Managing urolithiasis

Doctor: Can you tell me what painful, slightly colored urination, and burning pain while urinating may tell?

Nurse: Well, generally it’s cystitis, or maybe worse, a urothelial cancer for example!

Doctor: It may be so, but then it might signal the presence of a calculus in the urinary tract together with bleeding, infection or blockage of the urine flow. And what if the pain is unbearable and radiates in the area between the ribs and hips in the back?

Nurse: I’m not sure about that. Anyway, why do we have stones?

Doctor: Mainly because the urine is too saturated with salts or because it lacks the normal inhibitors of stone formation. This may happen to people whose diet is very high in animal-source protein or vitamin C, or who do not consume enough water or calcium, or who have a family history.

Nurse: What about the symptoms?

Doctor: Lithiasis causes pain in the lower abdomen. Stones that obstruct the ureter, the renal pelvis or any of the kidney’s drainage tubes may cause back pain or renal colic, and are characterized by an excruciating intermittent pain that spreads across the abdomen and extends to the genital area. Other signs include nausea and vomiting, restlessness, sweating, and blood or a piece of a stone in the urine. One may feel the urge to urinate frequently, particularly as a stone passes down the ureter. Chills, fever, burning pain during urination, foul-smelling urine, and abdominal swelling sometimes occur.

Nurse: What medical exams would we recommend?

Doctor: An imaging test and urinalysis are done to see if it’s renal lithiasis, urolithiasis or nephrolithiasis. Finding blood in the urine supports the diagnosis. However, most people are in so much pain that we need computed tomography (CT) to best diagnose and locate any lithiasis. Ultrasonography is an alternative but more often it misses small stones.

Nurse: What measures should be taken so as to prevent stone formation?

Doctor: Drink large amounts of fluids, about 8 to 10 glasses of water a day. Other preventive measures depend somehow on the type of stone. Diet low in sodium and high in potassium, diuretics and restricting dietary animal protein help reduce the concentration of calcium and avoid lithiasis. As for uric acid stones, potassium citrate should be given. And for stones made of cystine, a large fluid intake should be maintained. Those with recurrent struvite stones may need antibiotics to prevent infections.

Nurse: The treatment thus varies from one person to another depending on type of stone, doesn’t it?

Doctor: Yes. When it’s a minor case, we use pain-relief medication and calcium channel blockers. But when a blockage is severe and the stone causes an obstruction, surgical procedures and endoscopic devices and interventions are used to break up and drain the stone, like a cystoscope, nephroscope, ureteroscope or holmium laser lithotripsy, and we use potassium to make the urine more alkaline.