Urinary Stones

By in Urology

Dec 14, 2018

Comprehensive Guide to Understanding and Managing Urinary Stones

The human body contains two marvelous organs, the kidneys, which continuously filter blood and remove waste and harmful products. The kidneys are connected to the urinary bladder by separate ureters, which store urine until it is emptied. This intricate system is susceptible to various diseases, among which stones are a common issue that can be treated by the best nephrologist in Faridabad.

On average, the lifetime prevalence of stone disease ranges from 1% to 15%. It is relatively rare below 20 years of age and is two to three times more common in men than in women. High prevalence is observed in hot, arid, and dry climates like Rajasthan. The highest incidence is seen in summer months, and the risk also increases with body weight.

Types of Urinary Stones

Three-fourths of all stones contain calcium, making them visible in X-rays. Calcium oxalate is the predominant stone variant (60%). Non-calcium stones include struvite (infection stone) and uric acid stones. Uric acid stones are not visible in plain X-rays but can be detected by CT scans.

Symptoms of Stone Disease

Stones most commonly present as excruciating pain starting from the flank region and radiating to the groin or genitalia. Patients may feel nauseated or vomit, and often find no relief from the pain. Other symptoms include a burning sensation during urination, frequent urination with small amounts of urine, and occasional blood in the urine.

In some cases, stones may silently damage the kidney. They can block drainage from the kidney, leading to hydronephrosis (swelling of the kidney) and, in extreme cases, complete loss of kidney function.

Diagnosis of Stone Disease

Suspicious history or non-specific abdominal pain may lead to investigations that detect stones. Ultrasounds and X-rays can identify stones larger than a few millimeters, but each method has its limitations. Plain CT scans of the abdomen are up to 98% accurate in detecting even the smallest stones. Specialized radiological tests like IVP or CT-IVP may be required for proper evaluation before any surgical intervention.

When to Treat Stones

While many small stones pass uneventfully, larger stones or those farther from the urinary bladder have a decreased probability of passing on their own. Observation with periodic ultrasound is safe for small renal stones in the kidney’s periphery. However, some stones require surgical removal, including:

• Small stones blocking urine flow from the kidneys
• Large (staghorn) stones in the kidneys
• Stones in the upper ureter causing pain
• Stones larger than 5 mm in the ureter causing pain
• Bladder stones larger than 1 cm
• Stones in a single kidney
• Infection stones
• Recurrent UTIs
• Stones in individuals working as pilots or in the military

Treatment Modalities

• Medications: Small stones (<6 mm) in the lower ureter can be treated with antibiotics, painkillers, and medicines to relax the ureter. Immediate surgical intervention is required if pain persists, the stone remains for over two weeks, or fever with chills develops.
• ESWL (Lithotripsy): A non-invasive treatment that uses shock waves to break stones into small pieces, which are then passed in urine. Suitable for stones up to 2 cm.
• PCNL: Removal of stones through a 1 cm incision using a nephroscope, achieving >95% clearance rates. Patients are usually discharged on the 3rd or 4th day after surgery.
• URS: Removal of ureteral stones with a specialized scope.
• Litholopaxy: Crushing and removing bladder stones using a cystoscope.
• Laparoscopy: Used for specific circumstances involving large or poorly positioned stones.
• Open Surgery: Rarely required in modern practice due to technological advancements.

Choosing the Right Treatment

The choice of treatment depends on various factors, and the consultant urologist is best suited to recommend the appropriate modality based on the case’s merits.

Residual Stones

Complete clearance of stones is the goal, but some residual stones may remain. As long as these stones do not obstruct drainage, they are usually not a concern but require regular monitoring.

Recurrence of Stones

There is a 50% risk of recurrence in ten years for first-time stone formers. Regular annual check-ups are necessary to detect recurrences early.

High-Risk Cases for Recurrence

• Family history
• Intestinal disease with chronic diarrhea
• Pathological skeletal fractures
• Osteoporosis
• Urinary tract infections
• Gout

Dietary Precautions to Prevent Recurrence

• Increase daily fluid intake to ensure urine output of >2.5 liters/24 hours.
• Consume lemonade and orange juice, which contain citrate.
• Reduce animal protein and high sodium intake.
• Avoid high carbohydrate, high protein, and high-fat diets.
• Do not avoid dietary calcium; milk is a safe source.
• Limit intake of oxalate-rich foods like spinach, tomatoes, beets, chocolates, nuts, and tea.
• Restrict Vitamin C to < 2 gm per day.

Ignoring or neglecting stone disease can be dangerous for kidney health and overall longevity. Consultation with a urologist is essential for effective evaluation and treatment. Metro Hospital is the best heart hospital in Delhi/NCR, offering top-notch care for urinary stones.