Ureteric Stone

Stone disease is one of the most prevalent urological disorders. Stones are more prevalent in men than in women. It is often seen between 20-49 years of age, though it can occur in children and old age. It can also occur among family members.

As per the recent estimates, more than a million kidney stone cases are diagnosed annually. It is slightly common in men than women.

Who is at risk for kidney stones?

A low fluid intake, with a subsequent low volume of urine production, produces high concentrations of stone-forming solutes in the urine. This is an important, if not the most important, environmental factor in kidney stone formation.
Excessive stone-forming materials passed in the urine such as calcium, oxalate or phosphate and other chemical compounds including uric acid, magnesium, ammonium, phosphate and the amino acid, cystine.
Dehydration caused by reduced consumption of fluids or rigorous exercise.
Severe obstruction in the urinary tract.
Inhabitants of hot and dry regions are more likely to have kidney stones due to dehydration.

Infection in the urinary tract.
Obesity.
Inherited metabolic abnormalities.
Different types of medical conditions such as Gout, Hypercalciuria, Hyperparathyroidism, Renal tubular acidosis, inherited metabolic conditions such as cystinuria and hyperoxaluria, diabetes and high blood pressure.
People affected with inflammatory bowel disease.
People who have undergone intestinal bypass or Ostomy surgery.
Rare cause include medications including diuretics, calcium-containing antacids, and indinavir (Crixivan), a drug used for the treatment of HIV infection.
Inadequate intake of fluids, high consumption of animal protein, diet rich in salt, excessive intake of protein, excessive intake of vitamin D supplementation and consumption of foods rich in oxalate such as spinach. Reduced levels of consumption of dietary calcium.

Stones are produced in the kidney. They may move down the ureter, bladder and urethra and passed out in the urine. They may stay inside the calyceal system of kidney and grow in size.

Signs and Symptoms

Sudden and severe cramping pain in the low back region and/or side, groin, or abdomen.
- The abdominal, groin, and/or back pain generally fluctuates in severity. Sometimes, the pain may be so intense that it could be accompanied by nausea and vomiting.
Presence of blood in the urine.
Fever and chills
Difficulty in urinating
Urgency to urinate
Loin pain radiating to private parts

Diagnosis of kidney stones

Imaging tests are generally done to confirm the diagnosis. The most common test are Ultrasound and CT scan. These tests can diagnose location, number, size of stones and degree of obstruction to the urinary tract and status of degree function.

Treatment for kidney stones

There are various factors which affect the ability of a kidney stone to pass through the urinary tract. These primarily include size of stone passage, degree of and status of kidney function. Small stones are usually passed in the urine but around 15% of them can get stuck and need endoscopic treatment. Only 60% of stones larger than 9 mm to 10 mm can be passed in the urine. Certain medications such as calcium channel blockers and alpha blockers are used to enhance the passage rates of kidney stones.

How Needs Endoscopic Surgery for Stones?

If stone is not passed after reasonable period of time and causes pain.
Stone is too large to pass on its own
Stone associated with severe blockage to urinary passage
Recurrent UTI and reduction in kidney function

The procedure varies according to the location and size of stone

1. EXTRACORPOREAL SHOCKWAKE LITHOTRIPSY

Extracorporeal Shockwave Lithotripsy (ESWL): shock waves that are created outside of the body travel

Through the skin and body tissues and hit the dense stones. The Stones are broken into sand – like particles and are easily passed in the urine. This type of treatment is suitable for small stones within the kidney.

2. Percutaneous Nephrolithotomy (PCNL):

In this procedures, the surgeon makes a small incision in the back and creates a tunnel directly in to the kidney. Using an Instrument called a nephoscope, the surgeon locates and removes the stones. For large stones, some type of energy probe (ultrasonic or pneumatic) may be needed to break the stone into small pieces. Generally, patient stay in the hospital is for two days.

3. URETEROSCOPIC STONE REMOVAL:

The surgeon uses an instrument called a ureteroscope which is passed into the ureter. The Surgeon locates and removes the stone with device or shatters its using the probe that delivers energy to break the stone.

This is used to remove stones from middle and lower ureters. A tube called stent may be placed in the urinary system to facilitate passage of stone fragment the urine. This tube will be removed once the system free of stone.

4. FLEXIBLE URETEROSCOPY & LASER LITROTOPY:

This treatment is suitable for stones within the interior of the kidney called calyces and stones close to kidney. The thin long scope is passed through urethral opening all the way up to the kidney. The Interior of kidney can be examined as the scope can be bent to look inside & treat the stones by using laser energy delivered by a fibre.