 Good morning my name is Dr. Pupat Singh Bhatni, I am a Senior Consultant in Kidney Transplant Surgeon in Manipal Hospital, Kharadi, Pune, Practicing Girology since last 21 years. Today we are going to discuss about the kidney stones. I will brief you about what are the causes, how can we prevent, what are the treatment modalities of the kidney stone formations. Let's start with what is kidney stones practically are. Kidney stones are formed when they exist amount of crystals are formed in the urine and these crystal precipitates and form the niolus for the stone formations. Doctor, can I get a stone? Probably in the population anybody can get the stones, though who are at the risk of forming a stone. A patient with a past history of stone formations, they have a high tendency of forming a stone. One, patients who are taking a diet which is more centric to high protein diets they are more chance of getting the stone formations. Patients with a history of intestinal stones in the past, they are more risk of getting the stone formations. Patients with a medical disease of the kidneys like polycystic kidney disease, they are more prone to get the stone formations. Also, these are family histories of stones, you do get a tendency of forming this. Overweight, Cedentry, Lifestyles are also the risk factor for forming a stone formation. Now how can I diagnose Doctor, I am having a stone. See, normally you can diagnose a stone when you get a acute attack of pain and a pain which is severe intensity in the back, coming in the front and which is causing a discomfort to you going to the hospital and most likely you are dealing with a kidney stone. This is one of the findings which we come across in our patients and in our patient departments. Sometimes patients do present with blood in the urine, the second most common modality by which we diagnose the patient with a stone. Another symptoms are burning in the urine, fever and chills can also be the presentation for the kidney stones in the patients. Now once a patient is there with this symptom, what is to be done? First primary modality is to relieve the patient from the symptoms. How we reduce? Patient should be given the pain cure in the outpatient department to release in from the pain first and then we diagnose whether the patient is having a stone or not. How to diagnose? The basic investigations are done on the patients in the form of ultrasonic graphic examination of that domain. We are able to diagnose the block in the kidney, the stone size, stone location and how much other findings like in the, is it because of the stone or some other reasons of causing the pain was there. We can associated bowel abnormalities can be detected by the basic ultrasonic examinations. In addition to that, we do do patient urine examination to see whether the crystals are there, whether the bacteria is there, whether infection is there in the patients. Also the basic blood investigation in the outpatient department to know hemogram, kidney function test as a basic protocol in all patients. After diagnosing the patients, we do offering the treatment modalities. It depends on the size of the stone, location of the stone, blockage of the kidney pipes, how we are going to treat these patients. Modalities of treatments are quite variables. We give a medical therapy in most of the patients if a small stone is stuck in the pipe and approximately 70 to 80% patients do respond if a size of stone is small with a medical therapy in the form of anti-inflammatory pain relief tablets and the pipe to relax the kidney pipes and it do help to get the complete clearance of stones. Other modalities which come across is the outpatient department in the shockwave treatment. Patients who are having a stones which are there sitting in the kidneys, they can be treated without any operation non-surgical treatment by the shockwave treatments in which two to four sessions, majority of the stones get cleared by the shockwave therapy. Other modalities are endoscopic surgeries in which we depending upon the location of stone and the size of the stone, its stones are stuck up in the lower part of the kidney pipe for the urator. We do it by the urotoscopic procedure. It's a procedure in which patient admitted for a one day in the hospital and with the legit instrument we take out the stones. Other modalities we have now advanced treatment in our hospital by the flexible machines. We go into the flexible RIRS procedure in which we can go up to the kidney chambers and take out the complete clearance of stones. Our patients with a very large bulk and hard stones are treated by making a key hoot surgeries, making a small hole in the back and we take out the stone and patient do get admitted for two to three days in the hospital to get the complete clearance. Now come how can we prevent the stone formation or some few basic questions which are come across in our patient department from the patients. What is to be done? Our dietary advice is very important in the patients. I recommend all patients or in the population also drink a lot of water. It should be at least 2.5 to 3 liters. The best indicator is the color of urine should be the color of water which is the hydration status of the body by which we tell the patients people are low salt diet. It prevents the stone formation and third most important is low on the proteins. Low protein diet helps in reducing the recurrence of the stone in the long term in the patients. Patient do ask few basic questions. One, doctor can I get a tomato, brinjal, palak. These are also for modernity's care. Are these causing the stone formations? Fact is no, our dietary tomatoes does not cause the stone formations. Dietary palak and all other seeded foods don't cause stone formations. Takeer in excess quantity, we tell the patient not to take others in excess quantity but the normal lifestyle, these products are not the cause of stone formations. Doctor, is it a milk is the cause of stone formations? Answer is no, milk does not cause the stone formations. Patient can have a 2 glass of milk per day in a normal lifestyle. Doctor, is it the calcium supplement which I am taking is the cause of stone formation? Answer is spectacularly no. It calcium supplements does not cause the stone formations and it should not be restricted if a doctor has advised you for the orthopedic issues. Fluid habits, doctor you are talking about the fluid, can I take any form of fluids, can it be the cola drinks for me or the heart drinks? Answer is no, you have to take a water. Water is the only consumption of the water can prevent the formations. Other fluids in the form of tea, coffee, cola drinks, heart drinks, they does not prevent the stone formations. Instead, they do causes the formation of crystals and leads to stone formations. Very commonly asked doctor, can I have a beer which is and can lead to the stone relief? Answer is no. Intake of beer itself causes a lack of fluid concentrates from this thing and niolus for the stone formation. So, it is not encouraging to, encouraging from our end to drink beer. You should be taking a water. Quite often we come across patients asking doctor, I am sitting in the AC environment. Do I need to drink water still because I don't feel, I don't having this thing. Presence of sitting in an AC environment causes the lack of moisture also and yes, you do need to drink a water even if you are sitting in the AC environment. Very commonly asked question from the patients, doctor, I don't have a pain now. I had a stone last week but I am totally pain free now. Do I need to investigate unsuspectingly? Yes, you should get yourself investigated even if pain is not there because absence of pain does not mean you don't have a stone. You need to consult your doctor, get ultrasound scan done and then confirm this thing. Doctor, very commonly asked questions, give me the saline therapy or the IB fluids to get rid of stone. In a practical current scenarios, there is no evidence of any IB fluids can lead to the clearance of the stones on the pipe. IB fluids do help in a patient to relieve the pain or those who cannot take the oral intake of fluids but it is not any by chance lead to the clearance of the stone. Oral intake of water is sufficient, no IB fluids cannot lead to the clearance of the stones. We should not be incurring this type of habits. Doctors, ocean Poimand Anlias, I will go undergo operation, endoscopic surgeries do lead to the recurrence of the stone. Answer is no, no endoscopic surgeries can lead to the recurrence of stone formations. If a small fragment has been kept left or missed by the doctor, it can be the source of Midas but endoscopic surgeries itself cannot lead to the formation of stone in the future. You can safely consult your doctor, get your stone treated. At the end, I would say, drink a lot of water, low salt diet, low protein diet, do daily exercise for 45 minutes, healthy lifestyle and control your weight. This is what is required for most of the patients. Thank you.