Urinary stone disease is the most common disease of urinary system after prostate diseases and infection, and is seen in the rate of 1-20% among industrial societies. Although it may be seen anywhere in the world with any climate conditions, it’s more common in warm regions and climates. This is because of the increasing dehydration with sweating, low urine amount and increasing urine concentration with substances diluted and can precipitate easier. Diet, genetic predisposition, living area, dietary habits, frequent urinary tract infections, various metabolic disorders, physical activity can be mentioned among the factors regarding urinary stone disease. It’s assumed that regular fluid intake and regular physical activities decrease the risk of having urinary stones.

Urinary stone disease is the most common between the ages of 30 and 60. It’s seen three times more in male individuals than female ones. Lifelong risk of having urinary stone for adult males is around 20%, while this rate is around 5-10% in female adults. The possibility of someone with urinary stone disease to have it again has been reported as 50% chance. Calcium stones consist of 80% of kidney Stones, and the rest are uric acid, struvite, cystine and xanthin..

Stones have varying symptoms according to the area they occur. Kidney stones don’t cause any specific symptoms as long as they don’t prevent urine flow. When the stones drop into the canal called ureter between the outflow of kidney and bladder, they might cause severe pain (colic pain) since they might block urine flow. Along with it symptoms as blood in the urine, nausea and vomitting can be seen. Man female individuals passing stones claim that the pain is more severe than labor pains. When urinary system stones cause infection, they cause symptoms as fever, chill, shivering, sweating, fatigue, pain in the kidney, burning sensation during urination, cloudy and stinky urination. In this type of cases, you should immediately visit a doctor..


HOW IS IT DIAGNOSED?
Since the use of ultrasound is becoming more and more common everyday, it is quite easy and painless to detect urinary stones. On the other hand, most common complaints of patients are lumbar pain, repetitive urinary tract inflammation or blood in the urine. A certain diagnosis would be possible by applying the procedures below when the complaints are as mentioned above.

Direct Urinary System Graphy (DUSG): Most of the kidney stones that are opaque may be seen through this x-ray. Nonopaque stones or small ureter stones can’t be found through this technique..



Ultrasonography: Although it seems like a safe technique since no x-rays are used, it’s insufficient about showing the small stones in the ureter. It’s quite a common technique in our day.

Intravenous Pyelography (IVP): In this technique, both the kidneys’ anatomy and their functions can be examined with a contrast agent injected into the venes. It’s possible to obtain detailed info about the locations of the stones in the kidneys and the damage they cause with this technique. This technique should be applied on the persons whoa re allergic to contrast agent, pregnant women and the persons with renal failure.

Spiral Computed Tomography (CT): It’s the golden standard for urinary stones. Even the stones that are 1-2 mm in size can be seen with this examination that can be conducted in minutes. Additionally, frangibility degree of the stone can be determined by measuring the intensity of the stone.



TREATMENT

Monitoring and Medication
Monitoring is applied to give a chance to small stones to pass themselves. However, the doctor should be the one to decide the stones that might pass themselves and the stones on which other treatment methods should be used. Medication is applied especially to help small stones in the ureter pas sor prevent existing small stones from growing or prevent the forming of new stones after the stones are cleaned in some way.

Extracorporeal shock wave lithotripsy (Eswl)
It’s based on lithotripsy through high frequency sound waves (shock waves) by focusing on the stone. Today, thanks to advanced devices, all the stones formed in any part of urinary system can be broken. However, this technique is not preferred since the treatment period elongates and undesired side effects increase.

Surgical Methods:
1-Ureterorenoscopy (URS):
In this technique, the stone is broken and directly taken out by entering the ureter with a special endoscopic device through urinary tract. Majority of the patients are released on the same day and go back to their routines. This procedure can be applied on patients of any age thanks to flexible and rigid ureterorenoscopes. To break the stone, penumatical (air pressure) or laser lithotripsy is used as the energy source. Since it’s quite successful about breaking stones and there is almost no possibility for the stone to go back, laser energy is the best treatment technique for ureter stones. It’s also possible to reach any stone in the kidney (calyx or renal pelvis) and to break them through laser energy with flexible devices.

