URINARY TRACT STONES - Urology

Who may have urinary tract stones?

Urinary tract stones may occur in any individual. Although they can be observed at any age group, they are seen more commonly in the age range of 20 - 50 years. They are observed 3 times more in male than female.

What are the causes of urinary tract stones?

Although there are many factors which play role in the formation of stone (calculus), the exact cause thereof is not known. It has been found that one or more factors play role in formation of the stone. Genetic tendency is one of the most significant risk factors in formation of the stone. There is familial history of urinary stone in I 0-40 % of patients with stone. Geographical factors are also effective in the formation of urinary stones. The urinary stone disorder is more commonly seen in highlands and tropical regions. Nutrition is one of the most important factors in the formation of urinary stones. Diets rich in protein and carbohydrate and poor in fibrous food increase the risk of urinary stone disease. The risk decreases proportionally to the oral water intake. Repetitive urinary tract infections, various renal parenchymal diseases and disorders of collecting tubules, some medications, the previous intestinal surgeries, gout disease and metabolic diseases such as hyperparathyroidism also play role in the formation of urinary stone.

Are all stones similar to each other?

No. Stones are roughly examined in 2 groups according to their chemical structures; stones containing and not containing calcium. Calcium stones account for 85% of all stones. Whereas non-calcium stones are rare and the most common ones are uric acid, cystine and infection stones. The risk of recurrence may be decreased by prescribing medical therapy as per the type of the stone determined as a result of stone analyses.

What kind of complaints the patients with urinary tract stone have?

The urinary tract stones may develop without any manifestation or sometimes, they can also lead to severe symptoms. The most common complaint of patients with urinary tract stone is the pain. Such pain is usually observed in two ways. The more common is a very severe pain, also referred as renal colic which is felt as if a knife is stabbed to the side or to the groin. Such pain is usually associated with nausea and vomiting. The other type of pain is a lighter pain which is in blunt character and persists for long time. The second most frequent manifestation observed in patients is hematuria (presence of blood in urine). While the blood in the urine is sometimes is so severe that the blood is visible, but it can only be detected under microscopic examination. In rare cases, no blood can be observed in the urine. Urinary tract infection due to obstruction is also very common in patients with urinary stone disease. The infection may be very mild or it may even lead to severe nephritis (renal infection). Urinary tract stones may cause difficulty in urination.

Which tests are performed in order to diagnose the urinary tract stone?

When you apply to a doctor due to a complaint suggestive of urinary tract stone, your doctor may order one or more tests such as urine analysis, direct abdominal X-ray graph, urinary system ultrasonography, IVP and abdominal tomography. Currently, non-contrasted (a contrasting agent is not used) abdominal tomography is the best imaging method for diagnosing urinary stone since it is not affected from negative factors such as presence of excessive gas in the stomach and intestinal cleansing not being done and it is very effective even for very small stones.

Can every urinary tract stone be spontaneously excreted?

Most renal stones have the tendency of spontaneous excretion. Approximately 80% of all renal stones can be excreted with use of medical therapy and monitoring. However the most important factor influencing the excretion of the stone is the size. While 80% of the stones smaller than 4 mm are expected to be excreted, intervention may be needed for stones bigger than 6 mm since the probability of excretion drastically decreases. Nevertheless, your doctor should make the decision whether a stone is monitored or the intervention is necessary since the shape and localization of the stone along the urinary tract may affect the excretion.

What are the treatment options for patients with urinary stone?

Treatment approaches greatly vary in stone disease. While some patients are just monitored, immediate surgical treatment may be necessary for others. We can list the treatment options as follows:

I. Follow-up: Stones may be followed up for a certain period under medical treatment with regards their size, location and shape.

2. ESWL (Extracorporeal shock wave lithotripsy): In general, it is applicable to stones with diameter up to 2 cm and with suitable renal localization. It can also be applied to ureteral stones. The size, location, shape and type of the stone play important role for selecting this treatment modality among all treatment options. The patient is awake during the procedure. Painkillers are administered before the procedure since the patient may feel pain during ESWL session. It is conducted in sessions. While there might be stones that could be broken in a single session, subsequent sessions may be required. Hospitalization is not required following the procedure. The pieces of the broken stone are excreted from the urine.

3. Ureterorenoscopic lithotripsy: This method requires general anesthesia. No incision is made. The stone is broken or grasped at its localization using thin devices. It is especially effective for stones located in the lower and middle part of the ureter. Most patients are able to return to home on the same day and continue their normal daily lives the next day.

4. Percutaneous Nephrolithotripsy (Endoscopic kidney stone surgery - PNL) It is especially effective in the treatment of renal stones which are too large or resistant to ESWL. This procedure also requires general anesthesia Two open-end thin tubes are inserted in the kidney through a I cm incision on the back in line with the kidney under x-ray guidance. The stones are extracted using the special devices inserted through this tube. The most important superiority of percutaneous surgery is preserving the normal structure of body tissues. The recovery period is faster. The patients is much more comfortable in the post-operative period in comparison with the open surgery. Most patients are discharged on postoperative Day 3.

5. Open surgery: Although it is less preferred after the other treatment methods are widely used, it can be preferred in any and all types of urinary stones, when necessary.

What may happen if urinary tract stones are left untreated?

You may have chronic pain which may be uncontrollable. Ureteral stones are sources of urinary tract infections. Therefore, relapsing urinary tract infections may develop. If the stone leads to complete obstruction of urinary tract, it may lead to renal dysfunction in the long term.

Does stone disease relapse?

Ureteral stones tend to relapse at rate of 50% in 5-year period. Considering that some stones may be asymptomatic (silence case), routine semi-annual examination of stone patients is important.

Is it possible to prevent formation of stones?

The recurrence of the stone may be prevented or delayed in patients with recurrent urinary tract stone. For this purpose, an evaluation consisting of 24 hour urine analysis and blood analysis is performed. Also, the chemical structure of the stone is studied. The levels of substances which might cause stone formation in the urine are measured in this procedure, which is called metabolic evaluation, and a diet or medication may be prescribed in accordance with the results.

What can I do to prevent stone formation?

Two liters of water consumption per day, lowering intake of animal protein, preferring fibrous diet, decreasing salt consumption may delay the recurrence of the stone.

Are urinary tract stones related with the gall bladder stones?

Kidney stones are not related in any way with the gall bladder stones. They are stones of two different/independent systems and their structures are also different. The probability of renal stone does not increase in a patient with gall bladder stone.