Dr Augustine Shitiri
MBBS, MS, MCH (Urology)
Urinary stone diseases are the most common disease of the urinary tract. It is a commonly encountered disease worldwide. Most patients seen in our urology outpatient department comprise approximately 60-70 % of urinary stone diseases. It includes stones in the kidney, ureter, and bladder and less commonly in the urethra. Majority of the stones are formed within the kidney primarily which may pass down and get blocked in the ureter or bladder.
The cause of stone formation is multifactorial. Stone diseases may affect any age group and gender but most commonly is seen in the young male population. It is more prevalent in hot and dry climatic populations. The incidence of stone diseases is also rising due to our lifestyle changes (sedentary lifestyles), obesity, and increasing chronic diseases like diabetes mellitus. Early detection and treatment of the same is required as it is associated with an increased risk of end-stage renal disease (Renal failure).
The types of Urinary stones depend upon their various mineral composition. The most common type of stone is calcium-based stones like calcium oxalate, calcium phosphate, etc. It comprises around 60-70 % of urinary stones. Other less common types are uric acid stones (10%), Infection stones, cystine stones, and brushite stones.
The symptoms of urinary stones depend upon the location of the stone. Most commonly it may present with pain over the flank area (Kidney stones), pain abdomen (ureteric stones), hematuria, fever, nausea, or vomiting. If the presentation is late, patients may present with acute kidney injury or septic shock. Hence early detection and treatment is a must.
Diagnosis of the stones can be done with ultrasonography and radiological investigations like x ray and CT scan. Once diagnosis is established, treatment is done based on the location and size of the stone. Treatment is mainly surgical. For stones located in the kidney, depending upon the size and location of the stone, different treatment options are available like ESWL (Extracorporeal shock wave lithotripsy), RIRS (retrograde intra renal surgery) and PCNL( percutaneous nephrolithotomy), or nephrolithotomy (open \laparoscopic). For the treatment of ureteric stones, different surgical modalities like URSL (ureteroscopic lithotripsy), ureterolithotomy. For bladder stone treatment are cystolithotripsy and cystolithotomy.
We all know that prevention is better than cure. Hence to reduce the cost associated with surgery and more so, to avoid need for surgery, prevention of urinary stones are the best treatment strategy.
Well-documented and important strategies that have been shown to reduce the incidence of urinary stones irrespective of the type of stones are-
• Increasing the water intake to maintain at least 2.5-3 Litres of urine output in a day.
• avoid beverages with high sugar content.
• Reducing the sodium intake in the form of reducing salt intake and avoiding extra added salts like preserved foods, fast food, and salted chips and biscuits.
• Restricting dairy products like fish, chicken, mutton, pork, and beef which are a heavy source of uric acid.
• Increasing the intake of fruits and green leafy vegetables causes alkalinization of urine preventing stone formation.
• Reducing intake of oxalate-rich diets like spinach, almonds, sweet potatoes, etc.
• Calcium supplements within permitted limits after consultation with your physician can be protective against stone formation.
• Obesity being a risk factor for stone formation, weight loss, and maintaining BMI within normal limits is important for stone prevention.
• Limitation of vitamin C is recommended as Vit. C supplementation has been linked with increased calcium stone formation.
• Diabetes mellitus is a risk factor for uric acid stones. Maintaining the urinary pH of patients with Diabetes Mellitus within the alkaline range is helpful in the prevention of stones.
The writer is Junior Consultant (Urologist), Department of Surgery, CIHSR, Chümoukedima.
