The body maintains its water balance, salt balance and waste substances by producing urine. When urine becomes too concentrated (not drinking enough water or excessive fluid loss occurs) the minerals and salts in urine can become too concentrated and form crystals. Over time crystals adhere to one another and form a kidney stone.

Symptoms

Kidney stones can be completely asymptomatic or can lead to symptoms like back or flank pain, groin pain, blood in the urine (hematuria), nausea and vomiting or it can cause bladder symptoms (going to the toilet often -frequency, urgency). Kidney stones can also lead to complications like kidney damage (renal failure) or infection (with high fever and chills).

Treatment

The treatment of kidney stones depends on its presentation, the size and location (whether the stone is in the kidney or in the ureter/kidney tube) of the stone or whether any complications are present (kidney damage or infection).

Some stones are very small and may pass on their own and in the setting of a patient with minimal symptoms and no complications, a watch and wait approach can be followed to give the stone a chance to pass into the bladder.

If the stone gets stuck (does not pass on its own) or is too large to pass or if complications are present, surgical intervention is required. In most cases this will require a small telescope to be placed through the bladder into the ureter and up to the kidney (pyeloscopy and laser lithotripsy) to find the stone and destroy it with a laser. Some stones may be amenable to extracorporeal shockwave lithotripsy (ESWL) which is shockwave treatment delivered to the stone from outside of the body. Sometimes, as in the case of an infection or kidney damage, a silicone tube is placed (JJ stent) that runs from the bladder up to the kidney in order to drain the kidney and let it recover before definitively destroying the stone. Oftentimes, the ureter is too narrow and delicate to allow passage of the telescope up to the stone. In these scenarios a stent is also placed for two reasons. The first is to unblock the kidney and the second is that the stent would allow gradual dilation (widening) of the ureter so that a telescope can be passed safely, one or two weeks after placement of the stent. The stent could also be placed after surgery if there is any swelling present.

Although the stent serves a purpose it can cause significant bother: it may cause frequency (going to the toilet often), urgency, a feeling that you might have a UTI (without having a UTI) and bleeding.