Renal calculus: stones over 6 mm require surgery
Urine is composed of several substances, some of them solid that are diluted in a balanced way, and others that help make the solid material more soluble. The imbalance between the concentration of these substances with the increase of some or decrease of others can lead to the precipitation of insoluble crystals with formation of calculations. The major components of urine that can form stones are calcium, oxalate, uric acid, phosphorus, magnesium, and cystine. The most common risk factor, found in more than 80% of patients, is the family history of renal calculi. In these cases, in 90% of the times the calculations are formed by calcium. Other important factors in the formation of urinary calculi are low fluid intake and abusive use of cooking salt. The diet with foods containing oxalate may predispose the formation of calculi. Problems in the metabolism of some substances such as cystine and uric acid can lead to an increase in the elimination of these products in the urine and consequent formation of stones of these substances.
Kidney stones - Photo: Getty Images
When they are in the kidney, causes symptoms, renal colic occurs when calculi are being eliminated and end up blocking the ureters, which are the channels that carry urine from the kidneys to the bladder.
How is the treatment?
Kidney stones, in the majority, end up being expelled by the urinary tract. Calculations smaller than 5 mm have more than 70% chance of being eliminated without procedures or treatments. Thus, renal calculi less than 5 mm do not require specific treatment.
For renal calculi between 6 mm and 15 mm, the treatment of choice is shock wave extracorporeal nephrolithotripsy (LECO), which consists of the application of shock emitted by specific equipment that concentrates the shock waves on the kidney stone. The location can be done with the help of x-ray or ultrasound. This procedure has an efficiency of about 70% and success depends on the consistency and location of the calculation. (link to video //youtu.be/F5FTre9qOiY)
People who do not calculate or undergo treatments may experience recurrence if they have the same risk factors
Kidney stones greater than 15 mm require surgery for their resolution. The best surgery for kidney stones is done by means of a small incision of 1 cm in the lumbar region, with introduction of small tubes into the kidney, where the stones are. End-camera equipment is introduced and calculations, under direct vision, with the aid of ultrasonic equipment, are fragmented and aspirated. The surgery described is called percutaneous nephrolithotripsy. The word nefrolitotripsia comes from the Greek
= rim, lito = stone and trispsia = break. Some calculations can grow very large and reach dimensions larger than 5 or 6 cm, occupying the entire interior of the kidney, being associated with chronic infection. These calculations are silent, causing few symptoms, but leading to long-term loss of kidney function. Often, the treatment of these stones requires numerous surgeries (percutaneous nephrolithotripsy) or even conventional surgeries with the opening of the kidney.Another surgery that has recently arisen to treat kidney stones is done through the urinary tract without any incision. The thin, flexible device is introduced through the urethra, through the bladder, ureter, and into the kidney where the calculi are fragmented with the help of the laser (flexible ureterorrenolitotripsia). Already the calculations that have already left the kidney and are in the ureter on the way to being eliminated can cause pain, stop in the middle of the path and not be eliminated. These calculations often require surgical treatment and are dangerous, and may lead to a decrease in kidney function temporarily or even permanently if left untreated. The surgery is called ureterolitotropia, and it is also done through the urinary tract with equipment that has a camera at the end. The calculation is broken with the aid of the laser, and the fragments are removed with the help of a small basket (see video //youtu.be/dhLuFU0QHhM).
Surgery is not definitive
People who eliminate calculations or perform treatments for their elimination can present recurrence and formation of new calculations if they maintain the same risk factors. In this way, it is very important that the patients who have the renal calculus diagnosis change some habits of life to avoid the formation of new calculations. The changes are simple, like increasing fluid intake, avoiding excess cooking salt and some foods. If in spite of these measures the patient presents the formation of new calculations it is necessary the metabolic investigation of the origin of the calculation and sometimes the use of medicines to avoid them.
We emphasize that the indications of treatment exposed above must be individualized taking into account various factors and characteristics of each patient, and may often be different from that described above. It is important that the treatment of the stones be accompanied by a professional qualified for such as a urologist or nephrologist.
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Often, when we think of diseases in a region, we forget the role of each individual when it comes to fighting them. If the issue is a public health problem in our community, every correct attitude is worth a lot. " " A good deal of disease can be avoided or at least be at risk of being reduced by individual measures, "says the Rodrigo Lima, director of the Brazilian Society of Family and Community Medicine The epidemiologist Eduardo Hage, director of the Department of Surveillance of Transmissible Diseases (DEVIT) of the Ministry of Health, citizen participation is essential.