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PNL - closed removal of Kidney stones

kidney-stones-s2-illustrationKidney is one of the most important organs of our body. Kidneys are located on either side of the spine. The weight varies between 125-170 grams in men and between 115-155 grams in women. It is one of the pair organisms with length of 11-12 cm, thickness of 3.5-4 cm and width of 5-7.5 cm. Right kidney is located 1-2 cm below the left kidney. There are around 2400000 nephrons (a functional unit of the kidney) in both kidneys. 1.5 out of 5-6 liters of the blood pumped per minute from the heart goes (filtered) through the kidneys. 1 liter of blood per minute pass from the nephrons of both kidneys. After filtration of the blood passed through the kidneys, useful substances are returned back to the blood and useless substances are extracted from the body. All the mentioned shows how important the kidneys are for the organism.

What is the kidney stone?

Kidney stone, medically named as “nephrolithiasis” or “urolithiasis” is the name of hard substances collected within the kidneys. Kidney stone is a disease formed as a result of the settling down of different substances and salts. In normal cases, there are substances preventing such sedimentation, but sometimes the protection mechanism loses its ability. This is one of the most common kidney problems.

In most cases, even it is more common in men, some type of stones are more common in woman. There are many causes of the kidney stone formation:

  • Hereditary-genetic
  • Intake of salt in large quantities
  • Adynamia (low agility)
  • Little liquid admission
  • Hypertension (high pressure)
  • Increased body weight
  • Kidney and urinary tract infections and etc.

Kidney stones occur in different sizes, forms and colors. They can be size of a sea-sand up to a golf ball size. Mostly they are straight and oval. Some have ledges and are forked. The color of a stone depends on the chemical content. Mostly they are yellow-brown, some are black.

Occurrence frequency:

passing-kidney-stonesThe disease occurs quite frequently. It is common in 10-15% of men and 5% of women. Initially, it occurs at the age of 20-30. Particularly in men, if they previously had stones, it recurs approximately within 9 years.

In what cases kidney stones occur more?

In general, causes of the kidney stone are as follows:

  • Little liquid admission
  • Diet habit (excessive calcium and vitamin D intake)
  • Genetic factors
  • Urinary tract infections
  • Structural anomalies of the kidney
  • Hot climate zone
  • Some intestinal diseases and major operations
  • Excessive calcium, cystine, oxalate in the urine
  • Changes in the urine pH
  • Previous kidney stones
  • Foreign bodies in the urinary tract
  • Long inactivity
  • Excess weight


  • Kidney stone is more common in men than in women
  • More common in the workers with less mobility and bed patients
  • Liver insufficiency, excess of the vitamin D and other similar diseases ease formation of stones

Stones are different on the content, color and brittleness. The most common stones are uric acide and oxalate. They can stay in the kidney, increase and fall into the ureter and bladder. 

What are the symptoms of kidney stones?

Symptoms of the disease varies depending on the location of stones. If stone totally blocks the ureter, then clinical course is more severe. This blockage causes inflammation by backflow and concentration of urine in the ureter, and serious kidney damages. If the condition lasts for a long time, it causee kidney inflammation or thinning of the kidney walls called hydronephrosis and increase in size. Kidney stones may move and fall into the ureter and bladder. In this case, they cause serious damages in the place of fall and excruciating pain in patient.

Major symptoms:

  • Excruciating pain
  • Bloody urine (visible by naked eye or microscope)
  • Pain can be continuous or intermittent
  • If stone is in the bladder, pain is felt in the bottom part of abdomen
  • Severe pain
  • Heartburn and nausea
  • Bad smell urine
  • Feeling of burning during urination
  • Fever and shivering (in case of infection)

Types of kidney stones

Calcium oxalate and calcium phosphate stones:

  • They make 75% of all stones
  • Calcium is an important mineral for the body. It is the main content of bones and teeth, plays role in muscle contraction and other important functions. Body required calcium is absorbed in the intestines and excessive remains extracted by the kidneys. In some people, calcium is deposited in the kidneys and thus form calcium oxalate stones.
  • 40 % of the calcium oxalate stones is connected to the family history (hereditary) factors. Some develop the stones after taking certain drugs. Other causes include hyperfunction of the thyroid, high level vitamin C intake.
  • Citrate is a substance preventing binding of calcium and oxalate to form a crystal. Citrate decrease is also a cause of stones.

