08 September 2017
Written by Ben Grey MB.ChB. MD FRCS(Urol), Consultant Urologist
Ben Grey is a Consultant Urological Surgeon for Manchester Urology at Spire Manchester Hospital, and specialises in the management of urinary tract stone disease. Manchester Urology offers rapid diagnosis and all treatment options for stone disease.
What is stone disease?
Urinary tract stone disease (urolithiasis) occurs when stones (calculi) form within the urine. The number of patients affected is increasing, including the number of cases seen in children and young adults.
What causes kidney stones?
The kidneys work to cleanse the body of waste products, maintain hydration and ensure the body’s balance of salts and minerals is correct. An excess of certain salts and minerals or insufficient water within the urine can lead to crystals forming and subsequently these may clump together to form stones.
What are the symptoms of stone disease?
If stones are small or are only present in the kidneys, there may not be any symptoms at all. Stones usually cause problems when they prevent urine draining from the kidney by moving into the ureter, a narrow tube which carries urine to the bladder. This can result in patients experiencing severe pain (ureteric colic). Other potential symptoms include blood in the urine (haematuria) and urinary tract infection.
How are kidney stones diagnosed?
A stone specialist can often diagnose the condition through the patient's description of their symptoms, but confirmation is usually made with a CT scan. A CT scan can rapidly diagnose stones but also assist the specialist to advise whether intervention is required and, if so, which option is the most appropriate and likely to succeed.
How are kidney stones treated?
A specialist in stone treatment can discuss the benefits and risks associated with each of the treatments, so that a bespoke treatment plan can be devised, suitable for the particular patient’s medical condition as well as their lifestyle and occupational requirements.
Treatment options include:
Conservative treatment - Depending on the degree of symptoms, associated medical conditions and lifestyle factors (such as occupation), as well as the size and position of stones, the specialist may suggest monitoring the patient.
Medical treatment - Certain types of stones can be dissolved. However, this is reliant on an accurate diagnosis of the particular stone type being available.
Shock Wave Lithotripsy - This treatment is non-invasive and doesn't require an anaesthetic. Shock waves are focused from outside the body at the patient’s stone. This energy cracks the stone into smaller pieces which then pass out of the body in the patient's urine.
Ureteroscopy - This minimally-invasive (keyhole) treatment involves passing a small camera from the outside world through the bladder to the ureteric and/or kidney stone(s). A laser is then used to fragment the stone into small pieces which can then either pass out the body in the urine, or be removed using fine baskets.
PerCutaneous NephroLithotomy (PCNL) – This is another minimally-invasive technique but this time the kidney is accessed via a small skin incision in the patient’s back. A larger camera (nephroscope) and fragmentation device can then be used to treat larger or more complicated stones.
How can you prevent kidney stones from forming?
The prevalence of stones has always been linked with living in hot climates and certain genetic conditions. Increasingly, research supports additional correlation with the Western diet and obesity as well as, most importantly, dehydration due to insufficient water intake.
Understandably, once a patient has had experience of stone disease, they want to try and avoid recurrence. A good stone specialist will not only treat a patient's stones but should also investigate why they formed in the first place, so they can tailor advice about prevention to the individual.
The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.