Surgery Videos
PROXIMAL URETER STONE/LASER URS 
DISTAL URETER STONE TREATMENT
FLEXIBLE URS(KIDNEY STONE/RIRS)
Cystolithotripsy (Treatment of bladder stone with laser)


2- Percutaneous Stone Surgery (PCNL)
It includes the procedures of entering the kidney through a small hole on the back along with control over rontgen and breaking and taking out the stone after displaying the stone on the monitor with the help of optical device through special devices. This technique is typically used for thr stones bigger than 2-3 cm.

3- Open Stone Surgery
Thanks to new techniques today, open stone surgery is applied much less than before.


TYPES OF STONES;

a) Calcium stones

"a) Calcium stones 80% of all urinary stones contain calcium. Calcium stones depend mostly on the calcium, uric acid, oxalate increase in the urine and decrease of citrate level. .

b) Stones other than calcium

1. Struvite
These are magnesium amonium phosphate stones. They are mostly seen in female patients. They can relapse rapidly. Struvite stones are formed by bacteria lysing ures such as proteus, pseudomonas, klebsiella and mycoplasma. Urine pH is alkali. pH is over 7.
It’s impossible to strelize these stones with antibiotics.
Taking out the stone and treatment of the infection gives successful results.

2. Uric Acid
It constitutes less than 5% of all urinary stones. It’s more common among male patients. Uric acid level is high in the urine. It’s common among the persons with gout and myeloproliferative. High level of uric acid might be due to excessive pruine intake. The urine is acidic..

3. Cystine
It’s based on the abnormal intestinal mucosa absorption. A hereditary metabolic disorder causing tubular absorption of dibasic aminoacids (ornitine, lysin, arginine) causes cystine stones. It constitutes 1-2% of urinary stones. Forming of cystine stones completely depends on excessive cystine elimination..

4. Xanthin Stones
It develops due to congenital xanthin oxidase enzyme deficiency

5. Indivavir Stones
Protease inhibitor is an effective and popular treatment among the patients with acquired immunodeficiency syndrome. These are radiopaque stones.

6. Rare
Silicate stones are rare and are based on taking antacids containing silica such as magnesium silicat and magnesium aluminometasilicat for long periods.

 

What Are The Factors Increasing the Risk Of Having Urinary Stones?

Insufficient Fluid Intake: when sufficient amount of fluid aren’t taken, the concentration of chemicals causing stones in the urine increases and this increases the risk of having urinary stones. The risk of having urinary stones is higher among the persons living in warmer climates.
Hereditary Reasons: The risk of having kidney stones is higher for the persons who has kidney stones history within their families. Also, the chance of relapsing kidney stones within 5 years is high for the persons who had kidney stones before.
Age, Gender and Race: This disease which is more common among male individuals and white races occurs especially between the ages of 30 and 60.
Diet: Consuming food products with high amount of animal proteins and low amount of fiber increases the risk of having urinary stones. Consuming excessive amount of salt is also risky.

In Order To Prevent Urinary Stones From Forming ;

Change in lifestyle and dietary habits may decrease the risk of having urinary stones. The patients are asked to take more fluids (fluid intake is increased even more if the patient is losing a lot of fluid depending on the place lived). A healthy person should take 2-2,5 liters of water everyday regardless of having an urinary stone history. The patient should consume all types of food groups. It’s recommended to increase the consumption of fibrous foods and fruits because of their beneficial effects. Consumption of nutritiens rich in ocalate such as rucola, spinach, cress, wallnut, wheat bran should be reduced. The patients with high level of oxalate in their urine should especially be careful about this aspect

© 2016 - Op. Dr. Cem ÖZLÜK