By Dr. Saurabh Mittal
In India, kidney stones are a major health concern. According to research, kidney stones affect 12% of Indians, of which 50% are likely to have loss of kidney function. There are an estimated 10 million people suffering from kidney stones in the country, with the prevalence rate increasing every year. The most common morbidity of a kidney stone is renal colic, a condition that is painful, often acute, and warrants immediate attention. The lack of awareness about the condition and its proper treatment is a major contributing factor to the high number of cases. Additionally, the lack of access to quality healthcare in rural and remote areas means that many people with kidney stones go undiagnosed and untreated. This results in a high rate of complications and even death.
Factors leading to kidney stones and diagnosis
Most of these stones form due to a combination of genetics, and environmental factors such as diet and lack of physical activity. Studies have shown that people with a family history of kidney stones are more likely to develop stones. Certain disorders of the small intestine and some medications can also raise the likelihood of formation of calcium oxalate stones. Dietary factors that can increase risk of stone formation include sodium, protein, potassium, calcium, magnesium and other nutrients. Animal protein intake also may support the formation of calcium kidney stones. Urine analysis, serum creatinine, electrolytes and parathyroid hormone tests are the basic recommended tests for all stone formers as an initial evaluation. X-ray of the Kidney, Ureter, and Bladder (X-KUB) and ultrasound are done for all patients (90% of kidney stones are radio-opaque).
Preventive measures of Kidney Stones
In general, kidney stones can be prevented by certain food restrictions, lifestyle modifications, and drinking plenty of fluids, particularly water. The type of dietary recommendations depend upon the composition of the stone. For prevention of calcium oxalate, cystine, and uric acid stones, urine needs to be alkalized by consuming plenty of fruits, vegetables and high amounts of citrate – whether or supplemental. For prevention of calcium phosphate and struvite stones, on the other hand, urine needs to be acidified; cranberry juice and betaine-rich foods (wheat bran, wheat germ, spinach etc.) can help control urine pH.
In addition to this, limiting the consumption of animal-rich protein, sodium and stone forming foods such as chocolates and certain nuts can also prove helpful.
Treatment & types of surgery
The accepted treatment options for kidney stones range from watchful waiting to surgical removal of the stone. Small kidney stones may pass through the urinary tract spontaneously without treatment. For small stones, dietary modifications and drinking plenty of water can be helpful. In addition, it is also advised to reduce salt intake, increase citrate-rich foods (lemons, oranges), avoid oxalate-rich foods (spinach, nuts, beetroot) and purine-rich foods (animal protein, alcoholic drinks like beer).
For certain kidney stones — depending on size and site— a procedure called extracorporeal shock wave lithotripsy (ESWL) can prove useful. Shock waves from outside the body are targeted at a kidney stone resulting in its fragmentation. The tiny pieces are then excreted through the urine.
Stones that are too large to pass on their own or through ESWL may require surgical intervention. The type of surgery that is best for a particular patient depends on a number of factors including the size and shape of stone, its location in the urinary tract, presence of comorbidities, kidneys’ general health and the preference of the patient and surgeon. With advances in medical science, the focus of therapy has evolved away from open surgery towards less invasive methods. Pristyn Care provides painless laser techniques and minimally invasive methods for instant relief from kidney stone pain.
Ureteroscopy can also be used as a treatment option. This procedure involves inserting a small scope into the ureter (the tube that carries urine from the kidney to the bladder) and removing the stone.
Another type of surgery for kidney stones is Percutaneous Nephrolithotomy (PCNL). This procedure involves making a small incision in the patient’s back and inserting a scope into the kidney. The scope is used to break up the stone and remove it. PCNL can be used to treat larger stones that are not able to be treated with Ureteroscopy.
The most prevalent procedure is RIRS (Retrograde Intrarenal Surgery) which is for doing surgery within the kidney using a flexible ureteroscope to remove the upper ureter and small kidney stones.
Technology developments have improved minimally invasive surgery for stone disease, resulting in lower morbidity and higher stone clearance rates. The decision of which type of surgery to use for a particular patient is best made by a surgeon with experience in treating kidney stones.
Elective surgeries and other planned procedures were getting postponed due to fear of the effects of COVID. However, the mass vaccination drives, re-training of medical staff to manage COVID and non-COVID patients, and the reimagining of service delivery layout and protocols at hospitals and clinics have helped gain the confidence of patients undergoing these treatments. Many advancements have been made to successfully treat kidney stones. Minimally invasive surgeries using laparoscopic instruments and high-definition cameras have emerged as highly effective approaches. Although the procedures are not without risks for patients, studies have shown that benefits greatly outweigh potential drawbacks. Research into these surgical efforts will continue into the future, with a focus on improving camera resolution, instrument mobility and handling capabilities as well as tactile feedback during laparoscopic surgeries.
(The author is Urologist at Pristyn Care. Views expressed are personal and do not reflect the official position or policy of FinancialExpress.com.)