Everything you need to know about Kidney Stones

What are Kidney Stones?

Kidney stones or commonly known as renal calculi, are hard masses of salts and minerals that get accumulated in the kidneys, bladder, and pelvic ureteric junction. Kidney stones are mostly made up of calcium, oxalate, phosphate, cystine (rare), and xanthine (rare). While kidney stones are more common in middle-aged men, they can occur to anyone at any age.

Kidney stones vary in shape and size. The size of kidney stones can be as small as a grain of sand to as big as a golf ball. While most kidney stones usually pass on their own naturally within a few days to a few weeks, some stones can be stubborn and cause extreme pain. In extreme cases, you may require surgical intervention for kidney stone removal.

Prolonging kidney stone treatment can impact surrounding tissues and even obstruct the ureteral passage causing immense pain around the abdomen. Get a free appointment with our urologists near you for your kidney stone treatment.

How are Kidney Stones formed?

Kidney stones form as a result of low fluid concentration in the urine, which increases the amount of toxic waste. Our kidneys filter the toxic waste from the body and flush it out through urine. However, when the concentration of toxic waste in the urine increases, it lumps with each other to form kidney stones.

Kidney stones may also form due to excessive amounts of certain salts and minerals. Calcium stones are one of the most common types of stones that contribute to about 80% of all kidney stone cases. A diet rich in calcium or oxalate is absorbed by the kidneys, which increases the amount of calcium oxalate in the urine. Apart from that, kidney stones are also caused by frequent urinary tract infections (UTI), increased amounts of uric acid in the body due to high animal protein intake, and certain lifestyle habits.

Types of Kidney Stones

1. Calcium stones
2. Struvite stones
3. Cystine stones
4. Uric acid stones

Causes of Kidney Stones

• Low fluid intake (Dehydration)

• Consuming high calcium supplements

• High animal protein diet

• Excess salt consumption

• Family history

• Chronic diarrhea

Symptoms of Kidney Stones

• Severe back pain in the flank area

• Nausea and vomiting

• Pain while urinating

• Foul-smelling urine

• Fevers and chills

• Blood in urine

Diagnosis of Kidney Stones

Diagnostic Tests

• Imaging tests – These tests include abdominal ultrasound, x-rays, or MRI to obtain 3D images of the stones in the abdomen. This helps in locating the area where the stones may be present. The cost of abdominal ultrasound usually starts from Rs. 1200 and can go up to Rs. 1500 depending on the city and type of hospital. CT scan usually starts from Rs. 4300 depending on the location and the type of healthcare center.
• Blood tests – Blood tests help examine the contents in your blood that may result in kidney stones. It is important to determine the presence of calcium, phosphorus, uric acid, and electrolytes that may result in the progression of kidney stones. Blood tests usually cost between Rs. 200 to Rs. 500.
• Blood urea nitrogen (BUN) and creatinine test – This test helps identify any abnormal functioning in kidneys by determining the amount of nitrogen in the blood that comes from the waste product, urea.
• Urinalysis – This test is done to assess the contents of urine to identify any crystals, bacteria, or any other agents that can cause kidney stones or urinary tract infections.

Self-Diagnosis

Severity of Kidney Stones

Kidney stones cause excruciating pain that becomes unbearable for most patients. Kidney stones usually block the ureteral passage causing urinary retention, a complication that may cause hydronephrosis (swelling up of one or both the kidneys due to build-up of urine) and even result in kidney failure.

Kidney stones can be silent which means they can go unnoticed for a long time. Therefore, prolonging kidney stone removal surgery can increase the severity of the disease and increase the risk of complications.

Risks & Complications Related To Kidney Stones

Complications Related To Kidney Stones

Kidney stone removal surgery is one of the safe and effective procedures that to get immediate relief from pain and discomfort. However, in rare cases, due to existing medical condition or co-morbidities in patients, there is a slight risk of complications. Apart from pain, vomiting, blood in the urine,  etc. kidney stone removal surgery  can lead to the following complications –

• Severe infections including Septicaemia (blood poisoning) which is life-threatening and may require a blood transfusion.
• Sometimes, kidney stone surgery can also cause scarring and damage to the kidneys which can result in permanent renal failure.
• Some patients with co-morbidities and existing medical conditions result in the loss of kidney functioning and often require removal of kidneys (nephrectomy).
• When large kidney stones manage to pass into the bladder but get stuck in the urethra, it leads to bladder blockage. This may result in a painful urinary retention.

What if Stones are Not Treated?

