What Size of Kidney Stone Requires Surgery?

Kidney stones result from conglomerations of crystals that form when minerals in the urine increase. The treatment of kidney stones varies depending upon different factors, like kidney stone size and location. Using the latest technologies, like X-ray, renal ultrasound, and CT scan, the doctors easily personalize the treatment by determining the stones' location, size, and severity of urine flow obstruction. 

However, out of all the factors, size is the most important factor determining the treatment course. Many stones can be treated using conservative management pain control medications, hydration, and medical expulsive therapy. But, if the stones are larger, they won't pass out without the help of surgery. With the advancements in medical science, minimally invasive surgery for kidney stone removal procedures makes it easy to remove the stones with reduced chances of complications and issues. 

What are Kidney Stones?

Medically defining kidney stones are solid deposits of minerals due to the accumulation of minerals, salts, and other substances found in urine. The size of kidney stones can vary in size and composition, ranging from tiny particles resembling grains of sand to larger solid masses. The formation of kidney stones can be associated with different factors, like dehydration, dietary choices, genetic predisposition, certain medical conditions, and medications, like diabetes, obesity, gout, primary hyperparathyroidism, and any chronic diarrhea state. 

Understanding the Size of Kidney Stones 

Determining the size of a kidney stone accurately is crucial to choosing the right course of therapy. Physicians can measure and characterize a stone's size in a few different ways.

The millimeter (mm) is the most widely used and accepted unit of measurement. Kidney stones less than 5 mm can be easily removed from the body, but those larger than 10 mm seldom do so. Rather than being given a specific size, stones can be defined as being "less than" or "greater than" specific size cutoffs.

Doctors may use relative phrases such as "small," "moderate," or "large" to describe the size of the kidney stone instead of giving a precise measurement in certain situations, mainly if the stone is difficult to see on imaging. Patients can still use this to get a general sense of whether they could benefit from active treatment.

Imaging procedures such as kidney ultrasounds, CT scans, or X-rays of the kidneys, ureters, and bladder (KUB) are used by clinicians to quantify a stone. Using the built-in measuring tools in these photographs, they can measure the longest diameter of the stone in millimeters. It is possible to record two or more dimensions for irregularly shaped stones.

Surgeries for Different Types of Kidney Stones

The course of treatment for kidney stones is determined by several variables, such as the kind of kidney stone, its size, location, and the symptoms it produces. The following are some typical surgical techniques for treating various kinds of kidney stones:

Extracorporeal Shock Wave Lithotripsy (ESWL)

In this procedure, high-energy shock waves break down the kidney stones into smaller pieces, facilitating their passage through the urinary canal. It is recommended that small to medium-sized stones (often less than 2 cm) in the kidney or upper ureter are frequently treated using ESWL.

Laser Lithotripsy

In this procedure, the kidney stones are broken into tiny pieces using a laser fiber, which can be removed naturally or by other means. This treatment for kidney stones is suggested when they cannot be removed by ESWL, such as when they are bigger or lodged in the kidney or lower section of the ureter. 

Percutaneous Nephrolithotomy (PCNL)

It is one of the minimally invasive surgeries for kidney stone treatment, where laparoscopic instruments are used to make a small incision in the back, and a tube is put straight into the kidney to remove or break up the stone. The PCNL surgery is appropriate for kidney stones resistant to conventional treatment forms or bigger stones (usually over 2 cm). 

Ureteroscopy (URS)

Ureteroscopy treats stones in the ureter, particularly in the middle and lower segments. A ureteroscope, a narrow tube equipped with a camera, is used to access the stone and pass through the bladder and urethra. After that, the stone can be eliminated with a basket-like tool or broken up with a laser.

Open Surgery

Although open surgery is not commonly performed for kidney stones these days, it is one of the last resort to remove kidney stones in complicated instances. It is suggested in circumstances where less-invasive surgeries failed or cannot be utilized, anatomical abnormalities, like PUJ obstruction, morbid obesity, renal transplantation, or severe limb contractures. 

Causes and Symptoms of Kidney Stones

Kidney stones can affect anyone, although males are more likely to get them. Kidney stones typically affect males in their 30s and 40s. Although the exact causes of kidney stones are unknown, elevated levels of specific minerals in the urine are typically the reason.

These minerals consist of calcium, uric acid, and oxalate. Low urine production increases the likelihood of stones forming because it lessens the body's ability to flush out the high concentration of minerals. However, knowing the type of kidney stone can help doctors analyze why. There are different types of kidney stones, like: 

• Calcium Stones - Formed due to certain fruits and vegetables, like nuts and chocolate, high dosage of vitamin D, intestinal bypass surgery, certain medical conditions, like renal tubular acidosis, or medications to treat migraines or seizures 
• Struvite Stones - Formed in response to UTI
• Uric Acid Stones - Formed due to loss of excessive fluid because of chronic diarrhea or malabsorption, following a high-protein diet, and certain medical conditions, like diabetes or metabolic syndrome
• Cystine Stones - Formed in individuals diagnosed with a hereditary disorder,cystinuria, which increases the secretion of specific amino acids in kidneys

Here are the symptoms that indicate the presence of kidney stones: 

• Intense pain in the abdomen, back, and sides 
• Excruciating pain while urinating 
• Fluctuation in the severity and intensity of pain 
• Going to the bathroom frequently
• Red, brown, pinky, or cloudy urine 
• Burning sensation while urination
• Experiencing vomiting and nausea

Risk Factors of Kidney Stones

Myriad factors can increase the chances of developing kidney stones in an individual. Here is a list of risk factors that one should keep in mind and take essential steps to avoid the formation of kidney stones: 

• Family or personal history 
• Dehydration or drinking less water 
• Following a diet that's high in protein, sodium (salt), and sugar 
• High BMI (Body Mass Index) or obesity 
• Digestive diseases and surgery, like gastric bypass surgery
• Medical conditions like renal tubular acidosis, cystinuria, hyperparathyroidism, and frequent UTI
• Certain medications, like vitamin C, dietary supplements, excessive consumption of laxatives, calcium-based antacids, and certain medications for migraines or depression

Wrapping up, 

Kidney stones can be formed for numerous reasons; however, the treatment of kidney stones depends upon their size and location. Usually, doctors recommend conservative treatment options, like medications and therapies, to pass out the stones, but in some cases, the doctors might suggest minimally invasive surgeries depending upon the size. Small kidney stones, less than 4mm, pass out by themselves. For stones larger than 4mm, ESWL (Extracorporeal Shock Wave Lithotripsy), URS (Ureteroscopy), and PCNL (Percutaneous Nephrolithotomy) are suggested to remove the stones quickly and without requiring extended hospital stays.

Apollo Spectra's center of excellence can assist patients in overcoming the excruciating pain and other symptoms caused by kidney stones. With specialized and board-certified doctors and access to state-of-the-art technology, our doctors will plan a personalized plan per the diagnosis, patient's preference, and need of the hour. Schedule an appointment today or visit the nearest Apollo Spectra Hospital with your concerns.