Urolithiasis

Urolithiasis

A urinary stone disease is referred to as urolithiasis. This leads to the formation of uroliths in the urinary tract.

What is urolithiasis?

Urolithiasis is the medical term for the presence of urinary stones (uroliths) within the urinary tract such as the bladder and ureters or the renal pelvis. Urinary stones are pathological structures that are composed of different crystals. As a rule, the urinary stones are formed from calcium oxalate and occur in the kidneys. For metastases explained, please visit psyknowhow.com.

If they are deposited there, there is talk of kidney stones . However, there is also the possibility of stones being deposited in the urinary tract and the urinary bladder. Doctors then speak of urinary stones or bladder stones. In the urethra, however, the stones are only rarely deposited.

Depending on the types of salt that make up a urinary stone, in urolithiasis, calcium oxalate stones, which make up around 75 percent of urinary stones, are divided into struvite stones (about ten percent), calcium phosphate stones (about five percent), urate stones made from uric acid (about five percent) and rare xanthine stones and cystine stones.

The type of urinary stone plays an important role in determining the cause of the disease and in diagnostics and therapy. In Germany alone, around six percent of all people suffer from urolithiasis. Men get the disease twice as often as women. Seniors and overweight people are particularly affected.

Causes

The causes of urolithiasis are different. Usually several factors play a role at the same time. Urinary stones form when more substances are excreted with the urine that promote the development of urolithiasis. These are lithogenic substances such as oxalic acid, calcium and phosphates. In addition, fewer substances are excreted that counteract the formation of urinary stones.

These are primarily citrate and magnesium. Furthermore, the critical urine pH is between 5.5 and 7.0. Finally, urine that is too concentrated is excreted. The factors are considered typical of urolithiasis. They are often associated with osteoporosis (bone loss), an overactive thyroid gland and vitamin D overdose.

Other possible risk factors for the development of urolithiasis are urinary tract infections, accumulation of urine due to anatomical outflow disorders or neurogenic bladder emptying disorders, and lack of exercise. A diet that is too high in protein can also play a role.

In Germany in particular, a diet with foods containing oxalic acid and the consumption of animal fats are classified as conducive to the formation of urinary stones. Foods that contain oxalic acid include coffee, cocoa, spinach, beetroot, and rhubarb. The stone-forming substances such as oxalate can only be dissolved in the urine and transported out of the organism up to a certain amount.

If this amount is exceeded through the diet, there is a risk of precipitation of the stone-forming substances. Additional risks for urolithiasis are insufficient fluid intake and diet.

Symptoms, Ailments & Signs

Urolithiasis initially causes no symptoms. These only occur when the urinary tract is obstructed by the urinary stones. Then different symptoms appear. Staccatomic action is considered characteristic of urolithiasis. The stream of urine breaks off several times during urination. The bladder outlet is repeatedly blocked by the movable urinary stone, which in turn interrupts continuous urination.

Furthermore, small amounts of urine, the feeling of foreign objects, constant urge to urinate, blood in the urine, bladder cramps with colicky pain and pain when urinating can occur in urolithiasis. In men, the symptoms often radiate to the tip of the penis.

Diagnosis & course of disease

If the urolithiasis leads the patient to the doctor, the doctor first asks about the pain, when it occurs and whether the patient has ever had to deal with urinary stones. A physical examination takes place after the interview. Urine and blood are also checked.

Some imaging methods are also considered helpful. A sonography (ultrasound examination) and an X-ray examination are used to determine the position and size of the urinary stones. X-rays can also provide clues about the chemical composition of the stones.

Another useful diagnostic method is the cystoscopy with an endoscope. Smaller bladder stones can often even be removed. The course of urolithiasis is usually positive. Around 75 percent of all urinary stones go away on their own with conservative treatment. However, around 50 percent of all patients suffer from the formation of new urinary stones.

Complications

Urolithiasis can cause urinary retention, which causes inflammation and acid-base and electrolyte imbalances, among other causes. If left untreated, urinary retention can lead to kidney infection or even blood poisoning. Accompanying this, severe pain occurs, which ties the affected person to the bed and massively restricts the quality of life.

Sudden urinary retention can cause a fornix rupture, in which the renal calyx tears and urine leaks out. If a urinary stone presses on a calyx, this can lead to a kidney abscess. If the course is severe, there is a complete or partial failure of kidney function.