Kidney stones can be silent and do not cause any pain or discomfort. Such stones may grow in size if left untreated and can increase the chances of complications. Therefore, it is important to seek medical assistance for kidney stone treatment to reduce the chances of complications. Possible complications of kidney stones if left untreated are-

• Hydronephrosis – It refers to the swelling up of the kidney due to the building up of urine when it fails to drain from the kidneys.
• Renal scarring and damage to the kidneys result in kidney failure.
• Severe infections in the blood can cause septicemia, which can be fatal.
• Loss of kidney functioning can result in kidney removal or nephrectomy.
• When the stone is stuck in the ureter and obstructs the urinary passage, it can result in bladder blockage and, in some cases, painful urinary retention.

Complications After Kidney Stone Surgery

Most patients  with pain and discomfort often benefit from kidney stone removal surgery. However, due to any existing medical condition, co-morbidities, inexperience of the surgeon, etc. there is a possibility of risks and complications during the procedure. Some rare complications after kidney stone surgery  include the following –

Risks of ESWL surgery – 

• Infection
• Bleeding in or around the kidneys
• Injury to the internal organs due to repeated treatment.

Risks of URSL surgery – 

• Ureteral injury due to stent insertion
• Infection during the procedure
• Failure to remove all stone fragments
• Failure to keep the stent in place for a prolonged time

Risks of RIRS surgery – 

• Allergies due to stents
• Failure to remove stones completely
• Injury in the ureter due to stent insertion
• Failure to keep the stent in one place for the desired time

Risks of PCNL surgery – 

• Infection
• Injury to the surrounding organs and tissues.
• Unable to break and remove all the stones completely
• Blood loss, which may require a blood transfusion.

Doctors at Pristyn Care have an average experience of  more than 15 years with an excellent track record. Our kidney stone doctors provide diet charts, post-surgery recovery tips, and suggestions to minimize the chances of complications after the surgery.

How can you prevent Kidney Stones?

Prevention against kidney stones mostly involves dietary restrictions, lifestyle changes, and staying hydrated. However, certain preventive measures act differently for patients and so, it is important to consult your specialist doctor on how to prevent kidney stones.

Kidney stone prevention mostly aims to reduce certain risk factors that can increase the risk of kidney stones such as obesity, dehydration, etc. The urologist may also recommend certain preventive measures based on the composition of the stone to avoid recurrence in the future. This can help the urologist suggest specific preventive measures to avoid the recurrence of stones. Some of the measures that help in preventing kidney stones include the following –

• Staying hydrated
• Consuming less sodium
• Avoid calcium-rich supplements
• Consume less animal protein

When to visit a Kidney Stone Doctor?

Consult a urologist if your pain is unbearable and you cannot find a comfortable position to rest. Sometimes pain can be accompanied by nausea, vomiting, fever, and chills. You must also seek immediate medical assistance if you see blood in your urine or experience extreme difficulty while passing the urine.

Questions to Ask Your Kidney Stone Doctor

• Would you recommend any informative websites or study material that I can take with me?
• Will I need medication to treat my condition?
• What is the chance of recurrence of kidney stones?
• I am currently suffering from a (health condition). How can I best manage them together?
• How often do I need a follow-up visit?

Treatment Options for Kidney Stones Removal and their Cost

Non-Surgical Kidney Stones Treatment

Most kidney stones usually pass on their own naturally without the need for surgery. Depending on the size of the stone, it can take a day or even months to flush out the stone from the body. Kidney stone doctors may prescribe medications or recommend home remedies, alternative therapies, lifestyle changes, etc. Medicines like alpha-blockers, pain-relievers, etc. reduce pain and discomfort and help flush out stones from the body naturally. While these treatment methods are effective in managing symptoms of kidney stones, they are not the permanent cure. Surgical procedures for kidney stones ensure a high stone-free rate and negligible chances of recurrence. Here are some non-surgical methods to get rid of kidney stones –

• Medications – Kidney stone doctors usually recommend medicines to reduce the pain and discomfort due to the movement of stones. Medications like alpha-blockers are muscle relaxers that expand the muscles of the ureter to allow the stones to smoothly flush out of the body. Examples of alpha-blockers include tamsulosin and the drug combination dutasteride and tamsulosin. Doctors also recommend pain relievers to get rid of pain due to kidney stones. Painkillers such as ibuprofen or naproxen sodium help relieve mild pain and discomfort due to kidney stones.
• Home remedies – Home remedies are a combination of dietary restrictions and lifestyle changes. Kidney stones are broadly divided into 4 types – Oxalate stones, Struvite stones, Cystine stones, and Uric acid stones. Most of these minerals are present in the food we consume on a daily basis. However, increased consumption of one mineral can be a risk factor for the formation of stones. For example, oxalate stones are one of the most common types of kidney stones which are formed due to excess consumption of food containing oxalates, phosphates, and calcium. A diet high in animal protein increases the concentration of uric acid in the body. A high amount of uric acid decreases the citrate levels. A high citrate level prevents the formation of stones and also gets rid of them. Dietary restrictions that can help get rid of kidney stones include –
  • Limiting oxalate-rich foods
  • Increasing dietary calcium
  • Avoiding food with too much salt
  • Decrease high doses of vitamin C supplements
  • Minimizing consumption of animal protein

Therefore, restricting certain foods and beverages can help you get rid of kidney stones and prevent the formation of new stones. If you have a prior history of kidney stones, consult with your physician regarding what diet you should take.

