Urinary stone disease, or urolithiasis, is a common urologic problem. In the United States, the lifetime risk of stone disease has been estimated at 10% to 15%. Although historically urinary stones were more common in men, recent studies have suggested a rise in the number of women with urolithiasis. Stone occurrence is relatively uncommon before age 20 but peaks in the fourth to sixth decades of life. Stones are also more common in certain areas of the country, particularly in the southeastern United States. Diet, obesity, dehydration and the history of a previous stone are all risk factors for the development of urolithiasis. There are many different types of urinary stones, but calcium-based stones are by far the most common.
Kidney stones typically leave the body by passage in the urine stream, and many stones are formed and passed without causing symptoms. If stones grow to sufficient size they can cause obstruction of the ureter, the tube that connects the kidney to the urinary bladder. Obstruction of the ureter causes decreased kidney function and distension and dilation of the kidney as well as spasm of the ureter. This leads to pain, most commonly felt in the area between the ribs and hip, lower abdomen, and groin (a condition called renal colic). Renal colic can be associated with nausea, vomiting, blood in the urine, and painful urination. Occasionally renal colic can be associated with fever and chills, and low blood pressure, signifying a serious infection called sepsis. This requires urgent surgical intervention to relieve the obstruction and drain the infection. The diagnosis of kidney stones is made on the basis of information obtained from the history, physical examination, urinalysis, and xray studies such as a CT scan or ultrasound.
When a stone is symptomatic, it can be treated in a variety of ways. Certain medications will help stones pass through the urinary tract over time. Other times the stone will need to be treated with a surgical procedure. Surgery can be performed with sound waves (or Extracorporeal Shockwave Lithotripsy) in certain instances. Depending on the composition and location of the stone, often scopes are placed into the urinary tract to facilitate fragmentation of the stones with laser energy. In cases of large stones, a more invasive procedure called percutaneous nephrolithotomy is performed through a tiny incision in the back, which allows direct access to the inside of the kidney for removal of the stones. Fortunately, GHS Regional Urology is able to provide the full spectrum of surgical options for the treatment urinary stone disease.
Prevention of future stones is a critical part of the care of patients with urolithiasis. Metabolic evaluations can be performed that dramatically decrease a person’s risk of subsequent
stones. General recommendations for stone prevention include increasing fluid intake to more than 2 liters/day, increasing the intake of citrate-containing fluids (such as lemonade and orange juice) and avoiding high sodium intake.
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