Jakarta, IO – 2020 National Basic Health Research (Riskesdas) data reveals the prevalence of kidney stones in Indonesia at 3.8%, or 739,208 people. It is estimated that 6 out of 1,000 residents suffer from kidney stones, an affliction which becomes a burden on the family and impairs the quality of life. However, kidney stone sufferers usually do not experience symptoms, so they generally only seek treatment when the stones have enlarged, making therapy more painful, complex and difficult.
“A person is at risk if a family member has ever suffered from kidney stones. Another risk factor is dehydration or lack of fluids, especially for people who live in warm and dry climates: they tend to sweat and excrete more fluids than they take in. Consuming high protein, sodium (salt) and sugar can also increase the risk,” observed Prof. Dr. dr. Nur Rasyid, Sp.U(K), a urologist from Siloam Hospitals Asri, Jakarta, in a media briefing with the theme “Diagnosis and Treatment of Difficult Cases of Kidney Stones with Retrograde Intrarenal Surgery (RIRS) Procedure”, which was held on Wednesday (5/6/2024).
It was revealed that obesity, suffering from a digestive disease, having recently had a surgical procedure, or medical conditions such as renal tubular acidosis, cystinuria, hyperparathyroidism, recurrent urinary tract infections, frequently taking certain supplements and medications, also increase risk. “We need to be alert if urine is dark colored. Every day an adult excretes at least 2.5 liters of urine on average, so please drink enough water because fluid can also come out as perspiration. A patient will feel very severe pain when urinating and run a fever,” he explained.
Healthcare methods in the fields of urology and nephrology are developing, both globally and nationally. In Indonesia, the newest treatment method for kidney stones in the field of urology is “Retrograde Intrarenal Surgery” (RIRS). RIRS is a surgical procedure which leaves the patient without scars, so they recover more quickly and can return to normal activities.
“Basically RIRS is a kidney stone crushing procedure, using a laser. Before undergoing the RIRS procedure, patient must undergo a laboratory examination, followed by a CT scan, which is currently accessible and has become the standard for tracking urinary tract stones. Apart from determining the location and size of a stone, additional important information is the hardness of the stone in Hounsfield Units (HU). Patients should also stop taking platelet aggregation inhibitors 5 days before commencing therapy,” he warned.
Depending on the size and type of Stone
RIRS has a high level of accuracy because it can access the kidney directly and pulverizes kidney stones, breaking them into small fragments, shaped like sand or dust. In choosing an RIRS procedure, a doctor will consider factors such as the size and type of stone, as well as the patient’s general health condition.
“Information on stone hardness changes the algorithm and recommendations of urologists in treating urinary tract stones. ESWL therapy is increasingly limited because stones with a hardness of more than 1,000 HU are no longer considered, even if their size is not large. RIRS can be performed on kidney stones measuring less than 3 cm, and stones with hardness above 1,000 HU.”
Read: Never Take Antibiotics Before A Doctor Prescribes Them
The RIRS method is an innovation that provides benefits for patients, because the procedure is carried out more quickly, leaves no scars, ensures faster recovery, causes minimal pain, and there is a lower risk of infection compared to an open surgical method. The estimated time required for the RIRS procedure is a maximum of 2 hours to avoid complications such as sepsis or excessive heat from the laser. If repeat or follow-up procedures are needed, they can be carried out 1 week later, but can be postponed for a maximum of 2 months after the procedure.
“RIRS therapy, apart from being able to break stones into fine pieces like sand, in the case of very hard stones, a maximum size of fragments of less than 1mm can be evacuated during the procedure. With this tool, you can also obtain stone samples for stone analysis, so you can find out the type of stone and determine treatment to prevent recurrence,” he concluded. (est)