Kidney stones are one of the most common and most painful disorders of the urinary tract. According to a recent survey, there has been a rapid increase in the number of people suffering from these stones. The highest incidence of kidney stone is in 25-45 years of age group, and incidence declines after age of 50. The urinary stones affect men three times more than women. In India, approximately 5 to 7 million patients suffer from the disease.
Apparently, the incidence of kidney stone cases gets higher during summers when we see rise in temperature, raising the cases by as much as 40 per cent. Climate, temperature and humidity are important factors that contribute to urinary stones. When people relocate from areas of moderate temperature to areas with warmer climates, a rapid increase in stone formation has been observed. There is a known geographic variation also in stone disease that has been attributed to regional differences in temperature.
The incidence of kidney stone disease is particularly high in areas with dry, hot climate. In India, the “stone belt” occupies parts of Maharashtra, Gujarat, Punjab, Haryana, Delhi and Rajasthan. People who work in hot environment or have a work routine that does not allow them to have enough water are also prone to develop stones. Specifically, a 5 to 7 degree temperature rise due to climate change could yield a 30 per cent increase in kidney stone problems.
Human being on an average excretes about 1 to 1.5 litres of urine per day. Stones may form anywhere in the urinary tract, but are most commonly seen in the kidney. These stones are the crystals of the chemical substances dissolved in urine. These solid masses may be too small as a sand grain or as large as a lemon.
The biggest risk factor for kidney stone formation is dehydration. Other causes include wrong food choices and certain pre-existing medical conditions such as urinary tract infection, gout, hypercalciuria, etc.
The most common types of urinary stones are of calcium, uric acid, struvite and cystine. The kidney stones usually do not cause any symptoms unless they obstruct the urinary passage. When the stone obstructs the urine flow, the ureter dilates and stretches causing muscle spasms giving rise to sharp cramping pain in the area of kidney or lower abdomen. Other symptoms may include blood in urine, increased frequency of urination, smelly urine, fever, chills, nausea, vomiting, etc.
The treatment modality depends upon the size, location and nature of the stone and patient’s condition. It may vary from conservative therapy to removing the stone surgically. With the advent of new technologies, the need for open surgery has been drastically reduced.
In case of small sized stones (less than 1.5cm), the stone can be broken by shock wave impulses from outside the body through a machine called ‘Lithotripter’. This procedure is called Extracorporeal Shock Wave Lithotripsy (ESWL). The small broken pieces pass out in urine in next few days.
For stones over 1.5 cm, percutaneous nephrolithotomy (PCNL) is used. It is a keyhole surgery in which a tunnel is made in the kidney from the back to remove the stone instantaneously. This is the most widely accepted technique.
Ureterorenoscopy (URS) is highly successful procedure for the retrieval of stone in the ureter. The scope is passed through the normal urinary opening through the bladder into the ureter. Rigid scope can work only up till the uretero-pelvic junction (UPJ). Retrograde Intra Renal Surgery (RIRS) is a modality in which a flexible scope is used. It can be useful for stones anywhere in the urinary tract.
Laparoscopic stone management is utilized when other modalities fail or are deemed unsuitable, in case of inaccessible stone or fragmentation resistant stone.
It is advisable to drink plenty of water to make up for the fluid loss during summers. Water intake should not be at one go. It should be divided in 7-8 working hours during the day. A rough formula is a glass of water every hour. Besides drinking plenty of fluids, limiting protein, sodium, phosphorus diet, and caffeine can also keep kidney stones at bay. Certain medication that aggravates kidney disorders, such as Ibuprofen, Motrin and Alieve should also be avoided. There is a common myth that beer dissolves kidney stones. In fact, beer is a rich source of oxalate and uric acid which promotes its formation.
Dr. Harbans Singh is Chief Urologist with RG Stone Urology and Laparoscopy Hospital, New Delhi
