When kidney stones are examined, most of them are calcium stones and the other part includes infection stones, uric acid and cystine stones. Factors causing recurrent stone disease, childhood stones, diseases related to stone formation (hyperparathyroidism, cystinuria, renal tubular acidosis, hyperoxaluria, chron’s disease, intestinal surgery), drugs related to stone formation (calcium, vitamin D, vitamin C, sulfonamide, traimterene) ) and anatomical disorders associated with stone formation (medullary sponge kidney, calyceal diverticulum, cyst, vesicoureteral reflux, ureteropelvic junction stenosis, horseshoe kidney, ureterocele).
While stone disease often presents with complaints of pain, bleeding in the urine, nausea and vomiting, it is noticed in some patients during examinations performed for other reasons.
Clinical diagnosis should be supported by appropriate imaging methods such as direct urinary system radiography, ultrasonography, intravenous pyelography or computed tomography. Then, an appropriate treatment is planned by considering the patient’s age, clinical course (complaints), size and location of the stone, and whether it poses a risk for the kidney. This treatment may follow the patient with some drugs, external lithotripsy (ESWL) or endoscopic (URS-laser lithotripsy, percutaneous nephrolithotomy) or open operation. Each patient is treated individually.
Stone analysis is performed to determine the composition of stones that fall spontaneously without treatment, are removed by surgical intervention or are excreted as fragments in urine after fragmentation. Thus, necessary measures can be taken to prevent the recurrence of the stone. Our first goal is to relieve the pain in patients with acute stone removal, and then, when the patient is relieved, imaging examination is performed and treatment is planned. The success of ESWL in kidney stones is directly related to the size and location of the stone. Based on this, it is a fact that larger stones can be treated more successfully with percutaneous nephrolithotomy (PCNL). In the case of infected stones or bacteriuria, antibiotic therapy should be administered before ESWL treatment and continued for a while after treatment. It is necessary to use a double J stent to prevent obstructive and infective complications after ESWL due to large kidney stones. For stones 20 mm in diameter or larger, we recommend placing the stent prior to ESWL. In patients with a single kidney, it should be worn. In the pecutaneous stone fracture, the stones can be taken directly into the body beam, or they can be broken into pieces by laser or pneumatic lithotripters. In staghorn stones, we prefer direct open surgery. We apply technically different methods such as anatrophic nephrolithotomy, radial nephrotomy, and pyelonephrlithotomy. Indications for open surgery in children with complex stone burden, when ESWL-percutaneous-ureteroscopic methods fail, anatomical abnormalities in the kidney, morbidly obese, skeletal deformities and because of ease of surgical intervention and only a single anesthesia procedure are required.