneys, the same during the session, the patient can be treated with stones by entering both ureteral canals without changing the position. The second biggest advantage here is that there are no large incisions like in open surgery, like in percutaneous technique it is the absence of a hole in the kidney. For this reason, the recovery period is also 3-4 days in the percutaneous technique, while the endoscopic method, which is performed by entering the urinary tract, is also 1-2 days. Flexible URS, in which case percutaneous when deciding on surgical treatment, Prof. Dr. as you can emphasize by your own experience, the factors can be listed as follows:
1- In stones that completely cover the inside of the kidney.
2- On large and very hard stones. Inside the kidney on the other hand, percutaneous technique should be preferred from the first plan in stones with intense abscessed infection 1. a single stone measuring 4-5 cm in size or multiple different pools in the kidney if you have more stone.
3- If there are bilateral kidney stones If there are kidney stones along with ureteral duct stones, it is necessary to decide on the surgical treatment approach with the Flexible URS technique in the first place. But especially from 3 cm it should be shared with the patient for information that surgical treatment for large stones can be performed in more than one session. Currently, ESWL is used as the third treatment option for kidney stones of very limited proportions it is proposed. It can be recommended if it is a single stone in the kidney and in the upper pool and if it is 0.6-1 cm in size.
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WHAT CAN BE DONE PREVENTIVELY AFTER KIDNEY STONE TREATMENT?
A kidney stone is a type of kidney stone that can be passed from one kidney to another. Especially in the family if there is a history of stone, if the child has had a stone disease at an early age, if there is a history of recurrent stone dropping or stone treatment, this patient should definitely be examined from a metabolic point of view. Because after cleaning the stone when the patient is told to drink plenty of water, the risk of re-formation of stones in 5 years is about 45-50%, while the preventive approach to the risk factor after a metabolic assessment (we call it Metaflaxis when applied, this ratio decreases to 10%.
4-5 Weeks after the treatment of the stone with surgery or ESWL for Metabolic Analysis and complete cleansing of the renal system from the stone, that is, in the assessment of the mechanism of stone formation and risk factors it is recommended that it be done. It is very important that the stone fragments extracted during this period are biochemically examined and the type or types of stone are revealed.
For Metabolic analysis, 24-hour urine is placed in a collection container it is deposited and the level of substances in the urine that cause the formation of stones and prevent the formation of stones in the urine is checked. In addition, blood tests show that the substances that make up the stone (for example, calcium, uric acid) serum its level and parathyroid hormone level should be checked. If there is a risk factor in the results obtained, 7-10-day diets are organized for risk factors and again the level of these substances in the urine changes are considered.
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According to the metabolic risk factor determined by 80% after the metabolic evaluation, diet, drug therapy and even endocrinologically parathyroid hospital surgery or treatment in Turkey are also mentioned.
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Turkey's world-renowned organ transplant specialist. Dr. Demirbaş has 104 international publications and 102 national publications.
Physician's Resume:
Born on August 7, 1963 in Çorum, Prof. Dr. Alper Demirbaş has been continuing his work as the President of MedicalPark Antalya Hospital Organ Transplantation Center since 2008.
Prof. who performed the first tissue incompatible kidney transplant in Turkey, the first blood type incompatible kidney transplant, the first kidney-pancreas transplant program and the first cadaveric donor and live donor liver transplant in Antalya. Dr. As of August 2016, Alper Demirbaş has performed 4900 kidney transplants, 500 liver transplants and 95 pancreas transplants.
In addition to being the chairman of 6 national congresses, he has also been an invited speaker at 12 international and 65 national scientific congresses. Dr. Alper Demirbaş was married and the father of 1 girl and 1 boy.
Awards:
Eczacibasi Medical Award of 2002, Akdeniz University Service Award of 2005, Izder Medical Man of the Year Award of 2006, BÖHAK Medical Man of the Year Award of 2007, Sabah Mediterranean Newspaper Scientist of the Year Award of 2007, ANTIKAD Scientist of the Year Award of 2009, Social Ethics Association Award of 2010, Işık University Medical Man of the Year Award of 2015, VTV Antalya's Brand Value Award of 2015.
Certificates:
Doctor of Medicine Degree Hacettepe University Faculty of Medicine Ankara, General Surgeon Ministry of Health Turkey EKFMG (0-477-343-8), University of Miami School of Medicine Member of Multiple Organ Transplant, ASTS Multiorgan Transplant Scholarship. Lecturer at Kyoto University. Lecturer at University of Essen, Research assistant at the University of Cambridge .
Professional Members:
American Society of Transplant Surgeons, American Transplantation Society Nominated, Middle East and Southern Africa Council Transplantation Society 2007, International Liver Transplantation Association, Turkish Transplantation Association, Turkish Society of Surgery, Turkish Hepatobiliary Surgery Association.
Disclaimer:
Our website contents consist of articles approved by our Web and Medical Editorial Board with the contributions of our physicians. Our contents are prepared only for informational purposes for public benefit. Be sure to consult your doctor for diagnosis and treatment.
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