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Kidney stone

crystallisation of urinary chemicals such as calcium ,oxalate ,phosphate ,magnesium etc in urinary tract(kidney calyx ,pelvis,ureter,bladder,urethra)

Kidney stone formation:

These are the different sites of kidney stone

General measures to prevent stone formation

If kidney stones become lodged in the ureters, it may block the flow of urine and cause the kidney to swell(stretches the capsule over kidney) and the ureter to spasm, which can be very painful. At that point, you may experience these symptoms: Severe, sharp pain in the side and back, below the ribs. Pain that radiates to the lower abdomen and groin.

Myth 1 - All stones are very painful

Fact – Kidney stones are deposition of minerals that form in the urinary tract and may cause pain, bleeding, or an infection or block of the flow of urine. But they’re not always painful, especially when they first form. If the stone is in the pelvis or calyces or in the bladder, it may not cause pain. The first signs of the stones may be blood in the urine or minor back pain. In other cases such as ureteric stone , stones can be excruciatingly painful and cause nausea and vomiting.

Myth 2 - Larger stones are always more painful

Fact – Size is only one factor in how painful – and potentially dangerous – a kidney stone can be. The location of the stone is another factor to consider. A smaller stone in the wrong place such as a ureter can create a blockage that is incredibly painful and requires a trip to the emergency room. Depending on the location of the stone, individuals may feel pain in their back or lower abdomen, or they may experience renal colic – excruciating, intermittent pain usually in the area between the ribs and hip on one side of the flank or back that spreads across the abdomen and often extends to the genital area. The pain tends to come in waves, gradually increasing to a peak intensity, then fading, over about 30 to 60 minutes.

Myth 3 - Hydrotherapy helps to flush out urinary calculi

Myth: Drinking copiously will help promote passage of kidney and ureteral stones. The rationale of this advice is that by hydrating massively, pressure will be created to help passage of a stone present in the kidney or ureter. fact: The presence of a stone often causes urinary tract obstruction. Over -hydration in the presence of obstruction will further distend the already bloated and inflated portion of the urinary collecting system located above the stone. This increased distension can exacerbate pain and nausea that are often symptoms of colic. The collecting system of the kidney and the ureter have natural peristalsis similar to that of the intestine and over-hydration has no physiological basis in terms of helping this process along, being pointless and perhaps even dangerous. Drinking moderately in the face of a kidney or ureteral stone is sound advice

Myths 4 Everyone must drink 3-4 litres of water a day.

Myth: Many sources of information (mostly non-medical and of dubious reliability) dogmatically assert that humans need 3-4 litres of water daily to stay well hydrated and thrive. fact: Many people who drink a lot of water end up in urologists’ clinics with urinary urgency, frequency and often urinary leakage especially in old age . The truth of the matter is that although some urinary issues are brought on or worsened by insufficient fluid intake–including kidney stones and urinary infections–other urinary problems are brought on or worsened by excessive fluid intake. Water requirements are based upon ambient temperature and activity level. If you are sedentary and in a cool environment, your water requirements are significantly less than when in the hot conditions. Heeding your thirst is one of the best ways of maintaining good hydration status, in other words, drinking when thirsty and not otherwise. Another method of maintaining good hydration status is to pay attention to your urine colour. Urine colour can vary from deep yellow to as clear as water. If your urine is dark yellow, you need to drink more as a lighter colour is ideal and indicative of satisfactory hydration.

MYTH 5: Restriction of calcium in the diet helps to reduce urinary stone recurrence

Myth: Calcium is a major component of 75% of stones hence many people believe that restriction of dietary calcium is a logical means of preventing a recurrence. fact: Several studies have shown that severe restriction of calcium in the diet actually increases the recurrence rate of urolithiasis by increasing the oxalate absorption from the intestine. So calcium should be consumed in moderation and should not be restricted.

MYTH 6 :There are medicines to dissolve all urinary stones

REALITY: 80% of the urinary stones are composed of calcium oxalate or calcium phosphate. For these there are no medicines available that can dissolve the stones.In select patients with small uric acid stones (5 % of stones) or cystine stones (1-3% of stones), medications can potentially be used to help dissolve their stones. However, even in these, surgery may be required.

MYTH 7 :Shock Wave Lithotripsy (SWL) can be used to treat renal calculi of any size and form

REALITY: SWL is used to treat only small calculi less than 1.5 cm. If ESWL is used to fragment larger renal calculi then these fragments may block the ureter or some of these fragments may remain in the kidney and lead to a recurrence.. Thus SWL for large renal calculi has poor success rates and is associated with a high risk of ancillary treatments for the residual calculi. Also it is not ideal for very hard stones. It cannot be recommended as a universal treatment for all renal calculi but must be used selectively.

MYTH 8 : All Kidney stones has to be removed

FACT: Many men and women have tiny renal calculi which are detected during evaluation done for some other purpose, mainly master health check-up. Generally these are fine calculi which show the tendency to form stones. We don’t recommend active management of these calculi unless they are multiple and noted in both sides. Mere follow-up of these calculi would be sufficient and treated only when these calculi cause urinary tract obstruction. The internal diameter of the ureter (kidney pipe ) of adult men and women can stretch upto 5mm easily, so mostly the stones of this size can come out spontaneously.

MYTH 9 :Cranberry juice is good for kidney stones

Cranberry juice is an excellent choice for patients who want to avoid a urinary tract infection. It thickens the urine and flushes out accumulated particles, preventing the onset of infections. However, a kidney stone always makes the situation worse. Cranberries are high in oxalate, which can cause kidney stones. Skipping cranberry juice is the best choice to avoid kidney stone symptoms

Department of Urology

Dr. Anil Keskar
MBBS, MS, MCH (Urology &Andrology)
Fellowship in Endo-Urology & Laser Surgery

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