Renal stones affect approximately one in ten of the population and are more common in men.
Kidney stones can be often asymptomatic and picked up during investigations for other conditions.
They most commonly present with back pain, blood in the urine and recurrent urinary tract infections.
If the stones fall out of the kidney and block the ureter tube there is often a sudden onset of extremely severe pain. The typical pattern of pain is from loin to groin. In men it can radiate down to the testicles. Patients with ureteric colic often present to the accident and emergency department due to the severity of their symptoms.
Blood and Urine tests
Routine blood tests are undertaken to check for kidney functions and evidence of infection in the blood stream. These can also provide information regarding calcium and Urate levels in the blood (the two common sources of stone formation). A urine test can indicate presence of blood or infection in the urine.
This is a quick and reliable investigation. This provides the most accurate information regarding the site, size, shape and amount of stone burden in order to plan appropriate management.
If ureteric stones are small (less than 5mm) then there is a high chance that they may pass without any surgical intervention. Tablets called alpha blockers (which are usually used in men with difficulties passing urine) help to relax the ureter tube. These are used in conjunction with appropriate pain killers (anti-inflammatories) to increase the rate of spontaneous stone passage.
Emergency Decompression (JJ Stent Insertion or Nephrostomy)
In cases where the stones fail to pass conservatively and/or there is uncontrollable pain, significant blockage to the kidney, damage to kidney function or signs of infection then urgent action has to be taken. This often involves the placement of a plastic tube called a JJ stent which runs from the kidney to the bladder and unblocks the drainage system of the kidney. It is inserted under a general anaesthetic via a telescope which goes down the urethra (water pipe) and into the bladder.
Definitive stone Treatment
We offer a comprehensive management of kidney stone disease, including ESWL (Extracorporeal Shockwave Lithoripsy), Rigid Ureteroscopy, FURS (Flexible Ureterorenoscopy) and holmium lasertripsy of stones in ureters and kidneys and PCNL (Percutaneous Nephrolithotomy).
Extracorporeal shock wave lithotripsy (ESWL)
This is performed on an outpatient basis with the patient awake. A pain killing injection or tablets are often given prior to the treatment beginning. High energy shock waves are focussed at the stone using either X ray or ultrasound to try and break it up into smaller pieces. It may take multiple treatments before it is clear if ESWL will break the stone or not. Once fragmented the pieces will be passed by the patient. Complications are uncommon but include blood in the urine, bruising around the kidney and pain as the fragments pass or become stuck in the ureter.
Ureteroscopy (Rigid and Flexible) and Holmium lasertripsy to the stone
This is performed under a general anaesthetic as a day case procedure. A small telescope is placed via the urethra into the bladder and then up into the ureter and kidney if necessary. The stone is seen directly, often broken up with a laser and the fragments removed with a basket. A JJ stent is usually inserted at the end of the operation to stop the kidney becoming blocked by swelling of the ureter tube, blood or stone fragments.
Percutaneous Nephrolithotomy (PCNL) -Supine
This is a more invasive procedure reserved for the treatment of larger stones in the kidney or upper ureter. It involves being admitted to the hospital and staying in for 2-3 days.
Under a general anaesthetic a small incision is made in the skin and the kidney punctured using a fine needle. This tract is then dilated and a plastic tube inserted into the kidney through which a telescope can be passed. The stone is then identified and either removed whole or broken into small pieces.