What is urolithiasis
Urine is a solution in which salts are dissolved: oxalates, phosphates, urates, calcium salts. As long as there is enough fluid in the body, the salts remain dissolved and are quietly eliminated. As soon as the urine becomes too concentrated or its acidity changes, the salts begin to crystallize. Small crystals stick together and a stone gradually forms.
The stone may be in the renal pelvis, descend into the ureter, or form directly in the bladder. The size of the stones varies - from sand 1-2 mm to large coral-shaped stones, which follow the shape of the collecting system and occupy almost the entire kidney.
The main danger of the disease is not in the stone itself, but in the fact that it blocks the outflow of urine. At the same time, the kidney stretches, the pressure inside it increases, and the tissue gradually dies. That is why urolithiasis cannot be left “for later,” even if there is no pain yet.
Symptoms of urolithiasis
Manifestations depend on where the stone is located and whether it interferes with the flow of urine. A small, immobile kidney stone may not produce any symptoms for years and may be discovered by chance on an ultrasound during a medical examination.
- Dull, aching pain in the lower back, usually on one side; worsens after physical exertion, bumpy driving, heavy drinking
- Paroxysmal sharp pain in the side, radiating to the groin, genitals, inner thigh - renal colic
- Blood in the urine: urine turns pink, reddish, or the color of meat slop
- Frequent and painful urination, false urges - if the stone is in the lower third of the ureter or in the bladder
- Interruption of the urine stream, which resumes when changing body position, is characteristic of a bladder stone
- Nausea, vomiting, bloating and stool retention during an attack
- Passage of sand or small stones in urine
- Fever, chills, weakness - a sign of an additional infection
An important feature: the severity of the pain does not reflect the size of the stone. A small stone of 4-5 mm, stuck in the ureter, causes unbearable colic, and a large coral stone in the kidney may not hurt at all - and at the same time slowly destroy the organ.
Renal colic: what to do before the doctor arrives
Renal colic occurs when a stone blocks the ureter. The pressure in the kidney increases sharply, and the person experiences severe pain: he cannot find a position in which it becomes easier, he rushes about, and cannot lie still. The attack lasts from several tens of minutes to several hours.
- Call an ambulance or go to the emergency room - colic requires a medical assessment, not self-medication
- Do not apply a heating pad or take a hot bath if you have a fever: with purulent inflammation, heat sharply worsens the condition
- Do not take diuretics or drink large amounts of water “to flush out the stone” - this increases the pressure in the blocked kidney
- Remember or write down when the attack began, which side it hurts, whether there was a temperature and blood in the urine - this is important for the doctor
Causes and risk factors
Urolithiasis is almost always the result of a combination of several factors: metabolic characteristics, nutrition, drinking regime and climate.
- Insufficient fluid intake is the key and most manageable factor
- Hot climates and outdoor work: fluid loss through sweat makes urine concentrated
- Heredity: if parents or siblings had stones, the risk is noticeably higher
- Nutrition: excess animal protein, salt, foods high in oxalates (sorrel, spinach, strong tea, chocolate)
- Chronic urinary tract infections - promote the formation of struvite (infectious) stones
- Metabolic disorders: gout and high uric acid levels, hyperparathyroidism, obesity, diabetes mellitus
- Anatomical features that impede the outflow of urine: narrowing of the ureteropelvic segment, horseshoe kidney, calyx diverticulum
- Sedentary lifestyle and prolonged immobility
- Uncontrolled intake of calcium and vitamin D supplements, some diuretics and sulfonamides
Types of stones and why it's important
Both treatment and prevention depend on the chemical composition of the stone. The composition can be determined by analyzing the passed stone, by density on a CT scan, and by biochemistry data of blood and urine.
- Calcium oxalate - the most common, dense, difficult to dissolve, but easily crushed
- Urate - formed in acidic urine with high levels of uric acid; the only type that can actually be dissolved with drugs (citrate mixtures)
- Phosphate - grows in alkaline urine, often associated with infection
- Struvite (infectious) - grow quickly, tend to form coral-shaped forms, require complete removal along with sanitation of the infection
- Cystine - rare, hereditary, characterized by persistent recurrence
Practical conclusion: if the stone has passed on its own, it must be preserved and submitted for analysis. This is the only way to choose accurate prevention and not get a new stone in two to three years.
Why urolithiasis is dangerous: complications
- Hydronephrosis - enlargement of the kidney due to impaired outflow of urine with gradual death of kidney tissue
- Acute obstructive pyelonephritis - purulent inflammation of a blocked kidney, requiring urgent intervention
- Urosepsis - spread of infection throughout the body, a life-threatening condition
- Chronic kidney disease and decreased renal function with a long or bilateral process
- Shrinking of the kidney and complete loss of its function, up to the need to remove the organ
- Arterial hypertension of renal origin
It is worth mentioning separately about “asymptomatic” coral stones. They don’t hurt because they don’t completely interfere with the flow of urine, but they constantly maintain inflammation and silently destroy the kidney. Such stones always require active treatment.
