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Frequently Asked Questions - General faq's.
Most common questions you may want to ask.
Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive method in which high intensity sound waves (shock waves) are generated outside of the patient body and then focused on the stone within the kidney or ureter.
The focal point of the shock wave is fixed, and the patient is moved so that the stone (imaged by fluoroscopy or ultrasound) rests at the focal point (F2 for electro hydraulic Lithotripters). The urologist controls three parameters; number of shock waves administered on the ESWL, the shock wave repetition rate of the Lithotripter, and the voltage (or energy) of the shock wave generator of the ESWL.
The process of stone comminution is monitored by imaging, and treatment is terminated when it is judged that residual fragments are small enough to be voided in the urine or grasped and removed using transurethral or Percutaneous probes. A variety of factors are weighed in determining a treatment protocol, including the number, size, location and suspected composition of the stones, the age and health of the patient, and the type of lithotripter being used. Most ESWL patients are treated as outpatients.
As a rule stones between 4mm to 20mm are best treated with ESWL. For stones between 20-30mm, ESWL is still the first line treatment unless factors of stone composition, location, or renal anatomy shift the balance toward invasive but definite treatment modalities (PCNL or RIRS). Stones grater than 30mm should be primarily treated by PCNL, unless specific indications for RIRS are present (i.e. bleeding diathesis, obesity, etc).
A kidney stone is a solid piece of material that forms in the kidney out of substances in the urine.
A stone may stay in the kidney or break loose and travel down the urinary tract. A small stone may pass all the way out of the body without causing too much pain.
A larger stone may get stuck in a ureter, the bladder, or the urethra. A problem stone can block the flow of urine and cause great pain.
No. There are four major types of kidney stones.
The most common type of stone contains calcium. Calcium is a normal part of a healthy diet.
Calcium that is not used by the bones and muscles goes to the kidneys. In most people, the kidneys flush out the extra calcium with the rest of the urine. People who have calcium stones keep the calcium in their kidneys.
- The calcium that stays behind joins with other waste products to form a stone.
- A struvite stone may form after an infection in the urinary system. These stones contain the mineral magnesium and the waste product ammonia.
- A uric acid stone may form when there is too much acid in the urine. If you tend to form uric acid stones, you may need to cut back on the amount of meat you eat.
- Cystine stones are rare. Cystine is one of the building blocks that make up muscles, nerves, and other parts of the body.
- Cystine can build up in the urine to form a stone. The disease that causes cystine stones runs in families.
Kidney stones may be as small as a grain of sand or as large as a pearl. Some stones are even as big as golf balls. Stones may be smooth or jagged. They are usually yellow or brown.
The best way for your doctor to find out what kind of stone you have is to test the stone itself. If you know that you are passing a stone, try to catch it in a strainer.
Your doctor may ask for a urine sample or take blood to find out what is causing your stones. You may need to collect your urine for a 24-hour period. These tests will help your doctor find ways for you to avoid stones in the future.
The therapy your doctor gives you depends on the type of stone you have. For example, a medicine that helps prevent calcium stones will not work if you have a struvite stone. The diet changes that help prevent uric acid stones may have no effect on calcium stones. Therefore, careful analysis of the stone will help guide your treatment.
For unknown reasons, the number of people in India with kidney stones has been increasing over the past 20 years. Stones occur more frequently in men. Kidney stones strike most typically between the ages of 20 and 40. Once a person gets more than one stone, others are likely to develop.
Usually, the first symptom of a kidney stone is extreme pain. The pain often begins suddenly when a stone moves in the urinary tract, causing irritation or blockage. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur. Later, pain may spread to the groin.
If the stone is too large to pass easily, pain continues as the muscles in the wall of the tiny ureter try to squeeze the stone along into the bladder. As a stone grows or moves, blood may appear in the urine. As the stone moves down the ureter closer to the bladder, you may feel the need to urinate more often or feel a burning sensation during urination.
