Urinary stones (uroliths) are stone-like formations (concretions) that are found in the urinary tract. If they interfere with the removal of urine, the patient experiences extreme colicky pain. This is a urinary stone disease, which urology specialists also refer to as urolithiasis.
Below you will find further information and selected specialists for urinary stones.
Urinary stones are small, stone-like formations (concretions) that are formed from mineral salts and can block the urinary tract.
Urinary stones are one of the most common diseases in Germany. In recent decades, the rate of urinary stone diagnoses has tripled. This is due to changes in dietary habits and living conditions, but also to improved diagnostic possibilities.
Urinary stones have different names depending on where they are located:
Most urinary stones are very small so that the body can excrete them via the urine. Many patients therefore do not even notice that they have or have had urinary stones. However, if the urinary stones reach a certain size, they can get stuck in the urinary tract. They can then cause severe, cramp-like pain (colic). In this case, they must be removed.
It is estimated that one in ten people will be affected by urinary stones in the course of their lives. In every fourth person affected, they even occur several times.
If there are high concentrations of certain mineral salts in the urine, they are precipitated if the urine is acidic. This means that they are no longer soluble. They form small crystals(semolina), which then aggregate to form larger formations. In extreme cases, a urinary stone can be so large that it fills the entire renal pelvis (effusion stone).
Urinary stones differ in terms of their main constituent.
Known risk factors for the development of urinary stones are
In older men, bladder stones often occur together with benign prostate enlargement. Prostate enlargement is associated with impaired bladder contraction, which makes it difficult to pass urine.
Inflammation of the urinary tract favors the formation of stones. Certain neurological diseases(paraplegia, multiple sclerosis) also cause a restricted flow of urine. They therefore also often cause the formation of urinary stones.
Struvite stones often form as a result of urinary tract infections. An unhealthy diet with an excess of stone-forming salts also favors the occurrence of stones. The body cannot excrete sufficient quantities of the chemical compounds via the urine. These stone-forming salts include
Whether symptoms occur depends on the size of the urinary stone and its exact occurrence. Bladder gravel and small concretions do not usually cause any problems.
However, if urinary stones restrict the flow of urine, symptoms will occur. Sharp-edged urinary stones rub against the wall of the organ and cause
If the urine can no longer drain away, it backs up to the kidney. The resulting urinary retention (ischuria) requires urgent emergency medical treatment, as otherwise it can lead to blood poisoning. Inadequately drained urine can lead to permanent kidney damage.
When urinating, a sudden extreme pain in the lower abdomen (colic) may occur. Sometimes the urine stream simply stops. The irritation of the mucous membrane leads to blood in the urine. Other patients complain of a constant urge to urinate, but can only pass a few drops of urine (pollakiuria).
If the urinary stones cause pain, the patient tries to find relief by changing their posture. They lie down, stand upright and walk around. Sometimes the discomfort is so severe that the patient becomes nauseous and vomits.
If you notice these symptoms, please consult a urologist as soon as possible.
Urinary stones can get stuck in all areas of the urinary tract, including the kidneys © Henrie | AdobeStock
During the medical examination, the urologist first listens to the patient's lower abdomen and then palpates it carefully. If he suspects that a urinary stone is present, he will take a urine and blood sample. The urine sample shows whether bacteria, blood or crystals are present in the patient's urine. The blood sample provides information about the uric acid content, kidney function and a possible urinary tract infection.
The most important imaging procedures are ultrasound (sonography) and computer tomography (CT).
Sonography is easy to perform and radiation-free. On the ultrasound image , urinary stones in the kidney can be detected from a size of at least 5 mm. Above this size, the stones cause increasing problems.
Computer tomography is mainly used to detect stones in the ureters. It can also be used to visualize urinary obstruction and very small stones that are not visible on ultrasound.
Occasionally and as an alternative to computed tomography, an X-ray of the urinary tract is also performed without a contrast agent. However, this examination is not as sensitive as a CT scan.
If a urinary diversion has to be performed, a so-called ureteropyelography is carried out beforehand. A contrast agent is administered to the patient via a catheter, which allows the ureter and renal pelvis to be visualized very well.
Various medications help against renal colic. As a rule, these are non-opioids, with metamizole being the drug of first choice. However, indomethacin and dicofenac can also alleviate the symptoms. Heat applications, such as hot baths, may also have a pain-relieving effect.
The urologist does not need to treat urinary stones that do not cause any symptoms. They simply observe them at regular intervals. Urinary stones that are a maximum of 5 mm in size often pass spontaneously. Alternatively, flushing medication can also be used. Under certain circumstances, uric acid stones can also be dissolved with medication.
It is always important for the patient to drink plenty of fluids. A lot of exercise can also help to dissolve the urinary stone.
Urinary diversion is necessary if the urinary tract is so blocked that urine can no longer be excreted (urinary retention). A thin plastic tube (ureteral stent) is pushed past the blocked area and into the kidney. The urine can then flow out through this. This protects the kidney and reduces the risk of further kidney damage.
Urinary stones that block the outflow of urine must be removed. The same applies to stones that continue to cause pain despite treatment or do not pass on their own. In most cases, surgical removal is now minimally invasive.
Ureteral stones and smaller kidney stones are treated usingureteroscopy and renal pelviscopy(ureterorenoscopy). An endoscope is advanced through the urethra, bladder and ureter into the renal pelvis. The urinary stones are then removed using mini forceps; larger stones are first broken up using a laser.
Large kidney stones, including effusion stones, are removed using minimally invasive or open percutaneous (through the skin) stone surgery. This is known as percutaneous nephrolitholapaxy. However, open surgery is rarely used nowadays.
As part of shock wave therapy(ESWL, extracorporeal shock wave lithotripsy), energy waves are focused on a ureteral or kidney stone from the outside. This shatters the stone. The fragments are then excreted with the urine.
However, large urinary stones can also produce larger pieces of debris, which in turn can block the urinary tract. In this case, further interventions such as a ureterorenoscopy or a ureteral stent would be necessary.
If the urinary stone was formed in connection with another disease, the specialist must also treat this.
Once the urinary stone has been successfully removed, the specialist must find the cause of its formation. This is the only way to prevent the formation of further urinary stones in the future.
Many patients who have had a urinary stone removed go on to develop urinary stones again. To prevent this, you should drink at least 2.5 to 3 liters a day. This dilutes the urine so that the mineral salts can no longer precipitate and form crystals.
Sugar-sweetened soft drinks increase the risk of stone formation. You should therefore avoid these drinks.
In addition, make sure you eat a balanced diet. People with uric acid stones should only eat a small amount of purine-containing foods, as the body breaks down the substance purine into uric acid. The following have a high purine content
Oxalic acid stones can be prevented by avoiding the consumption of
coffee.
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