Diagnostics: what examinations are needed
The purpose of the examination is not just to see the stone, but to understand its size, exact location, density, condition of the kidney and the presence of infection. The choice of treatment method depends on this.
- Ultrasound of the kidneys and bladder is the first and most accessible method; shows kidney stones and pelvis dilatation well
- CT scan of the urinary system without contrast is the gold standard: it sees stones of almost any composition, determines the density and exact location
- Survey and excretory urography - assessment of the anatomy and excretory function of the kidneys
- General urine analysis and urine culture for flora with sensitivity to antibiotics
- General and biochemical blood test: creatinine, urea, uric acid, calcium, electrolytes
- 24-hour urine salt test and metabolic profile for recurrent stones
- Analysis of the composition of the passed stone
- Dynamic nephroscintigraphy - when you need to assess how much function the kidney has retained
Treatment: when the stone can pass on its own
Not every stone needs to be crushed. Small stones can pass away on their own, and in this case the doctor prescribes watchful waiting with drug support.
- Stones up to 5 mm pass on their own in most cases
- Stones 5–7 mm pass less frequently and require observation
- Stones larger than 7–8 mm rarely come out on their own; active tactics are usually needed
During expectant management, painkillers and antispasmodics are used, drugs that relax the ureter and facilitate the passage of the stone, and for urate stones, citrate mixtures are used for dissolution. A prerequisite is control: if the stone does not pass within a reasonable time, inflammation begins or the kidney expands, the tactics are changed.
Modern methods of stone removal
Today, open surgery for stones is rarely performed. The basis is minimally invasive methods in which the stone is destroyed and removed through natural means or through a puncture.
- External shock wave lithotripsy (ESWL) - the stone is crushed by a focused wave from the outside, without incisions or punctures; suitable for kidney stones and the upper third of the ureter of low density
- Contact ureterolithotripsy - an endoscope is passed through the urethra to the ureteral stone, the stone is destroyed by a laser or pneumatic probe and removed
- RIRS (retrograde intrarenal surgery) - a flexible ureterorenoscope is inserted into the kidney itself, the stone is crushed with a laser; method without a single cut
- Percutaneous nephrolithotripsy (PNL) and mini-perc - through a puncture in the lower back about a centimeter wide; the main method for large and coral-shaped stones
- Laparoscopic ureterolithotomy - for large impacted ureteral stones when endoscopic methods are ineffective
- Ureteral stenting and percutaneous nephrostomy - do not remove the stone, but urgently restore the outflow of urine in case of kidney block and infection
The choice of method is made by the urologist based on the size, density and location of the stone, the anatomy of the urinary tract, the condition of the kidney and concomitant diseases. A combination is often used: first a stent and antibiotic therapy, then planned fragmentation.
Prevention: how to avoid getting stones again
Urolithiasis is prone to recurrence: without prevention, a significant proportion of patients encounter a new stone within several years. Prevention is based on the composition of the stone and the results of a metabolic examination.
- Drink enough liquid, focusing on a urine volume of at least 2–2.5 liters per day; in the summer months and when working in the heat, the volume is increased
- Distribute fluids throughout the day, including a glass of water at night - urine is most concentrated at night
- Limit salt: excess sodium increases urinary calcium excretion
- Do not abuse animal protein, especially with urate stones
- For oxalate stones - moderately limit sorrel, spinach, beets, nuts, strong tea and chocolate, but do not give up calcium in food
- For urate stones - control uric acid, treat gout, use citrate preparations as prescribed by a doctor
- Treat urinary tract infections promptly
- Monitoring ultrasound and urine analysis at least once a year, and in case of recurrent course - according to an individual schedule
Where is urolithiasis treated in Tashkent
If you have kidney stones, it is important to go to a clinic where there is not only a urologist, but also all the necessary equipment: a CT machine, a lithotripter for remote crushing, an endoscopic stand with a laser, conditions for percutaneous operations and a hospital.
In Tashkent, such treatment is carried out, in particular, at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic. Here you can go from an initial appointment with a urologist and examination to stone crushing and subsequent observation, without moving from clinic to clinic.
What makes sense to clarify when making an appointment: what crushing methods are available, whether the operation is performed on the day of hospitalization, whether preliminary preparation is needed, and how observation is organized after stone removal. Contacts of both clinics and the online registration form are below on this page.