If fever and chills accompany any of these symptoms, an infection may be present. In this case, you should contact a doctor immediately.
Sometimes "silent" stones--those that do not cause symptoms--are found on x rays taken during a general health exam. These stones would likely pass unnoticed. More often, kidney stones are found on an x ray or sonogram taken on someone who complains of blood in the urine or sudden pain. These diagnostic images give the doctor valuable information about the stone's size and location. Blood and urine tests help detect any abnormal substance that might promote stone formation. The doctor may decide to scan the urinary system using a special x ray test called an IVP (intravenous pyelogram). The results of all these tests help determine the proper treatment.
Fortunately, surgery is not usually necessary. Most kidney stones can pass through the urinary system with plenty of water (2 to 3 quarts a day) to help move the stone along. Often, you can stay home during this process, drinking fluids and taking pain medication as needed. The doctor usually asks you to save the passed stone(s) for testing. (You can catch it in a cup or tea strainer used only for this purpose.)
Extracorporeal Shockwave Lithotripsy
Extracorporeal shockwave lithotripsy (ESWL) is the most frequently used procedure for the treatment of kidney stones. In ESWL, shock waves that are created outside the body travel through the skin and body tissues until they hit the denser stones. The stones break down into sand-like particles and are easily passed through the urinary tract in the urine.
There are several types of ESWL devices. In one device, the patient reclines in a water bath while the shock waves are transmitted. Other devices have a soft cushion on which the patient lies. Most devices use either x rays or ultrasound to help the surgeon pinpoint the stone during treatment. For most types of ESWL procedures, anesthesia is needed.
In some cases, ESWL may be done on an outpatient basis. Recovery time is short, and most people can resume normal activities in a few days.
Complications may occur with ESWL. Most patients have blood in their urine for a few days after treatment. Bruising and minor discomfort in the back or abdomen from the shock waves are also common. To reduce the risk of complications, doctors usually tell patients to avoid taking aspirin and other drugs that affect blood clotting for several weeks before treatment.
Another complication may occur if the shattered stone particles cause discomfort as they pass through the urinary tract. In some cases, the doctor will insert a small tube called a stent through the bladder into the ureter to help the fragments pass. Sometimes the stone is not completely shattered with one treatment, and additional treatments may be needed. ESWL is not ideal when stones are larger than 2 centimeters, about 0.8 inches.
The technique of Lithotripsy is basically split into two methods, The Intracorporeal Lithotripsy and Extracorporeal Lithotripsy.
Intracorporeal Lithotripsy:
Intracorporeal Lithotripsy (Which means breaking a stone by entering the body) uses Endoscopic apparatuses which could include ultrasonic, electro-hydraulic (EHL), and mechanical devices, as well as various lasers. These instruments are passed through the working channel of the endoscope to fragment stones into extractable pieces after entering the body either through a small hole made in the body or through opening like the urinary tract. Baskets and graspers are used during intracorporeal lithotripsy to immobilize stones and to remove stone fragments after the stone has been fragmented either by small impacts or lasers.
Extracorporeal Lithotripsy:
Unlike Intracorporeal Lithotripsy, Extracorporeal shock wave Lithotripsy (ESWL) is a technique to fragment stones without entering the body. Focussed high energy shock waves or pressure waves are used to fragment renal stones by letting these pressure shock waves enter the body to a predestined point (Typically a kidney stone) this is achieved by making a coupling between the patient body and a focussed energy source of ESWL equipment. Two to three thousand shock waves are administered in about 40 to 50 minute's treatment duration which constantly hit the calculus (stone) and fragments it into fine particles. These fragments pass of in urine in normal course.
Most kidney stone patients are candidates for ESWL. About 20 per cent may require some other form of stone treatment because of the size or location of their stones. As well, pregnant patients are not eligible for lithotripsy.
Advantages of Lithotripsy
- It is a safe, non-surgical procedure.
- It is less painful than alternative forms of kidney stone treatment.
