Medical Management Of Urinary Tract Stone Disease

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Medical Management Of Urinary Tract Stone Disease

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Kidney & Urinary Stones

Most kidney stones pass out of the body without any intervention by a Urologist. Stones that cause lasting symptoms or other complications may be treated by various techniques, most of which do not involve major surgery. Also, research advances have led to a better understanding of the many factors that promote stone formation and thus better treatments for preventing stones.

What is a kidney stone?


A less common type of stone is caused by infection in the urinary tract. This type of stone is called a struvite, infection or triple phosphate stones as they are made up of magnesium, ammonium and phosphate. Another type of stone, uric acid stones, are a bit less common, and cystine stones are rare.

Urolithiasis is the medical term used to describe stones occurring in the urinary tract. Other frequently used terms are urinary tract stone disease and nephrolithiasis. Urologist also use terms that describe the location of the stone in the urinary tract. For example, a ureteral stone—or ureterolithiasis—is a kidney stone found in the ureter. To keep things simple, the general term kidney stones are used throughout this fact sheet.


Who gets kidney stones?
For unknown reasons, the number of people in Nigeria with kidney stones has been increasing over the past 30 years. Stones occur more frequently in men. The prevalence of kidney stones rises dramatically as men enter their 40s and continues to rise into their 70s. For women, the prevalence of kidney stones peaks in their 50s, however, in recent times, the peak age of stone formation in female appears to be falling. Now 13.1% of all male and 19.6% of all female stone-formers form their first stone before the age of 20 compared with 4.7% and 4.0% respectively in 1975. Once a person gets more than one stone, other stones are likely to develop.

What causes kidney stones?






Calcium oxalate stones may also form in people who have chronic inflammation of the bowel or who have had an intestinal bypass operation, or stoma surgery. As mentioned earlier, struvite stones can form in people who have had a urinary tract infection. People who take the protease inhibitor indinavir, a medicine used to treat HIV infection, may also be at increased risk of developing kidney stones.

Foods and Drinks Containing Oxalate
Calcium Oxalate Stone Diet:
High-oxalate foods—higher to lower

  • Rhubarb, spinach, Beets, swiss chard, wheat germ, soybean crackers, peanuts, okra, chocolate, black Indian tea, sweet potatoes

Foods that have medium amounts of oxalate may be eaten in limited amounts:
Medium-oxalate foods—higher to lower

  • Grits, grapes, celery, green pepper, red raspberries, fruit cake, strawberries, marmalade, liver.

Does the consumption of certain juices help?
Orange juice is the most effective way to keep stones from forming. This is because it increases the alkalinity, and so the potassium and citrate content of the urine which helps prevent stone formation. Grapefruit, pineapple, and apple juice also help, but not quite as much as orange juice. Cranberry and lemon juice does not increase the citrate content, although they may reduce the rate that stones form. High urine level of Citrate in urine helps prevent stone formation.

What are the symptoms of kidney stones?
Kidney stones often do not cause any symptoms. Usually, the first symptom of a kidney stone is extreme pain, which begins suddenly when a stone moves in the urinary tract and blocks the flow of urine. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen this is called renal colic. Sometimes nausea and vomiting occur. Later, pain may spread to the groin.



How are kidney stones diagnosed?
Sometimes “silent” stones—those that do not cause symptoms—are found on radiological imaging taken during a general health exam. If the stones are small, they will often pass out of the body unnoticed. Often, kidney stones are found on an x ray, ultrasound or computerized tomography (CT) taken of someone who complains of blood in the urine or sudden pain. These diagnostic images give the doctor valuable information about the stone’s size and location. Blood and urine tests help detect any abnormal substance that might promote stone formation.

Preventing Kidney Stones


How are kidney stones treated?
Most kidney stones can pass through the urinary system with plenty of water—2 to 3 litres a day—to help move the stone along. Often, the patient can stay home during this process, drinking fluids and taking pain medication as needed. The doctor usually asks the patient to save the passed stone(s) for testing. It can be caught in a cup or tea strainer used only for this purpose.

Lifestyle Changes
A simple and most important lifestyle change to prevent stones is to drink more liquids—water is best. Someone who tends to form stones should try to drink enough liquids throughout the day to produce at least 2 litres of urine in every 24-hour period. In the past, people who form calcium stones were told to avoid dairy products and other foods with high calcium content. Recent studies have shown that foods high in calcium, including dairy products, may help prevent calcium stones. Taking calcium in pill form, however, may increase the risk of developing stones.

Patients may be told to avoid food with added vitamin D and certain types of antacids that have a calcium base. Someone who has highly acidic urine may need to eat less meat, fish, and poultry. These foods increase the amount of acid in the urine. To prevent cystine stones, a person should drink enough water each day to dilute the concentration of cystine that escapes into the urine, which may be difficult. More than four litres of water may be needed every 24 hours, and a third of that must be drunk during the night.

Medical Therapy
During the acute renal colic phase, pain killers including drugs such as non-steroidal anti-inflammatory drugs (NSAID) such as diclofenac or opiates are recommended.


Doctors usually try to control hypercalciuria, and thus prevent calcium stones, by prescribing certain diuretics, such as hydrochlorothiazide. These medicines decrease the amount of calcium released by the kidneys into the urine by favouring calcium retention in bone. They work best when sodium intake is low.






Who is the medical specialist who treats kidney stone?
Kidney stones are treated by urologist. These are surgeons who specialize in surgery on the urinary tracts.

Flexible ureterorenoscopy, holmium laser vaporisation of kidney stone by Dr Leye Ajayi.

Ureteroscopy and Laser Treatment of Kidney Stone at Euracare Multi–Specialist Hospital- Patient testimonial (Mr Milton Vandy).

Ureteroscopy and Laser Treatment of Kidney Stone at Euracare Multi–Specialist Hospital- Patient testimonial (Mr Elias Azar).

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