Urinary stone disease is a very common problem. Pain from the blockage of urine
is severe, and has been responsible for nearly 15% of all hospital admissions.
Understanding the various causes of stone formation and stone growth has greatly
reduced the number of recurrent stone disease in many susceptible people.
Most stones are composed of calcium oxalate. We have recently learned that dietary
restrictions of calcium do not decrease the incidence of new stone formation.
The restriction of this essential dietary mineral can also result in a debilitating
bone disease known as osteoporosis. This disease can leave bones in a brittle,
fragile state, easily subject to fractures from minor falls or bumps.
We now realize that oxalate-rich foods contribute much more heavily to the formation
of kidney stones. Foods such as chocolates, certain nuts, most berries, including
cranberries, and leafy green vegetables contain large amounts of oxalates. Limiting
their use can reduce the risk of calcium oxalate stone formation. Together with
an adequate fluid intake and supplements including citrates and magnesium to solubilize
urinary crystals, a person at risk for stone disease can protect himself from
future stones and their agonizing pains.
Other common stones are uric acid stones, and magnesium ammonia phosphate stones,
also known as infection stones. The recurrence of the stone can also be limited
by relatively simple changes in diet and with the use of medications.
How are obstructing stones treated?
1) Stenting - The pain and resulting impairment in kidney function
that can develop from an obstruction in the urinary tract can be managed with
the use of a stent. This soft slender tube sits in the ureter and allows urine
to pass through it, and around the obstructing stone.
The pain, and any infection that may have been caused by the stone, are then alleviated.
This often buys valuable time, especially in a very sick individual.
2) Endoscopy - The emergence of small, flexible telescopes for peering
into the urinary tract has allowed a variety of techniques to be used to treat
stones in a minimally-invasive manner. Stone baskets to extract stones, or stone-fragmenting
devices, such as ultrasound, electrohydraulics, and laser energy, have all been
used effectively to treat urinary stones without open surgery.
3) ESWL - This machine has revolutionized the treatment of urinary stones.
Less than 15 years ago, it was not uncommon for patients to have two and three,
sometimes more, open surgical procedures to remove recurring kidney stones. The
surgery was painful, resulting in long scars, prolonged hospital stays, and long
recuperative periods.
Now a days, in an outpatient ambulatory procedure without surgery - Under IV sedation,
a machine generates shock waves which pass harmlessly through the body focusing
on the stone in the kidney. These shock waves pulverize the stones to pass through
the urinary tract.
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