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Urinary Stones

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Overview of Urinary Stones

Urinary Stones Meaning in Urdu

مثانے کی پتھری خطرناک طبی علامت تو نہیں ہے مگر اس کی وجہ سے کافی تکلیف کا سامنا کرنا پڑ سکتا ہے۔ پیشاب کی نالی میں موجود منرلز کے اکھٹے ہونے سے یہ پتھری بنتی ہے۔ پیشاب کرتے وقت جب مثانہ مکمل طور پر خالی نہ ہو تو پتھری بننے کے خطرات میں اضافہ ہو جاتا ہے۔ اگر یہ پتھری چھوٹے سائز کی ہو تو خود بخود پیشاب کے ذریعے خارج ہو جاتی ہے، لیکن اگر اس کا سائز بڑا ہو تو یہ نہ صرف خارج نہیں ہوتی بلکہ اس کی وجہ سے شدید تکلیف بھی لاحق ہوتی ہے۔ بڑے سائز کی پتھری سے نجات پانے کے لیے بعض اوقات سرجری کی بھی ضرورت پڑتی ہے۔

Urinary stones, commonly known as (Gurday ki pathri/ گردے کی پتھری) affect our urinary system. Urinary stones are small pieces of solid crystals present in the kidneys, bladder, and ureter. These small pieces are made up of various chemical compositions that are:

  • Calcium oxalate
  • Calcium phosphate
  • Uric acid
  • Cysteine
  • Struvite

These crystal stones affect the parts of the urinary tract. A stone residing in the kidney is known as renal calculi. Similarly, if it is present in the bladder, ureter, or urethra termed as bladder, ureter, and urethra stones (calculi ) respectively. Altogether, these stones are referred to as urolithiasis (urinary stones). 

Prevalence of Urinary Stones

Urinary stones are equally found in both males and females. About 1%–19.1% of the population is affected by urinary stones disease in the whole of Asia. However, every year the variations in prevalence and incidence of countries or regions occur due to socio-economic status and geographic locations.  In Pakistan, the prevalence and incidence rate of urinary stones up to 2010 was 16% and 0.2-200 respectively. 

Signs and Symptoms of Urinary Stones

The exact symptoms of urolithiasis may vary depending on the location and size of the calculi in the urinary system.  Generally, these are the common signs and symptoms may include:

1- Kidney Stones Symptoms:

Common symptoms of kidney stones include:

  • Vomiting
  • Nausea
  • Discolored or foul-smelling urine
  • Chills
  • Fever
  • Frequent need to urinate
  • Urinating small amounts of urine

2- Bladder Stones Symptoms:

General symptoms of bladder stones are:

  • Frequent urination, particularly during the night
  • Lower abdominal pain
  • A burning sensation or pain in the urethra during urination
  • Bloody or cloudy urine
  • Urinary incontinence, or unable to control urination

3- Ureter Stone Symptoms

The ureter is the tube that connects the kidneys to the bladder, that's why ureter stones are also kidney stones. The stones are formed in the kidney and travel through urine into the ureter. This will obstruct the ureter and show the following symptoms similar to renal stones.

  • Pain or a burning sensation when urinating
  • Blood in your urine
  • Frequent urge to urinate
  • Nausea 
  • Vomiting
  • Fever
  • Pain characterizes both kidney and ureter stones

 

Types of Urinary Stones

Not all kidney stones are the same. Kidney stones can have variable composition, and size and can appear in different regions of the urinary tract.

Below are the most common types of urinating crystals which may appear in a urine test:  

  1. Struvite: This is a type of urinating crystal consisting of phosphate, ammonium, magnesium, and calcium. Struvite is usually made due to urinary tract infections or difficulty in bladder emptying.

  2. Uric Acid Stones: These stones are composed of uric acid and persistently high uric acid can be one major cause. Other less common causes are:

  • Increase the level of uric acid
  • Low urine volume
  • Metabolic diseases, such as heart disease, diabetes, and stroke
  • Gout, pain, and inflammation due to an excess of uric acid
  • Excess protein

  1. Calcium Oxalate: Typically known as kidney stones. It forms when an excessive amount of oxalate is present in urine. Oxalate is a chemical found in a series of foods. It is caused when a person is dehydrated which results in the formation of calcium oxalate stones and it makes it difficult to pass through the kidney.

  2. Cystine Stones: Cystine stones, just as the name indicates, are made up of cysteine and are seen in the kidneys or urinary tract. These are larger than kidney stones (calcium oxalate) and may have a chance of recurrence. Cystinuria is an inherited disorder that causes cystine stones. When the amount of cysteine gets higher than usual, it may form these stones.

 

Causes of Urinary Stones

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Risk Factors of Urinary Stones

Certain factors that contribute to increasing the risk factors are given below:

Male: Men may have a higher incidence of urinary stones than females because of the excretion of less citrate and more calcium than women.

Family History:  Some people are born into those families that can produce excess mucoprotein in the urinary system, which can enhance kidney stone formation.

Medical History: People with a chronic condition may be at risk of forming kidney stones, including intestinal disease, recurrent urinary tract infections, and cystinuria.

Food Products: Less intake of water may increase the risk of stone formation. Also increased consumption of products that contain sodium, oxalate, fat, protein, sugar, unrefined carbohydrates and vitamin C are more prone to urinary stones.

Environmental Changes: Tropical climates, and mountainous or desert terrain are associated with an increased risk of urinating crystals formation.

