Stones

Kidney stones form when crystals of salts or minerals in the urine aggregate together especially if the urine is concentrated. These stones forming in the kidney can often drop in the ureter (the tube that connects the kidney to the bladder) causing pain or an episode of ‘renal colic’. This pain is often a severe sharp and colicky pain. The stones if small can pass spontaneously, but if it is too large to pass then it gets stuck in the ureter. Apart from loin and back pain this can also cause UTI (urinary infection) or haematuria (blood in the urine) and occasionally might be totally asymptomatic. The diagnosis is usually made on an Ultrasound or X-ray and confimed on a CT scan. Once the stone size, location and number is determined treatment can be planned.

Symptoms of stone disease+-


Loin and back pain (episodic, often sharp and colicky)
Haematuria (visible or non-visible blood in the urine)
Urinary tract infection (UTI)
Occasionally asymptomatic
And rarely as sepsis (severe kidney infection which might be life threatening)

Shock wave lithotripsy or lithotripsy (SWL)+-


This involves targeted shock waves to break the stones into smaller fragments, which is then passed naturally. The procedure is done as a day case with painkillers but without the need for a general anesthetic. Although the procedure can be repeated it may not be suitable for certain type and location of stones. The passage of stone fragments might be painful and might need a secondary procedure (ureteroscopy) if the stone gets stuck in the ureter.

Ureteroscopy (URS)+-


For stones in the kidney or if they are stuck in the ureter (tube that connects the kidney to the bladder), a fine telescope can be passed via the bladder in the ureter or in the kidney. The stone is visualised and broken using a holmium laser. These stone fragments can often be actively removed using special baskets or graspers. The procedure itself is done under a general anaesthesia usually as a day case procedure.

Percutaneous nephrolithotomy (PCNL)+-


Large renal stones are sometimes removed using a special telescope through a small cut (key hole) at the back. Through this telescope a special ultrasound machine is used to actively break and suck the stone. This allows very large stones to be removed in a single session. A general anesthetic is necessary and a hospital stay of 2 or more days if often necessary.
We now also offer new Ultra mini PCNL technique (for some stones) in which a very small cut is made and the stone is broken using a laser. As well as a lower complication rate, with this technique the patients can go home within 1-2 days.

Diet for stone formers+-


You should reduce the amount of animal protein in your diet. Aim for no more than 3oz (85g) of red meat, poultry or fish per meal.

  • You should NOT reduce the amount of calcium in your diet.
  • You should reduce the amount of sodium (salt) in your diet by not adding salt to your cooking or food at the table.
  • You should reduce your intake of refined sugars. Refined sugars are found in many foods including cakes, sweets, biscuits, jam, honey and fizzy drinks.
  • You should reduce your consumption of food and drink rich in oxalate.

Oxalates are naturally-occurring substances found in plants, animals, and in humans and can cause stones to develop. Foods and drinks rich in oxalate include:
Beetroot, asparagus, rhubarb, nuts, chocolate, berries, leeks, spinach, tofu, tea.

Prevention of stone disease+-


The most common reason people develop a kidney stone is through dehydration. You should therefore drink plenty of fluid throughout the day. You should aim to pass around two litres of urine per day. This means drinking around two and a half to three litres of fluid per day. The colour of your urine should be pale rather than yellow.

You should also make sure you drink more than the recommended daily amount when it is hot, or when you are exercising, in order to replace the fluids that are lost through sweating.
Drinks such as tea and coffee can count towards your fluid intake, but water is the healthiest option for kidney stone prevention. Do not drink large quantities of grapefruit juice, apple juice or cola drinks as these help form kidney stones.

There are many causes of renal stones and it is likely that you may have more than one factor.

  • anatomical (structural) abnormalities
  • excess stone-forming substances in the urine
  • lack of chemicals that prevent stones in the urine
  • chronic infection in the urine

50-70% of patients presenting with a stone will develop further stones over the next 10 years.

Screening for stone disease+-


The simple stone screening involves checking certain blood parameters such as renal function, calcium and uric acid.

We do offer a detailed stone screening via Dr Paul Cook (Consultant in Chemical Pathology and Metabolic Medicine) where a more detailed blood and urine test is done. This can be especially useful in patients with recurrent stones, family history of stones, diabetes mellitus, obesity, certain anatomical and metabolic abnormalities (such as single kidney, crohn’s disease or previous bowel surgery etc.)

Specialist stone procedures+-


In addition to the standard stone procedures such as URS, PCNL and lithotripsy we also offer other specialist procedures such as Supine PCNL, Ultra mini PCNL, Ureteroscopy and stone treatment for kids (with a Paediatric Urologist) and bilateral simultaneous ureteroscopy (treating kidney stones in both kidneys at the same time).

Bladder stones+-


Bladder stones form within the bladder and can cause urine infections, haematuria (blood in the urine) or difficulty/pain while passing urine.

The most common cause is not being able to empty the bladder completely resulting in crystals in the urine aggregating to form stones. The commonest cause is in people the obstructed urine flow from an enlarged prostate, or those with long term catheters or neurogenic (nerve related) bladder dysfunction. Occasionally it might be related to a poor diet intake or a kidney stone that has grown in the bladder.

Treatment of bladder stones varies from washing the stones off the bladder (for small stones) to cystolitholapaxy (breaking/crushing the stone using a special telescope) or using a laser to break it. Rarely for a very large stone percutaneous or open surgery may be necessary. All these procedures need a general or regional anaesthetic and patients might need to have a temporary catheter afterwards.