Kidney stones are often associated with severe flank pain, but some stones act as silent threats, damaging the kidneys without obvious symptoms.
A man in his early 40s visited the clinic complaining solely of frequent urination. Diagnostic imaging revealed a large 3–4 cm stone in his right kidney, obstructing the urinary tract, causing additional stones to form, and leading to urine backup that resulted in kidney swelling.
Remarkably, the patient experienced minimal pain. Had treatment been delayed due to the lack of symptoms, his kidney function could have significantly declined within a few years. Many patients presenting without symptoms already have irreversible renal damage.
The stone’s size and position made extracorporeal shock wave lithotripsy (ESWL) unsuitable. The patient opted for percutaneous nephrolithotomy (PCNL), a procedure involving a 1 cm incision in the skin behind the kidney to allow endoscopic access for direct stone removal. PCNL enables visualization of the kidney’s interior, facilitating the fragmentation and extraction of large stones.
During surgery, the primary stone was fully fragmented using a laser. A smaller stone, located deep within the kidney, was challenging to access through the initial pathway. After discussion with the patient, surgeons used a flexible endoscope to create an additional route, successfully removing all stones.
The combination of PCNL and retrograde intrarenal surgery (RIRS) with a flexible ureteroscope is increasingly common for complex cases. The procedure was successful, and the patient is recovering well.
This case underscores a critical point: kidney stones can grow silently, impairing renal function without symptoms. Larger stones, especially when asymptomatic, pose significant risks. Kidney function declines gradually, and once lost, is difficult to recover.
Even without symptoms, suspected kidney stones demand prompt diagnostic evaluation and treatment. The kidneys can fail quietly, and vigilance is essential.
Lim Hye Jung, HEALTH IN NEWS TEAM
press@hinews.co.kr