Suddenly you have an intense pain that comes and goes that is located in the area of the flank or maybe in the lower abdomen. You may also be nauseous and vomiting, or you may even have a fever. Most women who experience this describe this as being worse than childbirth without anesthesia. You cannot find a comfortable position and will be pacing back and forth. What is it that I am describing? A kidney stone that is trying to make its way out of the urinary tract.
Kidney stones can come in many different shapes, sizes and composition. Many patients may have stones that are present in their kidney and not even know they are there. Patients only become aware of their stones when the stones cause symptoms. Symptoms that can be associated with kidney stones include bleeding, infection, or pain that usually comes in waves and can be located in your back and sides and may radiate toward the groin.
What is a kidney stone?
Most stones (80%) contain calcium; however, limiting calcium will not necessarily decrease stone formation—and for some patients may even increase the likelihood. Stones can be composed of calcium oxalate, calcium phosphate, uric acid, struvite, a form of an infectious stone, or cysteine.
After a long winter the warm weather is finally welcome….as long as you don’t form a kidney stone. Stone formation is more common in the warmer months. During these months, more fluid loss occurs from the body due to sweating. In order to prevent stone formation, increase fluid intake. Many patients do not ingest enough fluid, and stone formation may occur. Anybody who ever made rock candy can easily understand stone formation. As you add extra sugar into the water solution, and creating an environment of decreased fluid, eventually crystals of candy will form. Similarly with a stone, with relative decreases in volume of fluid, stone formation can occur. Genetic factors and dietary factors can both contribute to stone formation.
Pain that is associated with kidney stones can be very severe. The urinary tract has several natural narrowed areas between the kidney and the bladder. If a stone migrates from the kidney toward the bladder down the ureter (the tube that transmits urine from the kidney to the bladder), there are several places where the stone may get stuck and cause an obstruction. When an obstruction (hydronephrosis) occurs, backpressure behind the stone can occur, and this can be associated with significant pain. Patients in pain usually will present to an emergency room and treatment can be rendered.
If an obstruction occurs, patients will be evaluated and a treatment plan will be formulated. If the pain is unremitting or accompanied by vomiting that will not resolve, an acute intervention will probably need to be undertaken. The size of the stone and its location will dictate the type of treatment that is offered to the patient to relieve the obstruction.
This commonly consists of a procedure to remove the stone with an endoscope that is passed into the urinary tract under anesthesia (ureteroscopy). Depending on the size of the stone, a laser may be needed to fragment the stone into smaller pieces that can more easily be extracted. Usually patients who undergo this procedure will also have a stent placed. A stent is a hollow tube that drains the urine from the kidney to the bladder. The stent will help bypass the site that was previously obstructed. Most stents will remain in place for a short period of time (7-10 days) before they are removed with an endoscope in a very brief office-based procedure.
Certain stones that are located very close to the kidney may not be extracted. One option for this type of patient is just the placement of a stent, which will help drain the kidney and displace the stone into the kidney. A subsequent treatment known as extracorporeal shockwave lithotripsy would then be scheduled for stones, ideally, that are smaller than 2cm. This treatment consists of sound waves that are directed across the skin which fragment stones into smaller pieces that will be spontaneously passed.
Some stones that cause obstruction may be too large to be extracted endoscopically. This group of patients will undergo a percutaneous nephrostomy. A small tube (a nephrostomy tube) will be placed into the kidney that will relieve the obstruction. This tube will also provide access to the kidney for the urologist, who will ultimately place an endoscopic device (a nephroscope) into the kidney. With the scope once in place, the stone can then be fragmented into smaller pieces with several different types of devices (lasers, ultrasonic lithotripsy, mechanical fragmentation devices), and these fragments can then be extracted.
Published On: April 24, 2014