What is Kidney stone?
There is present of aggregation of crystals made out of calcium and other minerals in the urine form stones that may cause pain, bleeding or infection when they block the urinary tract which is in kidneys. As Singapore is a hot, tropical modern country with fast pace stressful lifestyle, urinary stone disease is common. It generally affects more males than females, between the ages from 35 to 60. Recently, the stone disease is also commonly seen in patients with a sedentary lifestyle and this may be related to their lifestyle and eating habits.
The treatments of the renal stone disease are mainly divided into following:
No treatment needed, if this stone is small and less than 5 mm in size. Even if it is treated, the stone may not pass out at all. A stone that is located at one end of the calyx usually will not cause any symptoms. Nevertheless, the patient needs to be followed up with regularly (at least once in 2 years) to review the size of the stone and the potential problems that it may cause.
Medical treatment is usually indicated if the nature and type of the stone can be determined before treatment, and by adjusting the pH of the urine, the stone can be treated, and the residual stone can be treated by other means. The time taken for this treatment is longer. As a result, the acute phase or stone complications may not be suitable for this treatment.
External corporal shock wave therapy (ESWL)
Extracorporeal shock wave lithotripsy (ESWL) is one of the common modalities for treatment for upper urinary tract stone. It is indicated for small kidney stone (<2cm) and non–obstructive upper ureteric stones. However, ESWL may not be suitable for stones causing significant obstruction, infection or gross haematuria. The other limitation for ESWL is unknown nature of the stone for shockwave, hence the patient may require second or third treatments.
This seems to be the only treatment for patients which may not be suitable for surgery or endoscopic treatment. The patient may need to be co-operative, so as not to shift during blasting.
Generally, ESWL is done as an outpatient procedure and the patient is given sedation when blasted. The bowel needs to be prepared before the blasting.
The side effects or/and complications for this treatment are back pain from blasting, some skin blister due to the blasting, blood in the urine due to shock wave to the kidneys and occasionally infection and sepsis especially when the stone is infected without antibiotic coverage.
There are a few routes for endoscopic treatment for urological stones:
Through the urethra
Through the loin into the kidney – percutaneous nephrolithotomy