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Urinary (Kidney; Ureteric; Urinary bladder) Stone disease

In the era of advanced ultrasound scanning, most renal stones (kidney stones) are diagnosed without any symptoms. Renal stone disease is a significant health problem in men. It is mostly found in persons whose diet is low in vitamins. The pain typically starts in your side or back, just below your ribs, and radiates to your lower abdomen and groin (the area where the abdomen ends and the legs begin).

Anyone who has suffered with kidney stones knows how painful they can be. A kidney stone begins in the center of the kidney as a tiny particle. As other waste particles cling to the initial particle, a stone forms. These stones can be as large as an inch in diameter. However, small stones are usually excreted from the body, but stones larger than 1/5 of an inch are likely to stay within the kidney.

Symptoms

Until a kidney stone moves into the ureter — the tube connecting the kidney and bladder — you may not know you have it. At that point, these signs and symptoms may occur:

  • Pain in the side and back, below the ribs
  • Fluctuations in pain intensity, with periods of pain lasting 20 to 60 minutes
  • Pain waves radiating from the side and back to the lower abdomen and groin
  • Bloody, cloudy or foul-smelling urine
  • Pain on urination
  • Nausea and vomiting
  • Persistent urge to urinate
  • Fever and chills if an infection is present
Facts
  • Men are affected by renal stones more commonly than women.
  • The male-to-female ratio is approximately 3:1.
  • It affects two out of every thousand people.
  • It occurs commonly between 30-50 years of age.
Treatment option
  • For detecting kidney stones X-rays or sonograms are done. However, both of these may not pickup all the stones in urinary tract. In fact the results of these screening investigations need to be confirmed by a plain spiral CT scan. In case CT scan facility is not available, an IVU (intravenous urogram) may be done.
  • Surgery is not the first option. Many kidney stones pass through the urinary system with the drinking of sufficient water.
  • The surgical intervention could be in the form of Endoscopic (or Endourological) treatment wherein a fine telescope is passed through the natural urinary tract upwards upto the kidneys and the stones encountered could be fragmented using Laser energy. These then can be retrieved using fine instruments passed through the same telescope. If the stones in the kidney are large, a passage is made through the back (flank) and telescope of the size of a pen could be passed up to the stone which could be broken into fragments by Laser and removed piecemeal.
  • “Lithotripsy” is a non invasive method of breaking down the kidney stones using sound waves focused on to the stone. The fragments of stone are then expected to flow out along the passage of urine. This modality has its own limitations and is used for small and recurrent stones.
  • High fluid intake of at least three to four litres a day can flush urinary tract. The best way to assess your fluid requirement is to look at the colour of urine that you are passing. The target should be to produce the urine as clear as water. If the urine has deep yellow colour, it means that you require drinking some more water.
  • Don’t avoid calcium. Take care with your diet by avoiding an excess of oxalic acid (found in various fruits and vegetables, e.g. spinach, grapes and also eggs, black tea, chocolates.)
  • The best way to avoid stones is to have balanced and regular meals, so that all the components of diet are in the right proportion, that is, none is in excess.
  • A person with a family history of stones or a personal history of more than one stone may be more likely to develop more stones.
  • A good step to prevent the formation of any type of stone is to drink plenty of liquids—water is best.
  • Some people will need medicines to prevent stones from forming.
  • People with chronic urinary tract infections and stones will often need a stone removed if the doctor determines that the stone is causing the infection. Patients must receive careful follow-up to be sure that the infection has cleared.
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