Kidney Stones
Symptoms, when to seek urgent care, and modern stone treatment with ureteroscopy and laser in Johannesburg.
Recognising a kidney stone
Few pains are as memorable as a kidney stone: sudden, severe pain in the flank that comes in waves and can spread to the groin, often with nausea and blood in the urine. Stones form when minerals crystallise in the kidney; problems start when a stone moves and blocks the flow of urine.
When it is an emergency: a stone with fever, shaking chills or feeling very unwell can mean an infected, blocked kidney. Go to a hospital emergency department immediately — do not wait for an appointment.
Diagnosis and treatment
A low-dose CT scan is the most accurate test — it shows the size and position of the stone, which determines the treatment. Blood and urine tests check kidney function and look for infection.
- Small stones (roughly 5 mm or less) often pass on their own with pain control, fluids and medication to relax the ureter — with follow-up imaging to confirm the stone has passed
- Ureteroscopy with laser: a fine telescope is passed up to the stone, which is broken up with a laser and removed — no incision, and usually a day case
- Large kidney stones that are best treated through a small opening in the back (PCNL) are referred to my colleague Dr Attie Visser
Ureteroscopy: what to expect
One stage or two
How a stone is treated depends on its size and, above all, on how easy it is to reach — for a stone operation, access is everything. If the ureter is narrow or the stone is difficult to reach, a small stent is placed first to let the ureter widen, and the stone is treated at a second procedure; the stent is then removed in theatre at that second stage.
Stents
A stent is a thin, soft tube placed inside the ureter to keep urine draining while it heals. When the stone is treated in a single session and a stent is still needed, I use a magnetic stent that is removed quickly in the rooms — no further procedure or anaesthetic. Stents usually stay in for 7 to 10 days. While a stent is in, some discomfort, frequency and blood in the urine are normal.
Going home
Ureteroscopy is usually a day case. Drink plenty of fluids, and contact the rooms if you develop a fever, severe pain or cannot pass urine.
Preventing the next one
Stones often come back, and much of that is preventable: enough fluid, dietary adjustments and, for people who form stones repeatedly, tests to find out why. It is worth doing properly.
- Stone analysis — the removed stone is sent to the laboratory to find out what it is made of, which guides prevention
- A metabolic stone work-up for recurrent stone formers — blood and urine tests that look for the underlying chemical cause
- Tailored advice on fluids and diet, and medication where it helps
If you have been told you have a stone, or recognise these symptoms, book a consultation. Call 011 794 3549 or email appointment@urology.joburg.
This information is general in nature and is not a substitute for a consultation.