When Chennai-based Subramanian had acute pain in his abdomen area a few years ago, he did not have to wait too long for the diagnosis he was expecting – kidney stones. A calcium oxalate stone of more than 6mm in size was found in his ureter, the duct from which urine passes from our kidney to the bladder. A surgery is usually recommended by doctors for a stone of this size.
Subramanian’s wife, however, insisted that the doctors not go for surgery. She wanted to try and dissolve the stone with homeopathy, and by having lots of water and vazhaithandu (banana stem) juice. But the pain was too much to handle for him, and somehow the doctors convinced the couple to go for a ureteroscopy to remove the stone.
For Dr. Thirumalai Ganesan, Senior Consultant Urologist at Apollo Hospitals, such responses from patients are all too common. From misguided dependence on native medicines to misconceptions about surgeries, there are several common myths about kidney stones which doctors like him have to deal with regularly.
What causes ‘kidney stones’?
“If I knew what definitely causes them, I would have won the Nobel Prize,” Dr. Thirumalai Ganesan says, with his trademark gentle smile. Often people think that it is a person’s diet or other environmental factors which cause stones – which is not entirely untrue, diet does matter. But, Dr. Ganesan says that genetic disposition also matters, possibly more. Research on this front is moving fast, and scientists believe that understanding the genetic basis of kidney stone formation is within human grasp.
“When patients come to us, we always ask about family history. It runs in families, there is genetic susceptibility. Not all of us have to be worried if our parents have stones, but it is a factor,” he explains. Further explaining why genetic disposition can matter more, he says, “If you look at environmental factors, like lack of water intake, humid weather and a diet with high oxalate or uric acid content, they will be common to most members of a family. But I have seen that among two siblings with the same diet and habits, one will have it and the other won’t.”
Just to be clear, he adds, genetic disposition doesn’t mean it is hereditary. “It does not necessarily pass on from one generation to another, it could just be in the genes of a person.”
Diet matters, but only so much
The treatment for a stone depends on its type, size and location.
There are different types of kidney stones, like calcium stones, uric acid stones and cystine stones. In India, a significant majority of the stones are calcium stones, which cannot be dissolved with medicines unlike uric acid stones. Cystine stones are rare.
“If it is a stone less than 5mm in size, we just put them on medication and a specific diet, and there is a 90% chance they will pass the stone out on their own,” he says. And yes, vazhaithandu juice can help with that. It will help push the stone out. However, this is where the misconception begins. It cannot 'dissolve' a calcium kidney stone.
Vazhaithandu juice, and several other beverages like beer and kernel juices, are diuretics - they help with the mechanical function of increasing the production of urine, thereby ‘pushing’ the stone out. In fact, research on rats has also shown than vazhaithanduj uice can help with some dissolution of both urinary and kidney stones. But that is not enough proof of its efficacy on humans if you have large stones in your kidney. “There is no medicine which can dissolve calcium stones in humans. I have had patients who refuse surgery and return to me after a year of native treatments etc., and the stone has only gotten bigger,” he points out, “The pain is immense if the stone is bigger than 6mmin the ureter.”
“I am not trying to discredit native treatment, some of it might work. And I am not saying allopathy is the best. If it’s a small stone, alternative treatment can be tried – but if it’s a big stone, then you must consider some form of intervention. It is too much of a risk since the chance of infection is more, especially if you are a diabetic,” he warns.
Dr. Thirumalai Ganesan
Even with water intake, the doctor points out that simply drinking a bottle of water in the morning and evening will not be useful. “You have to pace the consumption and drink a glass of water every hour or so, so you pass urine at least 5-6 times a day,” he explains.
Safe surgeries
The hesitation to have surgery comes from the belief that it can be dangerous. But times have changed, and today a patient can go home after a kidney stone surgery on the same day, without any major pain or risks.
There are several types of surgeries to treat large kidney stones, including mini-PCNL, conventional-PCNL and ureteroscopy. Kidney stones can also be treated with Extracorporeal Shock Wave Lithotripsy, in which shockwaves are sent from outside the body towards the stone in a targeted manner, which blast the stones into pieces.
PCNL (Percutaneous Nephrolithonomy), known commonly as puncture surgery, is done usually for stones inside the kidney or upper ureter. In the mini-PCNL procedure, an incision is done through the skin, a small tube is inserted, the stone is broken into small pieces using laser and a plastic stent is put in. The patient would then pass the stone out along with urine. This is very safe compared to the conventional-PCNL, where a bigger tube is inserted and the stone is taken out during surgery itself. With the mini-PCNL procedure, the patient can be discharged on the same day. “You can come in the morning, have the surgery and leave in the evening,” Dr. Ganesan says.
“The other way is we send the tube through the urethra, and break the stone. This is also preferred, as the patient can be discharged on the same day,” he says, explaining ureteroscopy, which is usually preferred for stones in the lower ureter.
Diet can be very important in preventing kidney stones, and food rich in minerals, citrates, and vitamins are recommended for people with kidney stones. “In the case of large kidney stones, the pain can be very high and native treatments might not be effective. Surgery is recommended for such patients,” he says.
This article has been produced by TNM Marquee in association with Apollo Hospitals.