MANAGEMENT OF URINARY STONES BY DR. SANJAY BHAT HATANGADI AL ZAHRA HOSPITAL DUBAI
Stones within the urinary tract are one of the commonest problems faced by Urologist and especially by patients in the Middle East. This is because of their young demographic, climatic conditions and dietary habits.
Stones can occur in the kidney, the ureter (tube that drains urine from the kidney to the bladder) and urinary bladder.
They usually present with excruciating pain on one side of the abdomen, nausea and vomiting, blood in the urine and sometimes with infection.
Management is usually in the emergency department where pain relief is the first priority followed by urine and blood tests and imaging by Ultrasound and CT scans.
Majority of stones usually are small and 6mm or less and can be treated by medical means.
If pain persists or stone does not pass or gets complicated by repeated symptoms, infection or worsening kidney function intervention is needed.
In the past this involved major operations. Over the last 30 years advances in technology and instrumentation have made treatments as outpatient or day care procedures. This has greatly benefitted patients in terms of comfort, loss of work days and prolonged recovery.
Current treatments include ESWL (Extracorpreal shock wave lithotripsy) for kidney and ureteral stones. Herein the patient lies on a couch and the stone is broken by sound waves delivered from outside. The stones fragment and pass out in the urine.
Stones in the ureter and bladder and kidney can also be extracted by endoscopy (passing fine instruments into any part of the urinary tract)under anesthesia, visualizing the stone and then grasping it out or fragmenting it under vision with lasers. Some times large stones in the kidney may need to be removed by “key-hole” surgery called laparoscopy and PCNL.(Percutaneous nephrolithotomy).
Strict hydration and dietary controls and follow up is needed to prevent further stone occurrence in all patients.
