Stone Disease

  • Kidney stones are common (10% lifetime risk)
  • Often found by ‘accident’ on a scan done for other reasons
  • Can usually be treated with laser endoscopically in a day surgery setting
  • Prevention strategies are important
Stone Disease
What Causes Kidney Stones?
  • Often no single cause is found: it is usually multifactorial
  • Common general factors that contribute to stone formation include
    • Dehydration
    • High salt diet
    • Obesity
    • Family history
    • Elevated uric acid
    • Recurrent urinary tract infections
  • Conditions where urinary tract stones occur more frequently
    • Excess parathyroid hormone secretion
    • Obesity
    • Polycystic kidney disease
    • Gastrointestinal disease – previous bariatric surgery, bowel resections, inflammatory bowel disease
    • Spinal cord injury
  • Anatomical abnormalities where stones occur more frequently
    • Medullary sponge kidney
    • PUJ obstruction
    • Horseshoe kidney
  • Genetic causes of stone disease (rare)
    • Primary hyperoxaluria
    • Cystinuria
    • Renal Tubular acidosis (type 1)
    • Xanthinuria
How Are Kidney Stones Managed?

Management of renal stones can be broadly divided into two main categories:

  • surveillance or
  • active treatment

The decision as to which is the best approach is not always a simple one and will take multiple factors into account. Some of these factors include:

  • Urological factors: number and size of stone(s), stone location, associated anatomical or genetic causes, associated infections
  • Risk of ureteric obstruction
  • Renal function
  • General medical and surgical history
  • Age and fitness for surgery

If actively treated, most stones will be treated endoscopically with a laser. This is where a camera in inserted into the urinary tract (via the urethra). Once the stone is reached a laser is used to break it into tiny fragments that are then removed.

Occasionally some stones will require more than one procedure or will involve a more complex procedure such as a PCNL or rarely robotic surgery.

What Investigations Might be Requested?

Not all the below investigations will be relevant to yourself. Your Urologist will be able to advise which investigations you will require and what information they will provide. A list of some of the more commonly performed investigations are included below.

Blood test

  • Kidney function
  • Levels of calcium, phosphate, uric acid & parathyroid hormone level

Urine test

  • Infection
  • Blood in the urine
  • 24 hour urine analysis: volume, pH, calcium, oxalate, urate, citrate, magnesium

Imaging

  • CT scan – usually always required. Provides detailed information about size and location of stone(s)
  • X-ray KUB – sometimes helpful

Ultrasound – the information provided about stone disease is not as detailed as in a CT scan but does have the advantage of minimising radiation exposure

How Can I Prevent Stones From Coming Back?

Urinary tract stones can commonly recur and so preventative actions are important.

General prevention strategies include:

  • Maintain adequate fluid intake: aim for urine to be clear or light yellow
  • Low salt diet

Specific prevention strategies can be implemented if there is a clear underlying cause identified. Addressing the underlying cause will help reduce the risk of stone recurrence.

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