Kidney Stones

10-20% of the general population is found to have kidney stones at least once in their lifetime.

You will usually be unaware until the kidney stones detach themselves from your kidney walls and start moving into your ureters, bladder, and urethra as you pee.

Kidney stones variate in shapes and sizes. They can be smooth, jagged, or sharp and can be anywhere from 2mm in diameter to the size of a golf ball! The record for the largest kidney stone to date is the size of a 17cm coconut.

Generally, they can either be asymptomatic or symptomatic. If asymptomatic, you might only be aware of their presence after an MRI or CT Scan targeting your kidneys.

If symptomatic, the symptoms could be:

• Blood in your urine (hematuria) – pink, red or brown urine
• Cloudy or foul-smelling urine
• A persistent need to urinate but in small amounts
• Pain when you pee
• Nausea and vomiting
• Fever and chills, if there is an infection

Your ureters have a relatively narrow diameter of 2-3mm and a long passageway of approximately 10-12 inches.

When these kidney stones force themselves down your ureters, they cause friction and could tear and rip your ureters. You may feel pressure that ranges from a mild and dull pain as you pee or tremendous pain if your kidney stones are above 5mm in diameter and have a jagged or sharp surface area as they squeeze themselves down your ureter – rubbing against your ureteric plexus (the nerves in your ureter).

Kidney stone patients have described the pain as excruciating! So, the earlier you treat the kidney stones before they grow larger, the less pain and damage they could cause to your kidneys and urinary system.

Depending on the size and hardness of your kidney stones as well as your body type, your urologist might suggest non-surgical or minimally invasive surgical procedures to help remove your kidney stones.

Generally, the idea is to identify the stone and break it into smaller particles or dust. This can be achieved through these procedures:

1. ESWL (Extracorporeal Shockwave Lithotripsy): Shockwaves are focused on the stone to break it. You will need to pass out the stone by yourself.
2. RIRS (Retro Intrarenal Surgery): A fine scope is inserted through the natural opening of your urethra and goes up into the urinary tract.
3. PCNL (Percutaneous Nephrolithotomy): A tract is created – from your skin to the affected kidney at the loin region – and a scope is used to identify the stone and break it.

There are 3 main treatments urologists may use to treat your kidney stones: ESWL, Ureteroscopy and PCNL.

Kidney Stone Treatments	Extracorporeal Shockwave Lithotripsy (ESWL)	Retrograde Intrarenal Surgery (RIRS)	Percutaneous Nephrolithotomy (PCNL)
Duration of the procedure	Outpatient (1 day)	Inpatient (2-3 days)	Inpatient (4-5 days)
Days needed to return to normal activities	Usually 2 days	Usually 1 week	Usually 1-2 weeks
Procedure	Non-surgical procedure 45-60 minutes of therapy and 1 hour of observation/rest X-rays and high-energy shock wave techniques More suitable for stones with a diameter of <2cm Not suitable for patients with bleeding disorders, infections, severe skeletal abnormalities, morbid obesity, a cardiac pacemaker, and those who are pregnant	Non-invasive procedure Insertion of RIRS from urethra up to the kidney Laser fiber inserted to break up the stones and turn them into fiber dust particles Requires preoperative urethral stent to dilate the ureter May require a temporary insertion of a ureteral stent post-operation to help with the healing and easing of ureter swelling	Minimally-invasive surgery 2 hours of surgery, depending on the character of the stone For large and firm stones that cannot be treated with ESWL or RIRS 1cm incision to be made at the flank, back or groin area
Pictorial Procedure
Benefits/ Success Rate	No incision needed and no hospitalization, which translates into a quicker recovery time There is a 50% chance that a repeat procedure is needed	High success rates No incision needed	High success rates to complete and eliminate larger stones without needing to repeat the procedure
Side Effects/ Discomfort/ Risks/ Complications	Potential kidney injury Possibility of treatment failing	Potential for sepsis/serious infection There is a chance that a repeat procedure is needed A temporary ureteric stent may cause irritation and urinary tract infection (UTI) {Stent Syndrome}	Highest risk due to surgery Bleeding Infection Tissue/organ injury

If left untreated, kidney stones might dislodge to your ureters and cause blockage, which may then lead to increased pressure in your kidneys, causing more damage to them.

Kidney stones or nephrolithiasis are small hard mineral deposits formed in the kidneys through a process called crystallization.

There are more than 3000 different compounds in the urine – mainly made up of salt and minerals. 80% of these crystals or kidney stones are made up of calcium and oxalates. The rest are either made up of calcium, uric acid and phosphates, or caused by bacterial infections, genetic disorders or some medications.

The best prevention is WATER. You need to pee at least 2.5L of urine per day to prevent the stone from forming again and help flush out your system properly. If you work in a place where you sweat a lot, then you need to drink even more water to achieve the urine output of 2.5L per day. If not, most of the fluid that you drink will pass out through sweat instead of urine. Other suggestions are to reduce the dietary consumption of purine (alcoholic beverages, anchovies, mussels, bacon, and more) or oxalate (beans, berries, chocolates, coffee, and more) as they facilitate the formation of stones.

This article was contributed by Dr Toh Charng Chee, Consultant Urologist at Pantai Hospital Ampang. To know more about where and when to see Dr Toh Charng Chee at his clinic, click here.