Lifestyle modification can help get rid of stones and also decrease the chances of formation of new stones. Lifestyle changes include staying hydrated and encouraging minimal exercise. Doctors generally recommend drinking 2-3L of water every day to increase the fluid volume in the body. This increases the urine output which can flush out stone fragments. Moreover, encouraging citrus fruits, lemon juice, apple cider vinegar, etc. can help get rid of kidney stones.

• Acupuncture – The primary aim of acupuncture for kidney stone treatment involves promoting flow along the affected acupuncture meridians. This instigates urination (could be in small amounts) which relieves the congestion allowing the small stones to pass. Moreover, some therapists add electrical stimulation to the acupuncture needles to create vibrations that allow stones to work their way down the ureter. However, only certain types and sizes of stones respond to electrical stimulations. Consult your kidney stone doctor before considering acupuncture as a treatment option.

Kidney Stones Removal

Urologists often recommend kidney stone removal surgery when the size of the stone is either too big or when non-surgical procedures are ineffective against the stone. There are different techniques such as shockwave lithotripsy (ESWL), ureteroscopy (URSL), laser procedure (RIRS), and minimally invasive surgery (PCNL) for kidney stones removal.

The size of our ureter is around 3-4mm. When the size of the stone is large enough to pass on its own, it may get stuck in the kidneys, ureter, urinary bladder, etc. resulting in unbearable pain. In such cases, kidney stone removal surgery becomes inevitable. Modern kidney stone removal surgeries are usually done as daycare procedures which means the patient does not require more than 1-day hospitalization. However, in case of any complications, the doctor may ask you to stay back until your recovery.

Hence, doctors can recommend RIRS, URSL, ESWL for stone sizes less than 14mm to 15mm and minimally invasive surgery or PCNL for stone sizes greater than 15mm. The cost of kidney stone treatment can vary depending on the type of procedure. Here is the approximate cost of different kidney stones removal procedures –

• ESWL– Rs. 40,000 – Rs. 50,000
• PCNL– Rs. 65,000 – Rs. 75,000
• RIRS– Rs. 95,000 – Rs. 1,05,000
• URSL– Rs. 40,000 – Rs. 65,000

However, the cost of surgery can vary depending on the choice of surgeon or urologist, selection of hospital, number of stones, size of stones, cost of non-medical items, insurance coverage, post-consultation charges, etc.

4 Types of Kidney Stones Surgery

1. RIRS (Retrograde Intrarenal Surgery)
   RIRS is an advanced procedure to treat kidney stones with sizes between 8mm to 15mm. First, the anesthesia doctor will administer either spinal or general anesthesia. In spinal anesthesia, the patient is sedated below the waist, whereas, in general anesthesia, the patient is asleep throughout the surgery. The urologist then uses a thin, flexible endoscope fitted with a tiny laser on the other end. The location of stones is determined by the x-rays and imaging tests that guide the surgeon inside the patient’s body. The stones are either removed using forceps or subsequently broken into smaller fragments with tiny lasers. The stone pieces are then expelled from the body through urine.
   The surgeon may insert ureteral stents through your urethra into the ureter. Stents enlarge the passage of the urinary tract for smooth movement of stones. Stents are usually kept for 10-14 days depending on how long it takes for stone fragments to fully flush out of the body. Stent removal can be done on the same day or during the subsequent visit to the surgeon. In the case of staghorn calculus(a type of kidney stone that resembles the horns of a stag), you may require two to three sittings to completely get rid of stones in the case of RIRS.
2. ESWL (Extracorporeal Shock Wave Lithotripsy)
   ESWL is also known as extracorporeal shockwave lithotripsy. It is a non-invasive surgery where the doctor uses external shock waves to break the kidney stone into smaller pieces. The patient is administered spinal anesthesia to reduce the pain when the stones are expelled from the body. ESWL is a conventional procedure that may require multiple sittings to break the stones completely.
3. URSL (Ureteroscopic Lithotripsy)
   In URSL, the patient is administered spinal or general anesthesia. The surgeon, then, uses a thin tube called a ureteroscope that is passed into the ureter with a camera and laser on the other end. The camera locates the stones while the laser subsequently breaks the stone into smaller fragments. These smaller pieces are flushed out through urine. The urologist inserts stents into the ureter to enlarge the ureter opening for smooth movement of stones. The stents are kept inside until the stones are thoroughly flushed out of the body.
4. PCNL (Percutaneous Nephrolithotomy)
   Percutaneous Nephrolithotomy is a minimally invasive surgery for treating kidney stones with a size greater than 15mm. It is also known as tunnel surgery due to the nature of tiny incisions. The anesthesiologist administers general anesthesia before the surgery so the patient feels no pain. The patient will be asleep throughout the surgery. Then, the surgeon will make a minor incision (around 1cm) on the flank area (lower back area). The surgeon uses a nephroscope to locate and break the stones into pieces. The stone can be removed in its intact form or if the size of the stone is too large, it is broken into smaller pieces and flushed out.

