KIDNEY STONES
The kidneys are located on both sides of the lumbar spine, weighing approximately 150 grams. weight of organs. Their main duties are to ensure the removal of waste products resulting from body metabolism and to regulate the density of substances contained in body fluids.
Stones form when minerals such as calcium, oxalate and uric acid in the urine crystallize and aggregate and the concentrations of substances that prevent stone formation decrease in the urine. Stone disease is seen with an average frequency of 15% in our country.
What are the Causes of Stone Formation?
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Genetics, environmental factors and diet are the main factors in stone formation. It is 3 times more common in men than in women. People with a family history of stone disease have a 20-30% risk of stone formation. Some enzyme deficiencies predispose to stone formation. Additionally, as the amount of fluid consumed decreases, the urine becomes more concentrated and it becomes easier for waste materials to accumulate and form stones. Although it is not valid in all cases, in some patients, excessive intake of animal protein, milk, table salt and foods containing oxalates such as spinach, beet and chocolate increases stone formation. Some drugs such as cortisone, antacids, diuretics (furosemide), and vitamin D have an effect on stone formation. In hot climates, increased fluid loss thickens the urine and facilitates stone formation. Recurrent urinary tract infections cause infection stones. It also facilitates the formation of other stones. Structural disorders of the kidney or urinary tract (urinary tract stenosis, horseshoe kidney), some systemic diseases such as hyperparathyroidism, gout, Crohn's disease, and kidney, urinary tract and bowel surgeries have increasing effects on stone formation.
What are the Symptoms of Stone Disease?< br /> Image
· Kidney and urinary tract stones generally cause complaints, but sometimes they can cause loss of kidney function without any symptoms.
· The most common complaint is side pain on the side where the stone is located. Depending on where the stone is located in the kidney or urinary tract, the pain starts from the flank area and spreads to the back area and groin. It occurs when the kidney expands and stretches due to the movement of the stone or the obstruction in the urinary tract. It is generally severe, excruciating and intermittent. Sometimes it may be in the form of mild and long-lasting pain.
· Kidney pain may be accompanied by nausea and vomiting due to the connection between the neural pathways that carry kidney pain and the intestinal nerves.
· Blood in the urine may be seen due to the irritation of the stone in the kidney and urinary tract. . There is no relationship between the amount of blood and the size of the stone. While sometimes it is visible to the eye, blood in the urine is usually detected microscopically.
· Due to the blockage caused by the stone, standing urine may cause inflammation. Urinary tract infection is sometimes accompanied by high fever.
· It may also cause complaints of difficulty, burning sensation and frequent urination while urinating.
What are the Diagnostic Methods of Kidney and Urinary Tract Stones?
· Taking the patient's history, The symptoms and characteristics of the pain are the most important steps in diagnosing stone disease. Guiding information about stones can be obtained during physical examination.
· Seeing blood cells in urine analysis is a valuable finding for diagnosis. The presence of accompanying inflammation should be investigated with urine culture.
· Kidney function tests (urea, creatinine), sodium and potassium should be examined in the blood test.
· T To investigate the cause of vaccine formation, various parameters should be examined in the urine collected by patients for 24 hours.
· The most commonly used imaging methods are computed tomography, IVP, lying abdominal radiography and ultrasonography. Lying down abdominal radiography detects 90% of kidney and urinary tract stones. While stones in the kidney are easily seen with ultrasonography, it is difficult to see stones in the urinary tract. Ultrasonography shows enlargement of the kidney and urinary tract due to stone obstruction. Stones that are not visible on ultrasonography or lying down abdominal radiography can be seen with non-contrast computed tomography.
What are the Treatment Methods for Urinary Tract Stone Disease?
Some of the stones in the kidney and urinary tract pass spontaneously. Sometimes medication and regulating fluid intake help the stones pass.
· The size and shape of the stone, as well as its location in the kidney and urinary tract, are the main factors in passing the stone. While stones less than 5 mm in size generally pass spontaneously, stones 7 mm and above generally require surgical intervention.
The main problem in stone disease is not pain, but the inability to excrete the urine produced in the kidney due to the obstruction in the urinary tract, and the accumulated urine causes the kidney to expand and gradually lose function. is the reason why. The obstruction must be removed immediately in order to preserve kidney function.
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What is Stone Crushing (ESWL: Stone Crushing with Shock Waves)?
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It is the process of breaking the stones in the kidney and urinary tract with shock waves sent from outside the body. It is recommended that the procedure be performed under light anesthesia. There is no need to stay in hospital for lithotripsy. It is expected that the broken stone pieces will be removed spontaneously through urine. Ta After crushing, stone pieces may block the urinary tract with a low probability.
Generally, this blockage opens spontaneously and the stones fall out. In cases where the stone is not broken or fragmented sufficiently, it may be necessary to repeat the stone crushing process.
After lithotripsy, there is pain, redness and bleeding on the skin where the shock waves enter the body, and these complaints usually disappear within a week.
What is Ureterorenoscopy (URS)?
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Endoscopic examination through the urinary tract Using an imaging device, it is first entered into the bladder and then into the upper urinary tract where the stone is located. If the stone in the channel is large, it is broken into pieces; if it is small, it is taken out directly. While the success rate is high for stones in the lower and middle parts of the urinary tract, the success rate decreases for stones in the upper parts. There is a possibility that stones in the upper part may escape into the kidney during the procedure. Sometimes a temporary tube (stent) can be placed in the urinary tract to ensure urine flow until the damage to the duct caused by the stone or procedure is repaired. It is a procedure performed without making any incisions on the body.
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