Kidney Stones Q&A with Mr Leye Ajayi
29th September 2017
London Urology provides a rapid, specialist service to all patients seeking treatment for Kidney Stones. Our multidisciplinary team of experts use the latest techniques and state-of-the-art technology to allow patients the best possible recovery.
We sat down with one of the country’s leading Urological surgeons, Mr Leye Ajayi, to discuss his expertise in treating Kidney Stones.
Tell us about your background in performing kidney stone removals?
Kidney stone treatment is an area of strong interest to me. I received extensive training at a number of teaching hospitals in London and in Brisbane. I am the clinical Lead for Urinary Tract Stone Disease at the Royal Free Hospital and work to ensure our patients receive a tailored approach. The technology for stone treatment continues to improve and allows us to perform very complex kidney stone surgery using true keyhole techniques. I perform percutaneous Nephrolithomy (PCNL) in the supine position. There is a growing trend in the utilisation of this position. It ensures that the patient is in a comfortable position with safe anaesthetic, without compromising on getting the patient stone free. I am the course director of the Masterclass in Supine PCNL which are attended by UK and European Urology consultants. I performed live surgery in the form of flexible ureterorenoscopy.
How many kidney stone removal surgeries do you typically perform in a month?
I perform on average 10 ureteroscopy and laser for smaller kidney and ureteric stones and 2-4 Supine PCNL per week, for larger kidney and complex stones.
What is the average age of patients that require kidney stone removal?
The prevalence of kidney stones rises dramatically as men enter their 40s and continues to rise into their 70s. For women, the prevalence of kidney stones peaks in their 50s, however, in recent times, the peak age of stone formation in females appears to be falling. Now 13.1% of all male and 19.6% of all female stone-formers form their first stone before the age of 20 compared with 4.7% and 4.0% respectively in 1975
Once a person gets more than one stone, other stones are likely to develop.
What are the causes of kidney stones?
A kidney stone is a hard mass developed from crystals that separate from the urine within the urinary tract. Normally, urine contains chemicals that prevent the crystals from forming. These inhibitors however, do not seem to work for everyone, so some people form stones. If the crystals remain tiny enough, they will travel through the urinary tract and pass out of the body in the urine without being noticed. There is a theory that kidney stones form in patients who become dehydrated. The concentrated urine becomes saturated by some chemicals which crystallise to form a stone.
What are the main warning signs of a kidney stone and how are they diagnosed?
Usually, the first symptom of a kidney stone is a sudden onset of extreme pain on the left or right side of the abdomen. This occurs when the stone suddenly moves from inside the kidney and blocks the flow of urine from the kidney. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen, this is called renal colic. Sometimes nausea and vomiting occur. Later, pain may spread to the groin. Occasionally, patients have blood in their urine.
The clinical history alone gives a very good inclination. However, to make an accurate diagnosis, we perform a CT scan without contrast. This takes 5 minutes and allows for a prompt diagnosis.
Are there different types of kidney stones?
Kidney stones may contain various combinations of chemicals. The most common type of stone contains calcium in combination with either oxalate or phosphate. These chemicals are part of a person’s normal diet and make up important parts of the body, such as bones and muscles.
A less common type of stone is caused by infection in the urinary tract. This type of stone is called a struvite, infection or triple phosphate stones, as they are made up of magnesium, ammonium and phosphate. Another type of stone, uric acid stones, are a bit less common, and cystine stones are rare.
When should a patient seek medical advice?
A patient should seek medical advice if they develop severe pain which is persistent or uncontrollable with normal painkillers.
What would be the timeframe from the initial consultation to undergoing surgery?
This will depend on local policy and expertise. At London Urology, we have a dedicated team and a robust stone pathway, which ensures our patients with kidney stones, are seen and treated the same day if clinically indicated.