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Stone disease is the presence of a stone or stones in the urinary system. Depending on the location, we have lithiasis of the kidneys (nephrolithiasis), lithiasis of the ureters, lithiasis of the bladder and finally lithiasis of the urethra. It is one of its most common ailments, affecting 10% of the general population.
There are different types of stones that are determined based on their chemical composition.
The creation of stones in the urinary system is still unknown, but it is believed to be determined by factors that are either idiosyncratic to each person (endogenous risk factors) or come from their environment (exogenous risk factors). Usually, it is a combination of factors that contribute to the creation of stones.
Endogenous risk factors include: age (more common between 20 and 50 years), gender (three times more common in men) and family history-heredity. Exogenous factors include: hot climate, diet, increased body weight, reduced fluid intake, sedentary work, lack of exercise and some medications.
In all cases, when the stone has been removed from the urinary system, either expelled automatically, or surgical, we send it for chemical analysis and determine its chemical composition. In some types of stones there are preparations that reduce its size or prevent its re-formation.
A specific lithiasis diet has to be followed to avoid the recurrence of lithiasis. In addition, in order to lose weight, moderate intensity physical exercise help to avoid relapse. These measures prevent the reappearance of a stone in a percentage of up to 75%.
As far as the diet is concerned, the foods that should be avoided are:
The diagnosis of urinary stone disease is made by the history, the clinical examination and the laboratory and imaging tests.
Imaging tests:
Laboratory tests:
Treatment of symptoms: When the patient has severe pain, the aim is to relieve him by analgesics.
Drug treatment: In some types of stones, drugs can be prescribed, which may reduce the size of the stone or prevent its re-formation.
Stone removal: Stone removal: it depends on the size and location of the stone in the urinary system. If the stone is smaller than 5mm, in a percentage of 70% it will be expelled automatically in a waiting period of 4-6 weeks. An a-adrenergic receptor blocker, which increases the diameter of the ureter and urethra, can be prescribed to facilitate passage of the stone. Patients who will need immediate intervention are those with obstruction of the kidney or when there is a urinary tract infection. In these cases, a ureteral catheter (pig-tail) may need to be placed until the stone is removed. In the remaining cases, however, invasive treatment will be needed. Invasive methods include:
Depending to its size and its location, the methods that can be used to remove the stone are shown in the table below:
|
<5mm |
5-10mm |
10-20mm |
>20mm |
|
|
Kidneys |
Follow - up or ESWL |
ESWL or Endoscopy and intracorporeal lithotripsy with laser |
Repeated ESWL with pig-tail insertion or Percutaneous nephro-lithotripsy |
|
|
Ureters |
Follow - up or ESWL |
ESWL or Endoscopy and intracorporeal lithotripsy with laser |
Endoscopy and intracorporeal lithotripsy with laser |
|
|
Urinary Bladder |
Follow - up |
Follow-up or cystoscopy and intracorporeal lithotripsy with laser |
Cystoscopy and intracorporeal lithotripsy with laser (with a possibility of transurethral prostatectomy) |
|
|
Urethra |
Follow - up |
Monitoring or removing a stone with tweezers (basket) |
Monitoring or removing a stone with tweezers (basket) |
|
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