Urolithiasis

—Specialisation

Urolithiasis, in simple terms is the formation of the kidney stones. In medical terms it is the formation of the urinary calculi or urinary stones. These stones can be located anywhere in kidney or urinary system.

It comprises of three kinds of stones in different places.

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The formation of the stones in kidney and this medical condition is called nephrolithiasis

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The formation of the stones in the ureters and this condition is called ureterolithiasis.

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The formation of the stones in the bladder and this condition is called as cystolithiasis.

Usually, urinary stones are categorised, either by the chemical composition or the location of the stones.

The urinary stones are usually occurred in men with major percentage, 80%. And the first occurrence or episode is occurred possibly during 20 to 30 years of age. However, for women, the first episode starts at the later stages or ages.

Signs & Symptoms

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The common symptom is the fixed renal pain, which is also called as flank pain

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Pain radiating towards the perineum, towards thigh and radiates towards the iliac fossa, according to the location of the kidney

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Pain at the tip of the penis, if the stone is present in the urethra or the neck of the bladder

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Frequent urination

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Increased hematuria

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Dribbling of urine

Causes

The development of the stones in the kidney usually results from the following causes.

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Increased exretion the components that form the stones

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Decreased volume of the urine

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Deficiency in vitamin A

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Deficiency in vitamin C

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Deposition of the calcium because of the decreased citrate levels in the urine

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Inadequate urine drainage that could lead towards stasis

Diagnosis

The medical condition called urolithiasis is diagnosed with various imaging methods, since the internal condition and picture has to be viewed clearly to understand the size and location of the stones.

Ultrasonography is the major diagnostic method implemented to view the internal image in the kidney, bladder and ureter clear. Another method is survey radiography. Both the methods are accurate, however, ultrasonography is used as more effective diagnostic method. Another way of diagnosing the medical condition is double contrast cystography.

There are certain urine tests are conducted in addition to the imaging techniques used for diagnosis. These tests are helpful to understand and explore the mineral composition of calculi. Based on the results of these tests, management of the urolithiasis is conducted.

Treatments Available

Stones in the kidney usually are passed out from the kidney, through the stream, while passing the urine. And these easily passing stones do not cause any symptoms. When the size of the stone is grown more than 3mm or 0.12 in, they will start obstruction and cause no easy passage of the urine.

So, the treatment is needed for the stones in kidney, which are bigger than 3 mm in size. For the smaller ones, treatment is not required. So, in case the stones in the kidneys do not cause any of the above symptoms, the patient has to go for watchful waiting. When the size of the stone is increased and causes the symptoms as specified above, the treatment has to be considered.

Surgery

The first measure and treatment for the symptomatic stones is medication to control the pain, by suggesting the non-steroidal anti-inflammatory drugs. The treatment is changed according to the size of the stone and the location of the stone.  So, when the condition is very severe and complex, the stone has to be removed through the surgery. Surgery is performed through various techniques varied according to the need to treat the condition.

When the surgery is performed to treat the condition of the urolithiasis, one of the techniques used is to shatter the big stone into smaller fragments. This kind of surgical technique is called extracorporeal shock wave lithotripsy.

In the cases, where the extracorporeal shock wave lithotripsy does not work out, more invasive surgical techniques will be required. These techniques or procedures are called laser lithotripsy and similar cystoscopic procedures. In still harder cases, ureteral stent, which looks like a tube is placed internal to the ureter, so that the obstruction can be easily bypassed.

For certain severe conditions, ureteral stent is inserted and placed in the ureter, so that the obstruction can be bypassed and the symptoms are also alleviated.