For Information on Kidney Stones and Treatment in Melbourne

Kidney Stones are a Common Problem

Crossection of kidneys, ureter, and bladder. Kidney stones can accumulate in the kidneys and in the ureter.Many people who are diagnosed with kidney stones (renal calculi) have no symptoms. Others will have pain, but will eventually pass their stone. A smaller percentage will need surgery to remove their stone.

Kidney Stones – What Are They?

Kidney stones are crystal structures that form in the kidney. They do not tend to cause symptoms if they sit and grow in the kidney. Symptoms and pain occur when the stone falls into the ureter and causes a blockage to the kidney. It is impossible to predict when or if a stone will cause problems. Once a stone has fallen into the ureter, the likelihood of passage of that stone (without the need for surgery), is determined by size and at which point in the ureter the stone is stuck. The larger the stone, the less likely it is that it will pass without treatment. The higher the stone is caught in the ureter, the less likely it is to pass without treatment. Multiple stones are also less likely to pass. If you have signs of an infection your doctor will be more inclined to intervene, rather than letting an infection worsen. If you have only one kidney, your doctor will also tend to suggest treatment.

What Are The Treatment Options?

Treatment ranges from pain relief and time (to allow the stone to pass without surgery), Extracorporeal shockwave lithotripsy (ESWL), ureteroscopy and Percutaneous nephrolithotripsy (PCNL). Your doctor will discuss these treatment options with you and decide upon the most appropriate plan.

Treatment

Medical Expulsive Therapy

ESWL (External Shockwave Lithotripsy)

Ureteroscopy

PCNL (Percutaneous Nephrolithotomy)

Description

Allow stone to pass with aid of pain killers and medication to relax the ureter.

Focused sounds waves are directed onto the stone, from outside the body. No incision or telescopes. The stone breaks into small fragments which then pass out of the body in the urine.

A small flexible telescope is passed up the urethra, through the bladder and then into the ureter and kidney. The stone is identified and then lasered to dust. A stent is often required for a short period after treatment.

Keyhole surgery vis a small incision in back/flank. A solid telescope is placed through the back and into the kidney to remove large stones.

Invasiveness

Non invasive.

Non invasive.

Invasive, telescopes placed through natural orifaces.

Invasive, small incision required.

Ideal treatment for;

Small stone in ureter, <5mm.

Smaller stone, 3-10mm in kidney.

Almost any stone in the urinary system – if performed by a specialist stone surgeon.

Large stones, >3cm in the kidney.

Benefits

Avoid surgery

Day surgery, min risk and side effects.

Very high success rates when performed by an experienced stone surgeon.

Ability to remove large volumes of stone in a single sitting – recommended for very large stones.

Risks

Could take days to weeks to pass with varying levels of pain. After weeks, with or without pain, stone may not pass requiring surgical treatment.

Highest failure rate and redo procedure rate, small risk of pain.

Small risk of injury to ureter. Often require a stent afterwards, which can cause discomfort.

More invasive than other options – small risk of significant bleeding requiring transfusion.

Success rates

Dependent on size and location of stone.

60-80%

>95%

>90%

Length of stay in hospital

1-2 days for pain relief.

Day case.

Day case – overnight.

2-3 days.

Time off work

Minimal.

24-48 hours.

24-48 hours.

2 weeks.

Once you have had a kidney stone, there is a high risk of having recurrent stones. Between 35% – 50% of people will suffer kidney stone pain again in the next 5 years.

What Should I do if I Have Kidney Stones?

joseph-thomasFor the best outcome, it is important to see a surgeon who specialises in kidney stones – even if there is no surgery required. Given the high risk of recurrent stones, a specialist stone surgeon will be able to keep you under close observation and recommend treatment at the first sign of recurrent disease. With 10 years international experience sub-specialising in kidney stone disease, Mr Joseph Thomas of Metropolitan Urology is one of the few kidney stone sub-specialists in Melbourne. The majority of his practice is dealing with kidney stones and surveillance of stones. He works closely with renal physicians and endocrinologists to ensure a multidisciplinary approach to stone management.

To further discuss your kidney stones, call 9890 7222 for an appointment.

* Special acknowledgement for www.KidneyStoners.org for allowing use of their images.