Medications: Few medications that may produce urinating crystals such as:

  • Ephedrine
  • Guaifenesin
  • Thiazide
  • Indinavir
  • Allopurinol 

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Prevention

Here are some of the tips that can help you to prevent urinary stones formation:

  • Consuming enough water can help to prevent the stone formation
  • Intake of calcium-rich foods as it will reduce your risk of stone formation
  • Limit the consumption of oxalate in your diet
  • Keep a check on salt and sugar intake
  • Don’t consume too much animal protein
  • Keep an eye on your symptoms
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Diagnosis

Urinary stones diagnosis begins with taking a brief personal family and medical history, alongside symptoms and causes. After that urologists physically check the lower abdomen for the presence of accumulated stones. To identify the exact location of the stones, urologists immediately refer the patient to a radiologist for diagnostic testing includes:

1- Blood Test: Blood tests can tell about the calcium or uric acid levels in the blood. It can help your physician to connect your signs and symptoms to the exact cause and rule out the possibility of other medical conditions. 

2-Urine Test: In a urine test, a urine sample of a patient is collected for analysis. During analysis, the physician examines the minute amount of blood, bacteria, and crystallized minerals. 

3- Computerized Tomography (CT scan): CT scan can help with the location of the urinary crystals or stones by providing a clear scan of the urinary tract.

4- Ultrasound:  It is also used for the detection of stones in the urinary tract as sound waves pass through the affected organs in an ultrasound test. 

 

5- X-Ray:  An X-ray of your kidneys, ureters, and bladder helps the urologist to determine whether it is a bladder stone, kidney stone, or any other.

 

Treatment of Urinary Stones | When to Consult a Doctor

Urinary stone treatment can vary depending on the location, cause, and type of urinating stones. It is firstly managed by home remedies and non-conservative treatments for mild to moderate urinary problems. If symptoms get worse, then a urologist might suggest surgical treatments.

  1. Home Remedies of Urinary Stones:

The most beneficial home remedies for the relief of urinary stones are:

  • Adequate intake of watermelon or its juice.
  • By boiling the fig in water and drinking it all on an empty stomach in the early morning.
  • Intake of fresh tomato juice with salt and pepper when the stomach is empty.
  • One of the best remedies is to eat kidney beans or French beans in the boiled or mashed form with the liquid.
  • Basil leaves or tulsi can be taken with honey.
  • Eating a lot of fruits such as apples, grapes, or pomegranates.
  • Vitamins B6 and A are good for reducing kidney stones. 

  1. Treatment of Small Stones with Minimal Symptoms 

Mostly, Non-invasive can be used for the treatment of small kidney stones because these therapies can easily dissolve small stones and pass through urine.

  • Water Intake: Intake of at least (1.8 to 3.6 liters) a day will keep the urine dilute and may prevent stones formation.  You can drink a lot of water until the urine is clear. 
  • Pain Relievers: When small stones are eliminated from the body, it may cause pain or discomfort. A urologist may prescribe the pain relievers to the patients such as:
  • Ibuprofen (Advil, Motrin IB, others) 
  • Naproxen sodium (Aleve)
  • Medications: The best medications help to pass the urinating stones with less pain from the kidney. These are involved:

Alpha blocker-help to relax the ureter muscles such as tamsulosin (Flomax) and the drug combination dutasteride and tamsulosin (Jalyn)

Other antibacterial medications that prevent the infections are:

  • Allopurinol (Zyloprim) for removing uric acid stones
  • Thiazide diuretics to treat calcium stones formation
  • Sodium bicarbonate or sodium citrate makes the urine less acidic
  • Phosphorus solutions to dissolve calcium stones formation

Important Note: Do not take any medications without a doctor's consultation.

  1. Treatment of Large Stones with Severe Symptoms

Larger stones are difficult to pass through the urinary tract and cause bleeding. This may damage the kidney, bladder, or urethra and may have the possibility of urinary tract infections. For the treatment of severe urinary stone cases, more extensive or technical techniques have been preferable. 

  • Extracorporeal Shock Wave Lithotripsy (ESWL): This procedure is opted to depend upon the size or location of the crystals. ESWL is responsible for breaking up the stones into tiny pieces through high-vibrating sound waves (shock waves). The duration of the procedure is 45 to 60 minutes. It can cause moderate pain so a doctor gives slight anesthesia.

A patient may experience certain side effects after ESWL, including: 

  • Blood in the urine
  • Back or abdominal bruising 
  • Bleeding around the kidney and other adjacent organs
  • Feeling irritated when stone pieces pass through the urinary tract
  • Removal of urinary stones through surgery: A procedure named percutaneous nephrolithotomy involves the surgical elimination of stones through the insertion of small incisions of small telescopes and instruments on the back.

Before or during the surgery, anesthesia has to be given to the patients for sedation. A urologist may suggest this procedure if ESWL fails.

  • Ureteroscope: The procedure helps to find the location of urethra stones by passing a thin lighted tube attached with a camera to a ureter. Once the area is identified, it will convert into smaller pieces and easily remove with urine. General or local anesthesia is required for the procedure. Also, place the stent into the ureter for healing.

  • Parathyroid Gland Surgery:  Hyperactivity of the parathyroid glands that release excessive amounts of parathyroid hormone. This consequently raises calcium levels in the body and leads to the formation of calcium phosphate stones called parathyroid hormone (hyperparathyroidism). A urologist can then opt for surgical removal of the parathyroid gland.

 

In case you exhibit any concerning signs and symptoms of urinary stones, consult a medical professional as soon as possible.

 

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