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Urolithiasis

Kidneys are one of the most important places for removal of the wastes that form as a result of certain biochemical processes that are necessary for the vital activities of the human body. Also, adjustment of the level of certain substances that are required for the body is carried out by kidneys. Kidney stones and urinary stones are hard formations that arise from the collection of the crystals that are not soluble in the urine.

Urolithiasis is one of the most common health-related problems in Turkey, and it has an incidence of 15-18%. Although the exact cause of urolithiasis is not established, probable causes can be listed as insufficient fluid intake, genetic factors, dietary habits, some drugs and diseases.

Who Are Prone to Kidney Stones?

Everyone has a risk of formation of kidney stones. While it is frequently seen in the ages between 25 and 55, the disease is most commonly observed in 30s. Men are 3 times more at risk than women. Insufficient fluid intake, living in a hot climate zone, dietary habits, genetic predisposition (family history), urinary tract infections, structural disorders of the kidney, certain intestinal diseases and previous intestinal surgeries, some medications and metabolic diseases are among the most known risk factors for stone disease.

What Are the Signs of Urolithiasis?

Stone disease can be detected incidentally during radiological examinations performed for other reasons without causing any symptoms, or it can lead to complaints that seriously impair the quality of life. The most common symptom associated with stone disease is usually severe colic pain that starts on the flank and reflects on the groin area, does not show any change in severity or location due to position changes, and impairs quality of life. In addition, the second most common symptoms are the presence of bleeding in the urine (hematuria) and a burning sensation in the urine (dysuria). Hematuria can sometimes be visible, and sometimes it is detected microscopically in the urinalysis. In addition, nausea and vomiting can be observed due to pain, or fever and fatigue can be observed if there is an infection present.

What Are the Treatment Options for Urolithiasis?

Treatment principles for urolithiasis are determined according to the location and the size of the stone and whether it causes an obstruction of the urine flow and the severity of pain. Treatment options include: 

  • Spontaneous passing of the stone
  • ESWL(Extracorporeal Shock Wave Lithotripsy)
  • Minimally Invasive Operations (Laparoscopic Renal and Urinary Tract Stone Surgeries) 
  • Open surgery for stones

Spontaneous Passing of the Stone

The possibility of spontaneous passing of the stones that are smaller than 4 mm is high. The medical treatment of the stones with a high possibility of spontaneous passing include increasing the fluid intake and mobility.

Minimally Invasive Operations (Endoscopic Surgery for Renal and Ureter Stones)

Thanks to the development of technology, the use of minimally invasive methods has become widespread in urological surgical treatments, as in all areas of surgery in recent years. In minimally invasive methods, instead of open surgical incisions, small incisions are made or natural entrances of the body are used to view internal organs and treat diseases. 

In the field of endoscopic urological surgery or endourology, it is aimed to treat kidney, ureter, bladder and prostate diseases by entering through the urinary channels without requiring open surgery. The instruments used are endoscopic surgical instruments. There are channels in these devices through which the camera, lighting system and the tools that will perform the operation are passed.

Endoscopic instruments aim to enter the body by using the natural entrances available in the body. For example, gastric endoscopy through oropharynx, colonoscopy through the anus can be shown. Sometimes there are methods in which endoscopic instruments are delivered into the organ through a small incision made in the skin.

The aim of these operations is to get rid of the stones that disrupt the urinary system and allow patients to carry on with their daily lives as soon as possible. Some of the operations of this group include Ureteroscopic Laser Lithotripsy (Endoscopic Renal and Urinary Tract Laser Surgery) and Percutaneous Nephrolithotomy.

Ureteroscopic Laser Lithotripsy (Endoscopic Renal and Urinary Tract Laser Surgery): 

Intervention is required if the kidney stone cannot spontaneously be passed since it is larger than a certain size, if it does not move and/or does not pass despite the medical treatment, if it creates an obstruction in the urinary tract, if it causes hydronephrosis, if it causes recurrent urinary tract infections or if it causes damage to the kidneys.

Even though open surgical methods were commonly used in the past, minimally invasive methods are much more popular nowadays, thanks to the advancements in technology. The aim of these interventions is to completely clear the kidney and/or ureter of stones and to ensure that the patient returns to his/her daily life as soon as possible (same day or the next day). Ureteroscopic Laser Lithotripsy (Endoscopic Renal and Urinary Tract Laser Surgery) is the most commonly used method among minimally invasive procedures and provides the fastest return to normal life.

In Ureteroscopic Laser Lithotripsy (Endoscopic Renal and Urinary Tract Laser Surgery) procedure, the body is entered through the external urinary tract (urethra) with an endoscopic instrument. After reaching the bladder, depending on the location of the stone, the ureter (using a semirigid ureteroscope) is reached or the kidney (using a flexible ureterorenoscope) is reached. The stone is visualized in the ureter and/or kidney, and the stone is cleared by sanding with an Holmium laser. If there is a need, small stone samples can be taken to analyze the stone type,cavities of the kidneys can be evaluated by means of a camera system. Thanks to this endoscopic method, most of the patients can return to their homes on the same day after getting rid of the stones and return to their normal lives one day after.

Percutaneous Nephrolithotomy: Currently, it is frequently used for the treatment of large stones. Ureteroscopic Laser Lithotripsy has undertaken many tasks of percutaneous surgery. In Percutaneous Nephrolithotomy, an incision of 0.5 – 1 cm is made at the level of the kidney in the lumbar region on the side of the stone. After this incision is enlarged with the appropriate technique, the kidney is entered with a camera system. The stone is viewed, broken, and the kidney is cleared of stone. Patients spend the postoperative period much more comfortably when compared to open surgery. Patients are usually discharged within 2-3 days and continue their daily activities. This is quite a short time compared to open kidney stone surgery.

Open Surgery for Stones

Currently, open surgical methods are rarely used for kidney stones or urinary tract stones (<1%).