What are the symptoms of kidney stone disease?

Urinary tract stone disease, although rarely, can cause no symptoms at all, while in other cases, it can lead to extremely severe pain that turns the patient's life into a nightmare.

The location of the stone and the degree of obstruction it causes in the urinary tract can affect the type and location of pain. Stones located in the kidneys without obstructing the urinary tract may not cause severe pain. These stones can lead to dull pain in the flanks, a feeling of fullness in the lower back, and nausea. However, if the stone obstructs the urinary tract within the kidney, the pain becomes more intense and colicky. This pain may also radiate to the testicle on the same side as the kidney.

In cases where the stone has passed from the kidney into the ureter, the pain becomes more intense. There may be colicky pain along with nausea on the side where the stone is located. If the stone has approached the bladder, symptoms may include a constant urge to urinate, burning sensations during urination, and pain in the scrotum on the affected side.

What are the treatment methods for kidney stone disease?

The methods used for the treatment of urinary tract stone disease can be divided into three categories: 1. Medication, 2. External shock wave lithotripsy (ESWL), 3. Surgery.

How is the decision made on which treatment to apply to whom?

The preferred method may vary from patient to patient, but the most important factors influencing the choice are: 1. the size of the stone, 2. the location of the stone, and 3. the condition of the kidney.

How is kidney stone treatment done with medication?

This treatment can be divided into two categories:

Expanding the ureter (urinary tract):
If the stone is smaller than 7mm, has passed from the kidney and entered the ureter, and has not caused excessive swelling or inflammation in the kidney, this method may be attempted. The waiting time for the stone to pass should not exceed one month, as stones that do not pass within this period are unlikely to pass naturally. There are medications that have been proven effective in expanding the urinary tract, including selective alpha blockers, which are also used in the treatment of prostate enlargement.
Shrinking the stone:
Medications taken orally that can shrink the stone are very limited and may only work for one type of stone (uric acid stones). This is a long-term treatment and should not be used if there is an infection or dilation (swelling) in the kidney due to the stone.

Although there are limited options for medication-based treatment, the chances of success are lower and the treatment duration is longer compared to surgery or external fragmentation.

Is there a place for herbal therapies in kidney stone treatment?

Many plants, medicinal waters, fish, and other natural remedies are used for stone treatment both in our country and abroad. However, since there is a lack of evidence-based data regarding these methods, it is not possible to make any definitive statements for or against their effectiveness according to the principles of evidence-based medicine.

How is extracorporeal shock wave lithotripsy (ESWL) performed?

ESWL (Extracorporeal Shock Wave Lithotripsy) refers to the process of breaking stones using shock waves from outside the body. The shock wave is focused on the stone, causing it to break into small fragments that can be passed out of the body. These shock waves cause minimal damage to surrounding soft tissues, such as the kidney and urinary tract, while effectively breaking the stone. ESWL is typically used for stones that are smaller than 2 cm in the kidney and smaller than 1 cm in the ureter.

However, not all types of stones can be broken by ESWL. It is not possible to determine the type of stone without laboratory examination. For patients with a history of cystine or whewellite stones, ESWL is not recommended as these stones are too hard to be effectively treated with this method.

If the stone type cannot be determined before treatment, a CT scan can be used to measure the stone's density. Stones with a density greater than 1000 HU have a lower chance of being effectively fragmented by ESWL.

If three sessions of ESWL have been performed but the stone has not yet been broken into small enough fragments to pass, further ESWL treatment is not recommended. Particularly for stones in the kidney, even if the stone is slightly broken, exposing the kidney to shock waves for more than three sessions is not advisable.

Can ESWL be applied to everyone?

ESWL (Extracorporeal Shock Wave Lithotripsy) is not performed in pregnant women, individuals taking blood-thinning medications, or those with an active urinary tract infection. Since the patient needs to remain still during the procedure, it may be performed under general anesthesia in children. In modern devices, even slight movements can be compensated for by adjusting the device's focal point, allowing it to continue targeting the stone.

What are the side effects of ESWL treatment?

Rarely, ESWL (Extracorporeal Shock Wave Lithotripsy) can cause bleeding in the kidney. However, almost none of these bleedings reach a life-threatening level. Long-term follow-up studies have shown no negative effects of ESWL on the kidneys.

The broken stone fragments can pass from the kidney and block the ureter. This can cause severe pain and swelling in the kidney. In this case, ESWL can be performed again on the lowest fragment, or a ureteral stent (Double J catheter) can be placed to allow the stones to pass. Depending on the patient's and kidney's condition, URS (Ureteroscopy) may be performed to remove the stones blocking the ureter. Therefore, although rare, surgery may be required after an ESWL procedure.

4o mini

What is a ureteral stent (Double J catheter) and what does it do?

The Double J catheter (JJ catheter) can be broadly described as a thin, flexible tube that runs along the entire ureter, with one end in the kidney and the other in the bladder. Its function is to maintain urine flow through the catheter in cases where the ureter is obstructed, such as due to stones or external pressure, in order to protect the kidney. The catheter has curved ends at both sides, preventing it from moving up or down.

4o mini

When is a Double J catheter used?

In cases where the ureter is obstructed due to stones, and if the obstruction cannot be relieved by ESWL or surgery due to a urinary tract infection or other reasons, a Double J catheter is inserted under local anesthesia to relieve the kidney and buy time until surgery or ESWL treatment can be performed.

Double J catheters can also be used in cases of ureteral obstruction caused by masses from surrounding tissues. Until the mass is treated, the catheter helps prevent the loss of kidney function due to the obstruction.

In URS surgery, if all stone fragments cannot be removed and the fragments are too large to pass within a short time, a Double J catheter is placed at the end of the procedure.

How is a Double J catheter removed and how long can it stay in place?

The removal of a Double JJ catheter is a 5-minute procedure performed under local anesthesia. If it is not a special type of catheter for one year, all Double JJ catheters should be removed within 3 months. Otherwise, these catheters, commonly used for stone treatment, may calcify and block the ureter.

How is kidney stone treatment done with surgery?

The most successful method in stone treatment is surgery. The choice of the surgical method depends on factors such as the size of the stone, its location, and the condition of the kidney. The surgical methods include:

Laser fragmentation of stones in the ureter using a rigid camera (URS)
(For detailed information, refer to the ureteral stone treatment section.)
Laser fragmentation of stones in the kidney using a flexible camera (RIRS)
(For detailed information, refer to the kidney stone treatment section.)
Percutaneous nephrolithotomy (PNL), where a camera is inserted through a small incision in the back to access and break kidney stones.
(For detailed information, refer to the kidney stone treatment section.)

Does kidney stone disease recur?

I wish I could answer "no" to this question; however, the reality is the opposite. A person who has passed a stone has a 50% chance of becoming a stone patient again in the following 10 years. Therefore, it is recommended that patients diagnosed with kidney stones have their kidneys evaluated with an ultrasound annually.

If a person has been diagnosed with stones at different times, and there is no treatable underlying condition (unfortunately, most stone patients do not have an identifiable, treatable condition), and they do not change their lifestyle or dietary habits, the likelihood of recurring stone formation is very high.

What can be done to prevent recurrence of kidney stones?

Regardless of the type of kidney stone, the most important preventive measure is consuming plenty of fluids. It is recommended that the fluid be water or lemonade, as tea, coffee, and acidic beverages can increase the likelihood of stone formation.

For ideal preventive measures, knowing the type of stone is essential. Approximately 80% of kidney stones in Turkey are calcium oxalate stones. Click here for the calcium oxalate stone prevention diet.