How to Prepare for your Kidney Stone Surgery?

A kidney stone procedure can be stressful, but if you know what to expect, it becomes easier for the patient emotionally and mentally. Here are some tips that can help you prepare for the kidney stone removal procedure –

• You must inform your urologist about any ongoing medications and current health conditions before the procedure.
• It is also important to inform the surgeon about any history of allergies related to anesthesia.
• Do not smoke tobacco or anything else before your kidney stone removal surgery.
• Consult your doctor before taking any medicines prior to the kidney stone procedure. Some medications such as blood thinners can result in complications during the surgery.
• Patients must not eat or drink 8 to 9 hours prior to the surgery.
• Have someone drive you home after the surgery as you may feel tired and exhausted after the procedure.
• The doctor may insert stents in your ureter via the urethra, which may be kept there for two to three weeks to enlarge the ureter and help drain the kidneys.

What to expect during Kidney Stones Surgery?

After the diagnostic tests, the kidney stone specialist recommends the course of procedure based on the size, location, and the number of stones. Therefore, depending on the type of kidney stone removal procedure, the surgeon may perform different methods and techniques. Here is what you can expect during the kidney stone removal procedures –

ESWL –

• The doctor will administer spinal anesthesia before the procedure.
• You will be made to sit inside a water-filled tub or cushion.
• The doctor will use external shockwaves/soundwaves to break the stones into smaller pieces.

URSL and RIRS

• You will be given spinal or general anesthesia before the procedure.
• A medical device called a ureteroscope will be inserted inside the ureter through the urethra to reach the location where the stone is present.
• The doctor may also insert stents which may be kept until the stones are completely flushed out of the body.
• Once the stones are removed, the doctor may remove stents on the same day or during the consecutive visit to the doctor.

PCNL

• The anesthesia doctor administers general anesthesia before the procedure.
• The surgeon then makes a tiny incision (about 1cm) in the flank area to access the site where the stone is located.
• Once the stones are removed, the surgeon seals the site of the incision using sutures.
• The surgeon may also insert stents if it is deemed necessary.

After your Kidney Stones Surgery

• The urologist will prescribe you medicines such as pain relievers and alpha-blockers to relax and open your ureter for a certain period after the kidney stone removal procedure. This allows the smooth movement of stones and reduces pain and discomfort.
• There may be mild bleeding during urination due to stent insertion. However, this is normal and you can expect little bleeding in the urine for the first few days after the surgery, especially if there are ureteral stents present. In case you suspect heavy bleeding, contact your medical professional.
• The surgeon may examine your kidney stone pieces for lab tests. This helps the doctor in understanding the primary composition of the stones to avoid certain diets and prevent a recurrence.
• The stents may be kept inside the ureter for a desired period of time after the surgery. Once the surgeon is convinced that stone fragments are fully flushed out of the body, he or she may remove the stent in the same sitting or during the post-surgery consultation.
• In the case of ESWL, the patients may feel slight soreness and bruise around the area where the lithotripter was in contact with the skin.
• You may also experience pain and nausea as the remaining stone fragments pass through the urinary tract.

Insurance Cover for Kidney Stones Surgery

Kidney stone removal procedures are usually considered a medical necessity for stones stuck in the ureter, kidneys, etc. Prolonged kidney stones can also lead to serious health issues in children as well as adults. Most health insurance companies cover the cost of kidney stone surgeries in India.

However, there is a possibility that the insurance coverage may differ from one policy to another depending on the terms and conditions set by the insurance provider. Insurance coverage usually reduces the cost of kidney stone treatment and decreases the financial burden on the individual. A few of the insurance providers that may cover kidney stones treatment in India are as follows:

• Star Health Insurance
• New India Health Insurance
• Bajaj Allianz
• Religare
• ICICI Lombard

Recovery after Kidney Stones Surgery

The recovery after the kidney stone surgery can vary depending on the health of the patients. If the patients have undergone ESWL or URSL, they will likely be able to resume normal activities within a week. For PCNL surgery, the recovery time is around one to two weeks due to its minimally invasive nature. However, if you have a temporary stent in place after your surgery, there may be some restrictions related to physical activities that may be limited due to the discomfort.