Written by Mr Andrew Ballaro for Doctify
If, like me, your knowledge of kidney stones consists of Joey bent over double in agony in an old episode of Friends then this is the article for you. These small stones can cause big problems when left untreated so it’s useful to know what to look out for and when to seek out a specialist.
Here to talk us through it is Mr Andrew Ballaro, a highly qualified Doctify Consultant Urologist and Specialist Stone Surgeon.
What exactly are kidney stones?
Kidney stones are similar to pieces of gravel and are formed from concentrated minerals found in urine. They can range in size from a few millimetres to over ten centimetres. About one in twelve people will get a stone at some point in their life and the chance of a stone recurring is approximately 50% in ten years. Some unlucky people form recurrent stones more quickly and this requires further investigation into the abnormalities in the urine.
What symptoms do they cause?
- Renal colic: Kidney stones may become lodged in the thin muscular tube (ureter) that drains urine from the kidney to the bladder. This causes severe pain requiring hospital admission. Small stones may pass spontaneously, larger stones require treatment.
- Loin pain: Kidney stones may also cause a dull back pain by blocking portions of the kidney, and also when they become lodged in the flesh of the kidney.
- Infections: Kidney stones often contain bacteria, and can cause recurrent urine infections.
- Blood in the urine: Kidney stones are sharp and can scratch the inside of the kidney and causing bleeding. Infections caused by stones are associated with bleeding.
- Kidney damage: When a stone blocking the ureter is untreated the kidney can be damaged. Large stones in the kidney can slowly destroy the kidney from the inside.
When should I go to the doctor?
Kidney stones need to be treated when they cause any of the symptoms listed above. Patients who have stones in the kidney that are not causing problems should be assessed for treatment if the stone is larger than 5mm. When it gets to that size the stone is more likely to become stuck in the ureter causing pain, or stay in the kidney and grow even bigger.
How are they treated?
- Ureteric stent: When a stone becomes lodged in the ureter a ureteric stent may need to be inserted in hospital. This allows the urine to drain – in some cases however, the stent can cause troublesome symptoms.
- Shock wave treatment (ESWL): This is an outpatient procedure that involves sending shock waves through the skin focused on the stone. It avoids an operation, but may leave fragments in the kidney which grow to form more stones later.
- Laser ureteroscopy (URS): This involves an operation to break up the stone using a tiny laser fibre. The fragments are removed and can be sent for analysis, which can help subsequent stone prevention.
- Percutaneous nephrolithotomy (PCNL): When stones grow to over 2cm they are removed by an operation through the back. This involves an overnight stay.
- Metabolic testing: Recurrent stone formers require detailed testing to identify and correct biochemical abnormalities in the urine.
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If you have experienced any of the symptoms listed in this article, you should speak to a urologist. They can then diagnose you and advise you on the most appropriate course of treatment.