Surgical Treatment of Stone Disease

Stone disease is more common in our country (15% on average) than in other countries. Factors affecting stone formation can be listed as follows:

Genetic predisposition: It is one of the most important risk factors in stone formation. There is a history of stone disease in the families of patients with stone disease, at rates ranging from 10 to 40 percent.

Age and gender: Stone disease usually starts in the twenties. It is slightly more common in men.

• Geographic distribution: It is more common in mountainous and tropical regions. It is seen most in Saudi Arabia and least in Italy and China. In Turkey, it is most frequently seen in the southeastern Anatolia region.
  Climate: Stone formation is more common especially in the summer months due to fluid loss in the body.
• Nutrition: It is one of the most important factors in stone formation. Especially the amount of water taken is important. The risk decreases as the amount of water consumed increases. In addition, a diet rich in protein and carbohydrates and low in fiber foods increases the risk of stone disease.

Stones are divided into two groups according to their chemical structure: stones that contain calcium and those that do not. Calcium-containing stones make up 85 percent of all stones and are usually found in 2 forms: calcium oxalate and calcium phosphate. Stones that do not contain calcium are rarer, and the most common among them are uric acid, cystine and infection stones.

Clinical Findings

Urinary tract stones often eventually cause pain. Pain usually occurs in two ways. The most common and most important of these is what we call renal colic, which is a stabbing pain in the side or groin. These pains are very severe and are usually accompanied by nausea and vomiting. The other type of pain caused by stones is dull pain that is not colicky. These pains are mild pains and are usually persistent. When stones in the kidney cause pain, gallbladder stones; Stones that have passed from the kidney and fallen into the urinary tract may be confused with appendicitis on the right side.

The second most common clinical finding in patients is blood in the urine. This condition is found in 85 percent of patients, either macroscopically (observed by the patient himself) or microscopically (in urinalysis examination). In rare cases of complete obstruction, no blood may be seen.

The second most common clinical finding in patients is blood in the urine. This condition is found in 85 percent of patients, either macroscopically (observed by the patient himself) or microscopically (in urinalysis examination). In rare cases of complete obstruction, no blood may be seen.

Diagnostic Methods

Direct urinary system radiography should first be taken in patients with the above clinical findings. With this film, 85 percent of stones can be diagnosed. In addition to this film, patients may undergo ultrasonography, IVP and tomography.

Treatment Methods

Treatment modalities in stone disease vary greatly. While nothing is done to some patients, some patients may receive urgent surgical treatment. We can list the treatment options as follows:
Monitoring: Stones smaller than 4 mm can be monitored regardless of where they are in the kidney. Again, stones of this size that have fallen into the urinary tract can be monitored if they have not completely obstructed. Ureter stones (the channel between the kidney and the bladder) larger than 4 mm can be followed up with medical treatment in 2-3 weeks. In some cases, subrenal calix stones can also be monitored.

• ESWL: (stone breaking with external sound waves): It is applied in kidney stones up to 2 cm in size. The second place where ESWL is performed is the ureter. It is especially effective in upper ureteral stones. It is done in sessions. The patient can go home after the procedure. The ESWL device (Siemens MODULARIS URO) that we use in our Şişli Kolan Hospital Urology Clinic is the most effective device used in this field, capable of focusing both ultrasonographically (on non-opaque stones that cannot be viewed radiologically) and fluoroscopically (on opaque stones that can be easily observed radiologically).
• URS (ureterorenoscopy): This method requires general anesthesia. With the instrument inserted into the urinary tract, the stones in the bladder and lower ureter are broken, fragmented and taken out of the body USING COMPRESSED AIR WAVE – ULTRASOUND AND MOST EFFECTIVELY HOLMIUM LASER ENERGY. In this process, the flexible ureteroscopy device we use in our clinic provides incredible advantages to both the patient and the urologist performing the procedure.
• PNL (percutaneous nephrolithotomy): This method also requires general anesthesia. It is especially effective in the treatment of stones in the kidney that are too large for ESWL to be performed, or stones that are too large for ESWL to be performed, or stones that are resistant to ESWL. It is the method frequently used in the treatment of lower calyx stones.
• MINI – MICRO PERC: It has several advantages compared to standard percutaneous nephrolithotomy. It provides better stone-free rates compared to lithotripsy and retrograde intrarenal surgery. It has significantly fewer hemorrhagic complications, making it an interesting method in the treatment of kidney stones.