THIRUVANANTHAPURAM: Urinary stone disease is a very common health issue. This disease has a significant social impact as it may cause significant pain and morbidity which would require abstinence from work and loss of productive hours. Urinary stone disease, also known as urolithiasis, implies the formation of solid stones in the urinary tract. The location of stones varies from kidney, ureter, urinary bladder and urethra. The usual place of origin of stones is either kidneys or urinary bladder.
The most common symptom caused by urinary stones is pain. The location of pain would vary depending on the location of the stone. A stone that obstructs the ureter or renal pelvis causes excruciating, intermittent pain that radiates from the flank to the groin or to the inner thigh. This pain, known as renal colic, is often described as one of the strongest pain sensations known.
Renal colic caused by kidney stones is commonly accompanied by urinary urgency, restlessness, hematuria (blood in urine), sweating, nausea, and vomiting. It is typically described as colicky pain as it occurs in intervals in a crescendo pattern lasting 20 to 60 minutes caused by peristaltic contractions of the ureter as it attempts to expel the stone. The embryological link between the urinary tract, the genital system, and the gastrointestinal tract is the basis of the radiation of pain to the gonads, as well as nausea and vomiting that are also common in urolithiasis.
Fever that accompanies pain due to urinary stones may be an ominous sign that points towards infection. This would mandate prompt treatment for relieving obstruction due to stone and also the aggressive treatment of infection.
The above-mentioned symptoms point towards a diagnosis of urinary stones. This needs to be confirmed with imaging studies to confirm the diagnosis of stone disease. The common tests performed are Urine analysis, Ultrasound scan (USS) and X ray of the abdomen. CT scan is also increasingly being used to diagnose stone disease and would be the best test to correctly diagnose and locate urinary stones.
Treatment
The decision to treat urinary stones depends on various factors like location and size of stones, presence of an obstruction to the urinary tract, co-existing alteration in kidney function, coexisting urinary infection etc.
Small stones in the kidneys are usually treated with medicines. When these stones are expelled, there is a chance of occurrence of pain. This is usually treated with painkillers, but further treatment would be ultimately determined by the patient's ability to tolerate pain and constraints and circumstances of the patient.
Stones which are refractory to medical treatment and stones which are larger in size are treated with procedures that aim at the clearance of stones. If there is associated infection, this is tackled first and any procedure to clear stones is done only after the infection is treated adequately. When there is a concurrent infection, a procedure called stenting is done to allow relief of obstruction by stone and to clear infected urine.
The actual procedure to clear stone is done after several days of stenting. Treatment decisions regarding kidney stones are taken taking into consideration the location and size of the stone, density of stone, anatomy of urinary tract inside the kidney etc. All treatment modalities may not suit to clear a given stone. The usual procedures adopted to clear urinary stones include Extra-corporeal Shock Wave Lithotripsy, Per Cutaneous Nephro Lithotripsy, Ureteroscopy, Cystolitholapaxy and Laparoscopy.
The author is a Consultant Urologist and Transplant Surgeon at KIMS, Thiruvananthapuram.(The views expressed are his own)