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Urology

Kidney Stone Disease

Urinary system stone disease is a common condition that significantly affects the quality of life, occurring as a result of minerals and salts in the urine crystallizing and clustering within the renal channels.

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ℹWhat is Kidney Stone Disease?

When the concentration of substances such as calcium, oxalate, phosphate, and uric acid found in the urine increases, or when the urine volume decreases, these substances precipitate to form crystal structures and, over time, create kidney stones.

Stone Types:

  • Calcium Oxalate and Phosphate (75-80%): The most commonly seen group.

  • Infection (Struvite) Stones: Formed as a result of chronic infections; they can turn into staghorn stones.

  • Uric Acid Stones: Seen in protein-heavy diets or Gout disease.

  • Cystine Stones: Hard stones formed as a result of a rare, genetic metabolic disorder.

Common Symptoms

Renal Colic
Severe, breathtaking pain starting in the flank and radiating to the groin.
Hematuria
Blood in the urine.
Urinary Urgency
Frequency or burning, especially with lower ureteral stones.
Nausea and Vomiting
Develops due to the severity of colic pain via the renointestinal reflex.
Fever and Chills
An emergency if infection accompanies the stone. Urinary drainage must be established to prevent urosepsis.

Diagnosis Methods

Non-Contrast Urinary System CT
Gold standard. Clearly shows stone size, location, and density (Hounsfield units).
Ultrasonography
Preferred as first-line and in pregnancy due to absence of radiation.
Urinalysis
Checks for the presence of bleeding and infection.
Serum Biochemistry
Renal function (creatinine) and calcium levels are assessed.

Causes

Genetic Factors
Familial predisposition is an important factor in stone formation.
Inadequate Fluid Consumption
Low water intake increases urine concentration, triggering crystallization.
Excessive Salt Consumption
High sodium intake increases urinary calcium excretion.
Obesity and Metabolic Diseases
Metabolic disorders such as hyperparathyroidism increase stone risk.

Treatments

Medical Therapy and Spontaneous Passage
The majority of stones smaller than 6 mm can pass with hydration, analgesics, and alpha-blockers.
ESWL (Extracorporeal Shock Wave Lithotripsy)
Breaking stones with shock waves from outside the body. Effective for stones smaller than 2 cm that are not very hard.
Ureteroscopy (URS) / RIRS
Endoscopic entry into the ureter/kidney with laser pulverization of the stone.
Percutaneous Nephrolithotomy (PCNL)
For stones larger than 2 cm or complex calculi; a small tract is created through the back into the kidney.
Robotic/Laparoscopic Stone Surgery
For very large stones or when accompanied by anatomical abnormalities.

Prevention

Metaphylaxis
A personalized preventive treatment strategy that reduces the 50% recurrence risk of stone disease to below 10%.
Metabolic Evaluation
Checking calcium, oxalate, citrate, uric acid, phosphate, and magnesium levels in 24-hour urine; and checking calcium, uric acid, PTH, and Vitamin D in the blood.
High Fluid Consumption
Sufficient daily water intake lowers urine concentration and prevents stone formation.
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