Jun 8, 2010

Dr G G Laxman Prabhu, a consultant Urologist and Prof of Urology, KMC, Mangalore, is popularly known as GG to his friends and acquaintances.   Boredom is the least trait one can expect in the company of this loquacious multi-talented doctor who has varied interests ranging from stamp and coin collection and learning music to his new found passion of trying to restore old Hindustani notations which are on the verge of destruction, apart from his own medical field.  A voracious reader GG is a bundle of knowledge on a variety of topics in addition to his specialized topic of Urology. 

While his other interests may require a separate write up to give the readers a glimpse of his multifarious talents in this interview with daijiworld.com he deals with everything that has got to do with Urinary Stone Disease, which is unfortunately on the rise in the last few decades.  Urinary stone disease is one amongst the many diseases that causes harm to the kidneys inflicting irreversible damage if neglected, says Dr Laxman Prabhu.

Q.  How old is the Urinary Stone Disease which in common parlance people call it as Kidney stones?

A.  This disease is as old as the mankind.  Several ancient scriptures speak about Ashmari Roga (Sanskrit word for stone disease).  Scientists have found evidence of kidney stones in a 7,000-year-old Egyptian mummy. In the Hippocratic oath taken by every doctor, there is a mention of stone surgery which says “I shall not cut for stone but leave it to those proficient in the art”, which tells us that the disease was prevalent  in those days. 

Q.  How common is the disease in our country?

A.  In general urology practice every 6 persons out of 10 (60%) have stone and unfortunately the disease has been witnessing an upward trend with more and more people becoming prone to the disease.  This is also regarded as the disease of the affluent.  We have to understand that the increase in the incidents of stone disease is due to better awareness and availability of proper diagnosis which helps in getting the right statistics and also because more people are becoming susceptible to it.    Interestingly, in India there is a preponderance of stones among people in the northern parts of the country than in the south.  Sometimes certain types of stones are found among people of certain states.  For example in Rajasthan Calcium Oxalate Dihydrate is very common where as in its cousin state Gujarath Calcium Oxlate Monohydrate is the common type of urinary stone. 

There are basically 4  types of stones  of urinary stones  commonly found among most people namely  Calcium Oxalate (calcium stone) which  is the most commonest of the urinary stones followed by Uric  Phosphatic stones, Uric acid stones and infection stones )strevite stones).  Occasionally we also come across Cystine stones which are usually big in size. 

Q.  What causes the formation of stones in human beings?

A.  Whenever a patient asks this question normally doctors advice them not to worry about such minutiae details because it is too complicated to understand. But it is necessary for people to understand the genesis of urinary stones so that they identify the symptoms.  Stone is a mass of precipitated material derived from the urine and are caused due to any of the reasons  namely:

 a. excessive precipitable material appearing in the urine resulting from intake of such material in huge quantities in the form of diet of increased production in the body.

b. Not having adequate water to hold the precipitable material in solution without occurrence of crystallization

c. Reaction of the urine when urine becomes acidic or alkaline which is called pH in scientific terminology.

d. Lack of substances called inhibitors within the body that discourage stone formation, thus creating a conducive atmosphere for stone formation

e. Stagnation of urine in the urinary tract due to anatomic impediments in the urinary tract

f. Epitaxy wherein two crystals of different chemical composition but with similar surfaces tend to cling to each other eventually forming a stone. 

In fact the entire process of stone formation can be compared to a badly managed classroom that comprises mischievous, dullards and boisterous students.  The dullards and boisterous usually cling on to each other.  The mischievous do not allow the rest to concentrate on the lessons.  In the absence of a competent teacher handing these boys becomes impossible (lack of inhibitor substance).  Finally examinations are like blocks that make these students stagnate in the same class.

Q.  What are the implications of urinary stones and how to detect them?

A. Stones can cause damage to kidneys which is brought about by blocking urinary passage resulting in infection.  A small percentage of stones can cause varying degrees of loss of kidney function which can be sudden when two stones block both the ureters completely or gradually.  aThere are basically two types of stones namely Speaking stones which speak (not literally)   by causing pain and Silent stones which cause silent but maximum damage.   That is why annual check up is a must for those who have a tendency to form stones.  In most cases stones results in pain, some people will feel irritation while urinating, fever and some stones may announce their presence by blood-tinged urine, which in medical term is know as haematuria.

Q How to diagnose the disease and what are the commonly available treatments modalities?

A.  Search is on for a 100% foolproof test but 90% of the cases can be detected by ultrasound which can also be supplemented by X rays and C T scan.  As for the treatment part there are basically 3 types of interventions commonly practiced namely, Surgery, Endoscopy and Shock Wave Lithotripsy.  But it has to be remembered that every case is different and treatment may also differ accordingly, just like the saying which goes “one man’s food is another’s poison”.    

These days with advanced surgical techniques, availability of antimicrobials to combat infections, safe and efficient anesthesia and imaging methods of high resolutions, stone surgery is effective and safe and it has stood the test of time. 

Endoscopic treatment is done through a telescopic instrument which also involves keyhole surgery, is also used to treat urinary stones in many patients.  In this procedure all manipulations are carried out through natural bodily openings or through a small incision or hole which is known as key-hole surgery.  Telescopic instruments are used to break the stone into smaller fragments before their final retrieval. 

Extracorporeal shock wave lithotripsy known by the popular acronym E S W L is the most fascinating technology developed recently in treating urinary stones.  It is a non-operative method of treating stones and the success rate is high with less complications.  In this procedure the stones are broken from outside through shock waves.   The machine can only fragment the stone and it is for the urinary track to expel it totally leaving everything to the mercy of nature after fragmentation. 

Q.   What are the chances of recurrence of urinary stones even after treatment?

A. Even after successful treatment there is a 40% chance of recurrence among people having a tendency to form stones, which in other words means that the disease cannot be eradicated completely.  It tantamount to saying that the logic of ‘prevention is better than cure” does not apply in this case.  Prevention is no doubt better but difficult in this disease.  However certain preventive measures can be adopted to keep the stone disease at check, such as by increasing water intake, cutting down high protein diet, promptly treating infections, correcting any structural abnormalities etc., which can help contain the disease to a certain extent.  These days there are some medicines which are available to curb the tendency of stone formation. 

Q. Is it true that men are more susceptible to stone diseases as compared to women?

A.  It is true men are slightly more prone to the disease as compared to women because certain hormones present in female body offer some kind of protection to them. 

Q.  What is the common misconception people harbor about urinary stones?

A.   Generally people expect even the minutest gravel to come out after the treatment.  This is not required once the big stone is treated.  Normally doctors adopt a three tier approach of patient first, kidney second and stone third.  If the doctor suggests no intervention is needed it is better to leave the stone as it is.   At the same time if removing every piece of gravel is going to harm the kidney, doctors just leave it at that as total destoning is not possible.   People have to understand that even with all the latest gadgets and availability of drugs it is still not possible to clear all the stones in all the patients all the time. Therefore patients should not think otherwise if small gravels recur or remain.

Q.  Are there any alternative treatments available for stone diseases?

A. Alternative treatment called phyto-therapy is available but there is no clear-cut proof of its utility as it is not time tested or is scientifically based.  Recently British Journal of Urology has made a mention of banana stem juice as a possible treatment for the urinary stones. 

Contact Dr Laxman Prabhu:

Cell: 0091 - 9845428532
For Appointments (Clinic) : 0091 - 824-2433506 (After 11.00am, IST)
Email : gglaxman@gmail.com