Urinary stone (calculus) are one of the most painful medical conditions. Calculus is solid crystallized mass present mainly in the kidneys but may also be in the ureters, bladder or urethra.
Prevention is always better than cure and proper hydration is the key to prevent stone formation. We recommend drinking up to 12 glasses of water daily. Mayo Clinic advocates passing 2.5 liters of urine a day to flush the kidneys. Water can be substituted with ginger ale, lemon-lime soda and fruit juice. Eating oxalate-rich foods in moderation and reducing intake of salt and animal proteins can also lower the risk of kidney stones.
Diet advise depends on the type of stone. Patients with calcium oxalate stones are advised to eating fewer oxalate-rich foods such as potato chips, peanuts, chocolate, beets, and spinach. Uric Acid stones develop when urine is too acidic and for this it is best to avoid fish, shellfish, and meats.
Your doctor may prescribe medications to help prevent the formation of calcium and uric acid stones and for pain relief or infection.
Urinary stones form more in men especially in those who are chronically dehydrated due to less water intake so as to produce less than one liter urine per day. Kidney stone disease may run in the family. Over weight, high-protein diet, hyper-parathyroid condition and certain medications like diuretics, anti-epilepsy and antacids containing calcium can enhance urinary stone formation.
Kidney stones are frequently silent and cause no pain. Pin starts when they move down the urinary track. Kidney stones pain can be very severe. It comes in waves on one side of the back or abdomen and can radiate to the groin. Kidney stones can also cause reddish urine due to blood in the urine, vomiting, chills and fever. When stone passes from the kidney into the ureters it can block the passage and obstruct the flow of urine leading to kidney infection and kidney damage.
Kidney stones can be diagnosed by its typical pain and a physical exam. Tests include blood tests for urea, creatinine, electrolytes, calcium, phosphorus, uric acid, urinalysis, ultrasound, x-ray and intravenous pyelogram (IVP). MRI and CT scan may be required in few patients. When stones pass out they can be analysed to determine what type of stones they are.
Treatment depends on the site and site of the stone and the status of the kidneys. Small stones less than 4 mm can often be made to pass out by drinking six to eight glasses or more of water a day to increase urine flow.
Extracorporeal shock wave lithotripsy removes stones with rays without surgery. The sound waves break up large stones so they can more easily pass down the ureters into the bladder and out of the body with urine. It requires no surgery, cuts or hospital stay and usually with little uncomfortable rarely requiring anesthesia. It is the treatment of choice in most patients having 10 to 16 mm stones.
Some patients may require surgery – either Percutaneous Nephrolithotomy stone removal through a small hole made in the back or open surgery with a large cut. Doctor may remove a stone stuck in the ureter or is in the bladder with an instrument called ureteroscope.
BY: Dr. S.S. Sibia, Director and Consultant, Sibia Medical Centre, Ludhiana