Infected stones:

  • In 10-15% of the kidney stone cases, there is a ureter infection. Ureter infection is more common in women.

Uric acid stones:

  • Make 10% of the kidney stones. This is a product of normal body metabolism. Dissolved in the blood and extracted with urine. Gastroenterological system disorders, intake of some drugs, obesity and excessive meat eating are the causes of such stones.

Cystine stones:

  • In persons with congenital metabolic disorders, there is high cystine concentration in the urine, which forms stone by collection. This is the rarest type among other types. Treatment is more complex compared to other stones and lifetime observation is required for such patients.

Diets in the kidney stones:

Recommended: Animal and vegetable oils, egg white, meat, fish, poultry products, old white and black bread, vegetables (cucumber, pumpkin, white cabbage), fruits (non-sour apple, pear, apricot, banana, quince, peach), vegetable soups, oxalic tea, 2 liter liquid (low alkaline mineral waters, juices, nettle, tilia, pot marigold)

Prohibited: Vegetables (spinach, sorrel), fruit (black currant, strawberry, lemon, orange, tangerine) chocolate, cocoa, coffee, dark tea, calcium and vitamin C containing mineral waters and drugs

Limited: Salt, spices, milk and dairy products, vegetables (eggplant, carrots, beets, beans, onions, tomatoes, bell peppers, mushrooms and parsley) fat meats and liver.

Diet in uric acid stones

Recommended: alkaline mineral water, milk and dairy products, (cheese, cottage cheese), butter, eggs, vegetables (eggplant, bell peppers, potatoes, tomatoes, parsley, bay), cereals (wheat flakes, buckwheat), nuts, sugar, wheat and rye bread, pasta, sweets fruits, lemon tea, uralitin tea

Prohibited: Meat products (liver, kidney, brain, tongue, veal, fatty meat sorts), fats, concentrated meat and fish bouillons, red wine, beer, chocolate, calcium containing mineral waters

Limited: Salt, spices, dark tea, cocoa, coffee, sea and river fish, beans, yeast bread, vegetables (spinach, sorrel), fruits (figs, raspberry)

Diet in phosphate stones:

Recommended: Bread and bakery products, animal and vegetable oils, all meat sorts, fish, eggs, little sour cream, vegetables (pumpkin, green peas, beans, mushrooms) and fruits (sour varieties of apples, blueberries, currant), light tea, coffee, cocoa, sugar, honey, confectionery products, phosphalitin tea, hips tea

Prohibited: Yeast bread, milk and dairy products (curds, cheese, yogurt), vegetables, (potatoes, cabbage, carrots, beets, cucumbers, tomatoes, marrow), fruit and vegetable juices, salted and smoked meat and fish, fats.

Required tests and examinations for diagnosis:

  • Required tests and examinations for diagnosis
  • Ultrasound examination
  • Intravenous pyelography - producing an image of the renal pelvis and urinary tract by the introduction of a radiopaque fluid
  • Computer tomography

Tests to identify the stone type:

  • Stone analysis
  • Blood analysis
  • 24-hour urine analysis: checking for the substance that believed to cause stone formation (calcium, oxalate, citrate etc) and urine environment (pH)


  • The treatment varies depending on the stone type: melting, breaking, surgical method and other methods of stone extraction
  • ESWL ( Extracorporeal shock wave lithotripsy)
  • In this treatment method, shock waves break the stone from the body surface without harming the body. The method involves directing high-energy shock waves onto the stone without harming the skin and internal organs. Broken stones are extracted from the body by urination. It is not suitable for the stones bigger than 2cm, hard or totally covering the kidney.

Urethroscopy (URS)

This method is used to remove the stones in the middle and bottom parts of the ureter. It is the way of removing the stones through entering the bladder and ureter by breaking the stone or direct extraction.

Percutaneous Nephrolithotomy (Percutaneous stone-breaking)

kidney-stones-s2-illustrationNowadays, it is the most common method. A tiny incision with dimension of 1cm is made in the back flank of the patient. Stones are extracted through this incision either by breaking or as whole using pen-size instruments. Patient recovers in a short time and resume his normal life.


Note*: Open surgical method is the least common method today