Urinary stone disease
Stones can be found anywhere in the urinary system due to process of crystallization as a results of increased production and concentration of particular solutes in the urine or less water intake which makes the urine more concentrated. It can also develop if there is an anatomical abnormality affecting the kidney, ureter or the bladder. 1 in 11 people may get kidney stones in their lifetime. It is more common in hot climate countries.
Several factors can contribute to the development of urinary stones such as:
- Suboptimum intake of water
- Hot weather
- Chronic diseases such as Diabetes, hypercalcaemia, hyperparathyroidism, gout
- Urinary tract infections
- Excessive intake of some types of food such as red meat, seafood, brown chocolates, black tea, refined sugar and salts
- Excessive intake of multivitamins
- Incomplete or slow bladder emptying
- Anatomical abnormalities
- Strong family history
Signs and Symptoms:
Urinary stones may not show any symptoms and can be found incidentally (by chance) in abdominal scans. Patients with stones commonly present as flank or back pains that may radiate to the groins or genitals. Patients with stones can also develop blood in the urine, fever, burning upon urination, passage of gravel, and/or urinary tract infection. It is important to consult your doctor if you develop any of the symptoms mentioned.
Urinary stones can be suspected from personal and family history. Tests include urine sample and imaging mainly ultrasound, X ray and/or CT. Blood tests can show if there is an associated kidney impairment, infection or contributing imbalance of blood salts. Specific tests can be conducted in special conditions to help in treatment and prevention of stones such as specific blood and urine tests, and stone analysis.
Management of urinary stones depends on symptoms, their location and size. Treatment can range from simple observation and monitoring (especially if they are not causing symptoms), medicines, and/or more invasive measures including surgical procedure. Its is usually the case to adopt multiple methods to treat the stone.
Small stones that are found by chance can be observed. Problematic stones can be treated with one of more of the options below:
- Medical management including pain killers, supportive medications such as herbal diuretics.
- Extracorporeal Shockwave Lithotripsy (ESWL): This is a technique were sound wave energy can be applied externally to aid breakage of the stones in the kidney or the ureter (pipe connecting the kidney to the bladder) without the need for anaesthesia. Patients are usually discharged the same day. This treatment is not suitable for stones bigger than 2 cm nor stones in the bladder.
- Ureteroscopic stone fragmentation using LASER or pneumatic devices. This is a procedure is done under general anaesthesia, a small camera is used and inserted through your Urethra (urinary opening) to locate the stone and guide fragmentation using LASER technology. This procedure are performed for stones in the ureter and kidney stones for up to 2 cm. No cuts or openings are needed and patients can have the procedure as a day case.
- Percutaneous Nephrolithotomy (PCNL): this is a keyhole procedure under general anaesthesia for surgical treatment of large (> 2cm) stones or stones which are difficult to reach using the simpler methods. A small cut is made in the side over the kidney area, through which a camera can be inserted and the stones are broken and extracted. This will require at least a one day admission
- Ureteric stents: These are plastic tubes inserted endoscopically through the urethra into the kidney and ureter under general anaesthesia. This is usually a temporary measure to relief the blockage caused by stones in the ureter or after surgical treatment of the ureteric or kidney stones. This can be removed either under local or general anaesthesia depending on the technique used to treat the stone.
- Percutaneous Nephrostomy: this is mainly used in cases of emergencies where the stone is causing a sever blockage and infection in the kidney. It includes insertion of an external tube into the affected kidney. This will help temporizing the situation ahead of a planned procedure to treat the stones
- Bladder stones can be treated either endoscopically (via the urethra) or open procedure (through a cut over the bladder area). In men, treatment of the prostate (which is the most likely cause of bladder stones) is recommended.
As classically said, prevention is better than cure, simple measures can be undertaken to avoid forming stones or to stop stones from getting larger. Measures are mainly to enhance hydration and avoid contributing factors as following:
- Increase daily water and fluid intake. You should drink enough to produce at least 2 L of urine. Drinking lemon juice is deemed very beneficial in preventing stones.
- Reduce intake of refined sugar and salt
- Avoid food with high animal proteins such as red meat, seafood
- Avoid excessive intake of multivitamins and protein supplements
- Treatment and optimum control of chronic underlying medical conditions like diabetes and gout