Kidney Stone Disease

What is the function of the kidneys?

Kidneys are organs that filter harmful wastes in the blood and ensure that these wastes are excreted in the form of urine with water. Kidneys also have other important functions other than producing urine. The kidneys are responsible for making a hormone called erythropoietin that matures blood cells in the bone marrow. In this way, they protect the body against anemia. In addition, they regulate the balance of calcium and phosphorus by contributing to the synthesis of vitamin D. This makes our bones resistant.

How do they form?

When the density of some minerals in the urine increases in the urine due to some metabolic disorders or insufficient fluid intake, first crystal formation occurs, then stone formation occurs by clustering and combining these crystals.

What are the types?

Stones are divided into 5 main categories according to the type of crystals that form their structure: Calcium Oxalate Stones (most often), Calcium Phosphate Stones, Infection (Struvite) Stones, Uric Acid Stones and Cystine Stones. Knowing the structure of the stone is important to prevent recurrence of stones after treatment and to take precautions for this.

What is the reason?

Although the reason why stone disease occurs is not fully clarified today, it is accepted that many factors such as some genetic reasons, congenital diseases, nutrition and fluid intake habits, living geography, climate, race and profession. In particular, insufficient fluid consumption, high consumption of salt and refined sugar, excess animal protein intake, living and working in warm environments, sedentary lifestyle, urinary tract infections, some metabolic and genetic diseases and structural disorders of the kidney are blamed.

What are the symptoms?

Urinary stones can sometimes be detected incidentally without any symptoms, or it can sometimes cause severe pain by falling into the urinary tract. The nature of the pain is usually in the form of colic, comes in waves and is writhing. The area where the pain is felt is the lateral (flank) area and spreads to the groin area. The most important symptoms other than pain are nausea, vomiting, burning while urinating, blood in the urine and urination problems.

How is it diagnosed?

In addition to a detailed history and examination, some laboratory and imaging methods are used for the diagnosis of kidney stone disease. Ultrasonography, direct radiography and low-dose drug-free tomography are the most important radiological imaging methods used in the diagnosis of stones. When an intervention is planned for the stone, medicated (contrasted) examinations or scintigraphic examinations can be planned when necessary. In order to investigate the causes of stone disease, it is important to perform some metabolic examinations in blood and urine and to analyze the stone in order to prevent recurrence of the disease in the future.

Treatment of Kidney StonesKidney stone disease treatment; The location of the stone is planned considering the size, type and some factors of the patient.

• ESWL (Extracorporeal Shock Wave Lithotripsy),
• URS / RIRS (ureterorenoscopy), ,
• PNL (percutaneous nephrolithotomy),
• Open and laparoscopic surgical methods

are the treatment methods used for this purpose. In order to prevent recurrence of stone disease, some lifestyle changes, diet therapy and drug therapy can be recommended according to the results of metabolic research.

Laser Lithotripsy

Breaking down kidney stones with laser is the process of breaking or removing the stones with the help of laser by passing up through the urethra up to the kidney by means of a flexible thin endoscope without making any cutting or holes in the body.Specially produced endoscopes (flexible ureterorenoscope) are used for the process of breaking down kidney stone with laser. The tip of these instruments, approximately 3 mm thick and 60 – 70 cm long, can be controlled by the surgeon from the back of the device. In this way, each chamber of the kidney can be entered and the stones can be reached and broken with the help of laser.

Kidney Stones in Infants and Children

Although stone disease is less common in infants and children compared to adults, its incidence has increased in recent years due to changes in nutritional habits. In addition, since the underlying cause of stone disease in these children is usually a metabolic or anatomical disorder, the stone disease is extremely prone to recurrence.Miniature special devices should be used in the treatment of this age group due to the small size of the pediatric kidney and the urethra, and the surgeon should have sufficient experience in this regard. I have one of the largest series on kidney stone surgery in children in the world and my success rates are well above the general literature. Over 80 of my international articles have been published on this subject.We trained many of our colleagues incoming from abroad and from different cities in the Turkey on these surgeries at the institutions where I have worked. We organized dozens of symposiums and conferences. We published the series of endoscopic kidney stone surgery with laser in preschool children (J Ped Surg 2011) for the first time in the world. We are the first surgeons to report to the literature the youngest children undergoing these surgeries at that time. With all this experience and knowledge, I continue to apply stone surgeries in infants and children in a very intensive, effective and safe way.