- Hospital stay is dramatically reduced to a few hours compared
- with 7 - 14 days for kidney stone surgery.
- Patients can return to work and resume other normal
- activities more quickly.
- Partial disability after the procedure is reduced
- from six weeks to just a few days.
Success of Lithotripsy
Extensive studies reveal a success rate of over 90 per cent in lithotripsy procedures. Most patients are stone free within six weeks of treatment. In most cases only one shock wave treatment is required.
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The main composition of Kidney stones and their percentages are as follows:
- Calcium oxalate, phosphate, or both (70-80%)
- Uric acid (5-10%)
- Cystine (1%)
- Struvite (magnesium ammonium phosphate) (5-15%)
- Other (such as xanthine, guaifenesin) (1%)
SO ! We have to understand and keep in mind to the foods that are worth saying "NO" to, though a difficult word to say yet is the most rewarding for the patients of renal calculi or those at risk of developing renal calculi (Stone).
These have high oxalate content that aggravate calcium oxalate stone formation, the most common type of renal stone. If the level of urinary oxalate is high, limiting high oxalate foods reduce the risk of forming renal stones.
NO to Cauliflower - it has high uric acid purine content NO to Pumpkin - it has high uric acid purine content NO to Mushrooms - they have high uric acid purine content NO to Eggplant (Brinjal) - it has high uric acid purine contentFoods rich in uric acid/ purine increase urinary excretion of uric acid which predispose to both uric acid and oxalate stones.
The foods that we can say "YES" to , which is easy to say and easy to follow for those who want to know what is right for healthy kidneys.
YES to Coconut water - rich in dialyzable bio-molecules inhibiting the initial phase formation and subsequent growth but also stimulate demineralization of preformed mineral phase.
YES to Corn silk (makaai) - rich in tartrates thereby acting as a good inhibitor of stone formation; exerts diuretic action. It s specifically healing, supporting, strengthening, protecting and protect urinary bladder helping eradicate calcium.
YES to Barley - exerts diuretic action and has healing and fortifying properties. It also is rich in stone inhibitors.
YES to Pineapple - contains enzymes which break down fibrin, thereby preventing renal stone formation. Dietary fibers reduce excretion of calcium in urine perhaps by 40%.
YES to Bananas - rich in Vitamin B, which breakdown oxalic acid in the body thereby preventing stone formation.
YES to Almonds - provide rich source of magnesium and potassium, which act as stone inhibitors.
YES to Lemons - rich I citrates, thereby preventing calcium oxalate stone formation.
YES to carrots - rich in pyrophosphates and plant aids which act as stone inhibitors. Also provide Vitamin A, lack of which has been implicated in the pathogenesis of urinary bladder stone.
YES to Horse gram- water extract (kultha daal) - act as good stone inhibitor of stone formation.
YES to Bitter gourd (Karela) - it has been found to contain stone inhibitors like magnesium, phosphorous and phytoconstituents useful in urinary system and gout.
Though this is a complex question and needs a lot of explanation there could be a simple mechanism to understand stone formation and understand ways by which stones form in the urinary tract:
In a container with water if you add some more salt, it dissolves. When you add more and more salt, a stage comes when the salt is no longer able to dissolve. The reason for this is that the solution in the container is supersaturated with the salt. So above this point any further salt added to this saturated solution will start precipitating.
This exactly is the mechanism by which stones form, except the container is kidneys and the solution is urine and the chemical composition of the salt is different.
Another reason for stone formation is : First a negatively or positively charged crystal is formed, which keeps attracting opposite charged crystals as a result it grows in size and then a large number of such grown - up crystals has to aggregate to each other before it becomes large. This could be controlled or avoided if kidneys remain flushed by drinking enough water.
But nature has its own protective mechanisms to prevent stone formation. There are certain substances in urine which control the growth and aggregation of crystals which are responsible for stone formation. These substances in urine (that most of us have) do not let stone formation, As stone forming substances are kept in a dissolved state in our urine.
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