Kidney stone disease, which is one of the kidney diseases and is frequently encountered, can lead to kidney loss and kidney failure if it is not treated by the formation of stones in the inner part of the kidney where it filters urine.

Therefore, it is very important to diagnose and treat it on time. Factors that increase the risk of kidney stone formation are: Obesity Recurrent urinary tract infections Having had a kidney stone problem before Insufficient physical activity Congenital kidney abnormalities Presence of any other disease in the kidneys Chronic intestinal problems Gout disease Kidney Stone Symptoms The most common known symptoms of kidney stone disease are: Severe chest, abdominal, waist and side pains. Nausea and vomiting. Blood in the urine. Burning in the urine. Inability to urinate. Types of Kidney Stones: Calcium stones: These are stones formed by various compounds of calcium, such as calcium oxalate and calcium phosphate. Approximately 75% of all kidney stone cases are calcium stones. Uric acid stones: This is a type of kidney stone seen in individuals with gout who eat a high-protein diet that increases the amount of uric acid in the blood. Cystine stones: It is a rare type of kidney stone caused by metabolic disorders. Citruvite (infection) stones: This type of stone, formed due to urinary tract infections, can cause serious kidney damage in a short time due to its very rapid growth. How Are Kidney Stones Diagnosed? In diagnosing kidney stones, physical examination and medical history, various laboratory tests, as well as medical imaging techniques are used.

Some of these diagnostic tests are: Ultrasonography Ureteroscopy As the size of the kidney stone increases, the patient's chance of passing the stone spontaneously or medically decreases. In addition, if the stone is located in the upper part of the kidney, the chance of passing it is higher than in the lower part. In patients with frequently recurring stones, determining the underlying cause of stone formation is very important in terms of reducing the risk of recurrence and treatment. In particular, stone analysis, checking blood calcium, magnesium, phosphorus, uric acid, vitamin D and parathormone levels, examining urine pH, urine cystine, uric acid and oxalate levels, and if an underlying metabolic or hormonal cause is detected, treating these kidney problems. It is important in the treatment and prevention of stones. In recurrent kidney stones, drug treatment may vary depending on the type of stone.

The aim of medical treatment is to increase the solubility of crystals in the urine and prevent them from precipitating in the kidney and turning into stone. Treatment Methods Stone Breaking with Sound Waves (ESWL) ESWL (Stone Breaking with Extracorporeal Shock Waves) Sound waves coming from a source are transmitted from the skin to the kidney stone under the guidance of fluoroscopy (x-ray), and the small pieces broken by the sound waves are excreted through the urinary tract. The success of the procedure depends on the location and hardness of the stone. The number of stones is affected by many factors such as the anatomical structure of the kidney, the distance between the skin and the kidney. Generally, stones smaller than 2 cm are suitable for ESWL. The procedure takes 30 - 45 minutes, although it varies depending on the location of the stone, its size and the device used.

If necessary, it can be applied in up to 3 sessions. While the most important advantages of the procedure are that it is performed on an outpatient basis and does not require anesthesia, the most important disadvantages are that the stone cannot be broken, the broken pieces cannot fall out or cause pain during falling. It is a closed surgery technique performed by entering through the external urinary tract, used in the treatment of stones that have passed into the ureter (the urinary channel between the bladder and the kidney). The procedure can be performed under general or spinal anesthesia (anesthetized from the waist down). Using rigid or flexible endoscopic devices, the stone is accessed through the external urinary tract, and then the stone is broken down with the laser sent through the device. If necessary, the pieces are removed with a basket catheter. If edema occurs in the ureter after the procedure, if the broken stone is very large, or if there is an injury to the urinary tract, a temporary stent can be placed.

The stent is usually removed after two weeks. Since there is no incision or drilling during the procedure, the return to normal life is very fast. The chances of success are very high. It can be applied easily except for patients with active urinary tract infection. The most important risks are; If there is a stenosis in the urinary tract that would prevent the passage of the device, a stent can be placed and the stone can be treated in 2 sessions. Injury to the urinary tract: Bleeding in the urine and fever. It is the process of entering from the urinary tract to the kidney through a thin, flexible endoscope, without making any incision or hole in the body, and breaking or removing the stones there with the help of laser. Specially produced endoscopes (flexible ureterorenoscope) are used for this procedure. The tip of these instruments, which are approximately 3 mm thick and 60-70 cm long, can be controlled by the surgeon from the back of the device. In this way, every chamber of the kidney can be entered and the stones there can be reached and broken with the help of laser. What are the advantages? Since no incision or drilling is required, the patient can be discharged on the same day; He can return to his normal daily life the next day.

It is a surgical technique that has a very high chance of success and a low rate of complications (undesirable side effects). It can be safely applied to all patients except patients with active urinary tract infection. Percutaneous Nephrolithotomy (PCNL) is an endoscopic (closed) surgery technique used for the treatment of kidney stones by entering the kidney through a small hole in the back. It is generally preferred if it is larger than 2-3 cm or if other methods (ESWL, RIRS) fail. Under general anesthesia, the kidney is accessed through a 1 cm incision on the back, and the stones are broken or smaller ones are removed whole. If necessary, a plastic tube can be inserted through the incision for 1-2 days after the procedure. PCNL surgery can be performed through smaller incisions thanks to new devices developed. While tubes with a diameter of 30 fr (1cm) are required in the standard method, this is reduced to 15-18fr (5-6mm) in mini-PCNL and 12-14 fr (3-4mm) in ultra-mini-PCNL. As the thickness of the device used decreases, the risk of side effects such as bleeding decreases and recovery after the procedure becomes faster.

Kiss. Dr. Serhat Ozgun

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