Kidney stones, (urolithiasis, renal lithiasis, or nephrolithiasis) one of the oldest surgical problems, is widely distributed throughout the world although it is more common in some geographical areas e.g. lndian, Pakistan, Middle East than in others e.g. West and East Africa. In Western Europe about 2-3 % of the population will develop stones while in Nigeria the incidence is 7-34 per 100,000. A calculus or stone maybe found in the kidney, ureter, bladder or in the urethra. Calculi vary in size
and shape. Some are minute and multiple and termed gravel. Large stones which fill the pelvis and calyces and make a cast of them are termed “staghorn” calculi. The surface may be smooth or rough.
A kidney stone may not cause symptoms until it moves around within your kidney or passes into your ureter — the tube connecting the kidney and bladder. At that point, you may experience these signs and symptoms:
- Severe pain in the side and back, below the ribs
- Pain that radiates to the lower abdomen and groin
- Pain that comes in waves and fluctuates in intensity
- Pain on urination
- Pink, red or brown urine
- Cloudy or foul-smelling urine
- Nausea and vomiting
- Persistent need to urinate
- Urinating more often than usual
- Fever and chills if an infection is present
- Urinating small amounts
Pain caused by a kidney stone may change — for instance, shifting to a different location or increasing in intensity — as the stone moves through your urinary tract.
Risk factors/causes of kidney stones
Factors that increase your risk of developing kidney stones include:
- Family or personal history. If someone in your family has kidney stones, you’re more likely to develop stones, too. And if you’ve already had one or more kidney stones, you’re at increased risk of developing another.
- Dehydration. Not drinking enough water each day can increase your risk of kidney stones. People who live in warm climates and those who sweat a lot may be at higher risk than others.
- Certain diets. Eating a diet that’s high in protein, sodium (salt) and sugar may increase your risk of some types of kidney stones. This is especially true with a high-sodium diet. Too much salt in your diet increases the amount of calcium your kidneys must filter and significantly increases your risk of kidney stones.
- Being obese. High body mass index (BMI), large waist size and weight gain have been linked to an increased risk of kidney stones.
- Digestive diseases and surgery. Gastric bypass surgery, inflammatory bowel disease or chronic diarrhea can cause changes in the digestive process that affect your absorption of calcium and water, increasing the levels of stone-forming substances in your urine.
- Other medical conditions. Diseases and conditions that may increase your risk of kidney stones include renal tubular acidosis, cystinuria, hyperparathyroidism, certain medications and some urinary tract infections.
- Affluence: Calculi are commoner in people with a high standard of
living probably because of a high intake of animal protein which
is correlated with the incideoce of stones
Treatment of Kidney Stones
The management of stones already present in the kidneys or urinary tract requires a combined medical and surgical approach. The specific treatment depends on the location of the stone, the extent of obstruction, the nature of the stone, the function of the affected and unaffected kidney, the presence or absence of urinary tract infection, the progress of stone passage, and the risks of operation or anesthesia given the clinical state of the patient. Medical therapy can enhance passage of ureteral stones. Oral α1-adrenergic blockers like tamsulosin, alfuzosin, terazosin, and doxazocin relax ureteral muscle and have been shown to reduce time to stone passage and the need for surgical removal of small stones. In general, severe obstruction, infection, intractable pain, and serious bleeding are indications for removal of a stone.
Advances in urologic technology have rendered open surgery for stones a rare event. There are now three alternatives for stone removal. Extracorporeal lithotripsy causes the in situ fragmentation of stones in the kidney, renal pelvis, or ureter by exposing them to shock waves. The kidney stone is centered at a focal point of high-intensity shock waves. The waves are transmitted to the patient using water as a conduction medium, either by placing the patient in a water tank or by placing water-filled cushions between the patient and the shock wave generators. After multiple shock waves, most stones are reduced to powder that moves through the ureter into the bladder. Percutaneous nephrolithotomy requires the passage of a cystoscope-like instrument into the renal pelvis through a small incision in the flank. Stones are then disrupted by a small ultrasound transducer or holmium laser. The last method is ureteroscopy with stone disruption using a holmium laser. Ureteroscopy is generally used for stones in the ureter but some surgeons are now using ureteroscopy for stones in the renal pelvis as well.
Cost of kidney stones surgery
So I spoke with a Consultant Urologist based in Lagos about her price list of kidney stone removal surgeries and she listed them out for me as below:
- Nephrolithotomy- #300,000 naira
- Percutaneous nephrolithotomy- #500,000 naira
- Extracoporeal lithotripsy: #700,000 naira
- Urethroscopy: #350,000 naira
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