Summer Alert: 40% Increase in Kidney Stone Risk; Treatments Available in UAE

Many people are searching for kidney stone treatments in Dubai.

What are kidney stones? 

Kidney stones are like stones in any other part of the earth. If you go on the road and you look at a stone, a similar kind of stone forms in the human urinary tract. In the human body, 90% of stones are due to a combination of calcium , oxalate or uric acid or a combination of calcium, oxalate and uric acid. So, if you look at it from a chemistry point of view, when there is too much of a salt in a solution, the salt precipitates. In the same way in the kidney, if there is too much calcium or uric acid or oxalate compared to the amount of urine or water that is available in the system, it will precipitate. So, 90% of stones are either calcium oxalate, uric acid or a combination of both.

How do people form stones?

If there is too much calcium, oxalate or uric acid in the urine or the urine is too concentrated because the patient is working in very hot climates like labourers in the open or engineers in a ship engine room or policemen on the street or anybody who is sweating a lot, then, the urine is very concentrated. They start forming into crystals, the crystals grow into stones and the stones cause the problems. The human body also has a system to prevent calcium, oxalate and uric acid from getting together in forming a relationship. There are many substances in the urine like magnesium, citrate and some organic materials which prevent calcium ,oxalate and uric acid to get together and form an association.

If the level of magnesium and citrate in your urine is low and the level of calcium and uric acid is high, then there is more chance of you forming a stone. In summary, if you want to prevent stones even if you may not be a known patient with stones, the best way to prevent stones is to reduce calcium and uric acid in your diet and increase the fluid inatke. The simplest way of increasing your fluid is to drink sufficient fluid so that your urine looks like water. If you find that your urine is looking yellow, make sure you go and drink a few glasses of water to make it colorless again.

How do you reduce the calcium and uric acid in your diet? Make sure you do not eat too much red meat. Make your diet something like one day of red meat in a week, but that does not stop you from eating chicken and fish. So, as you do not eat too much shellfish, shellfish can also cause increase in uric acid and calcium.

The history of the patient is most important. The patient will come with sudden onset of pain on one side of the abdomen, radiating to the groin with vomiting and difficulty in passing urine and nothing relieves his pain. He may even come in an ambulance. In such a situation, they go to an emergency department and the first thing that is done is to give them pain relief, which may need strong pain killer even like pethidine or morphine or tramadol .

Once the patient settles, the best way to diagnose the kidney stone or the ureteric stone is to do a CT scan. 90% of stones will pass with medical management. Stones that are less than 6mm can pass with medications to increase the size of the urinary passage. We also give pain killers and medicines to reduce the size of the stone, helping it to slip through.

Many people ask, how do I know I have a kidney stone? 

The most severe form of pain in the human body is from kidney stones. Women patients tell me that the pain of a kidney stone is more than pain of delivering a baby. It usually starts on one side of your body from the back to the front, radiating to the groin and it is so severe that many patients come in an ambulance to the emergency department. You feel nauseated, you feel like vomiting, you feel like rolling on the ground, you feel like passing urine, you feel like passing stool, but nothing relieves your pain. And most often these are small stones which cause more problems. As they say, small people talk more.

Same way, the small stones cause more pain. Why do they do that? It is because the stone is always formed in the kidney which has a lot of space. But from the kidney, the passage down to the urinary bladder is only four millimeters wide. When these small stones go out of the kidney and go into the ureter (or the passage going down to the bladder), they block it. When it blocks it, the pressure of urine in the kidney builds up so high that it is the most unbearable form of pain.The patient wants to vomit because it reflexly affects his stomach and intestines. The whole abdomen goes into disarray. 


How do we remove the stones from the urinary tract?

In 10% of patients with stones, the stones don’t pass. They are bigger in size and cause obstruction and infection in the urinary system. They cause deterioration in kidney function. And the patient needs repeated admissions due to pain. In these situations, urologists come into the picture to remove the stones from the urinary tract.

Suppose the stone is in the kidney. It’s not very painful. But if the stone is more than 6 millimeters in size, there is a high possibility that that stone will move out of the kidney into the smaller passages and cause severe problems. In such a situation, we have a procedure called ESWL, (extra corporeal shockwave lithotipsy). The patient lies on a table. And like a video game, we using ultrasound and x-ray will localize the stone. And we use high intensity ultrasound and sound waves to break the stone into small pieces so that they will pass out the kidney easily without any pain.

Suppose the stone has already passed out the kidney and entered into the narrow tube leading from the kidney to the bladder. The patient will be in severe pain. We treat the patient according to the size of the stone. Suppose the stone is 6 or 7 millimeters. We tend to treat the patient conservatively with painkillers, methods using medicines to increase the size of the tube so that the stone can slip out and methods to use medicines to dissolve the stone. But still in 50% of patients, the pain is not relieved and they need to have intervention.

How do we intervene in these patients who have stones in the ureter? 

If the stone is very well seen on X-ray, we can still do a non-invasive treatment called ESWL. This treatment, which I mentioned earlier, is extra corporeal shockwave lithotripsy. 

If the stone is not visible on X-ray or it is in a situation or the size is too large, we need to do invasive procedure. But it does not involve cutting your abdomen or your stomach open. This is all done through endoscopy. For the last 40 years, urology has evolved in such a way that most stones can be treated by endoscopy. We give you anaesthesia, we go through the urinary tract, we go into the ureter, we see the stone, we break it with a laser into small powder or dust and remove the stone. 

What do we do with a large stone in the kidney? 

Very rarely we see large stones in the kidney. Seeing large stones in the kidney is more common in underdeveloped nations, where patients don’t have access to health care. In advanced nations, for every small complaint, they have access to the health system. In underdeveloped nations, unless the symptoms are so severe, very often patients don’t reach the hospital. 

For stones more than 2-3 cm we do minimally invasive surgery. 

One method is to do Retrograde Intrarenal surgery (RIRS). Flexible endoscopes of small cailbre are passed into the kidney from the bladder and laser is used to completely fragment the stone.

Another method is called PCNL or percutaneous nephrolithotomy. We make a one-centimeter cut over the back of the patient under anaesthesia and directly enter the kidney with special equipment. The stoneis broken into small pieces with special equipment, we remove all the pieces and the patient stays in the hospital for one day before he is discharged. 

Best kidney stone treatments in Dubai?

Many people are searching for the best kidney stone treatments in Dubai?. The Urology Department at the Al Zahra Private Hospital offers both pediatric and adult urology services. The department has five Urology Consultants available from 8 am to 8 pm, seven days a week. Urology Emergency Services are available 24 hours a day. The department consists of four Arabic Consultants and one Indian Consultant who speak multiple languages, including English, Arabic, Hindi, Tamil, Malayalam, Kannada, and Konkani.

The department is equipped with the latest equipment, including urodynamics, ultrasonography, transperineal biopsies of the prostate, Resume procedures for prostate surgery, and Thulium lasers for the treatment of prostate diseases and urinary stones.

In general, kidney and ureteric stones are the most common problems faced by most urologists in the world. It should be mentioned that once treated stones can recur. At least and annual check up with the urologist is mandatory.