In the surgical treatment of urolithiasis, small bleeding and bruising occasionally occur. Inflammation is also possible. The crushing of the urinary stones can result in a bacterial infection. Sometimes a fragment or an entire stone lodges in the ureters, causing renewed urinary retention and painful colic.

In addition, allergic reactions can occur. Patients who suffer from a previous illness or are on medication have an increased risk of interactions and long-term effects from prescribed painkillers and sedatives.

When should you go to the doctor?

In the case of urolithiasis, medical examination and treatment should always take place, since this disease cannot heal on its own. The earlier the disease is recognized by a doctor, the better the further course is. The affected person should consult a doctor as soon as the first symptoms and symptoms appear.

A doctor should be contacted if the water jet breaks off several times when urinating. As a rule, this complaint occurs permanently and does not go away on its own. Bloody urine can also indicate this disease. Some sufferers also experience severe pain when urinating, which can also spread to the penis. If these symptoms occur without a particular reason, a doctor must be contacted.

The disease can be diagnosed and treated by a general practitioner or by a urologist. The further course depends heavily on the time of diagnosis, so that no general prediction can be made.

Treatment & Therapy

Often no special treatment of urolithiasis is required. Small urinary stones in particular are excreted from the body with the urine. This process can be promoted by administering certain medications such as alpha-receptor blockers.

In addition, the patient must drink plenty of fluids. If the urinary stones cause pain or cramps as they migrate through the urinary tract, painkillers such as diclofenac or pethidine can be taken. If the bladder stone is too large to be excreted, a cystoscopy can be useful to remove it, which is done under local anesthesia.

In most cases, however, urinary stones are removed by extracorporeal shock wave lithotripsy (ESWL). The shock waves destroy the urinary stones, the remains of which can then be excreted with the urine. Surgery to remove the stones is rarely required.

Prevention

To prevent urolithiasis from occurring in the first place, you should drink a lot and make sure you get enough exercise. It is also important not to eat too many foods that are rich in oxalic acid or purine.

Aftercare

Aftercare plays a very important role in urolithiasis. Many patients can later suffer from urinary stones again, which depends on the type of stones and the triggering cause. Without suitable follow-up treatment, around 50 to 60 percent of those affected will suffer from urolithiasis again. In 25 percent, there are even three or more recurrences, which in turn lead to the formation of urinary stones.

Appropriate aftercare measures can reduce stone frequency by up to 50 percent. Patients who are prone to stone recurrence are particularly in the focus of follow-up treatments. It is important for the doctor to determine certain risk factors such as metabolic disorders or the composition of the stone. The follow-up treatment should take place with a specialist in urology.

Adjusting your diet is also important. This is particularly useful for calcium phosphate stones, calcium oxalate stones or uric acid stones. In addition to dietary adjustments, excess weight should also be reduced and sufficient exercise should be carried out.

Follow-up care for patients suffering from cystine stones or magnesium phosphate stones must be taken particularly seriously. The risk of new stone formation is highest in these forms of urolithiasis. Consistent aftercare can prevent up to 75 percent of all patients from developing urinary stones again, for which general measures such as drinking three liters of fluid per day, a change in diet and sufficient physical exercise are usually sufficient.

You can do that yourself

Urolithiasis therapy can be supported by various self-help measures. The first thing to do is drink enough fluids. Citrus juices and mineral water rich in bicarbonate have proven their worth. The diet should consist of high-calcium and low-salt foods. Avoid oxalate-rich foods such as walnuts, spinach or chocolate. Animal proteins should only be taken in small amounts, since they contain purines, which can intensify urolithiasis. Basically, the proportion of meat, sausage and legumes in the diet should be as small as possible. Physical exercise supports an adapted diet.

If the stones do not go away by themselves, the urologist must be consulted promptly. Drug or surgical treatment may be necessary, especially in the case of larger kidney or uric acid stones. If signs of a renewed illness appear after the therapy, a doctor’s visit is recommended.

Finally, after a urinary stone disease, the annual clinical examination must be used. The condition of the involved organs can be monitored by means of a CT scan and a blank kidney scan, and treatment can be initiated if necessary. The self-help measures should first be discussed with the attending family doctor or urologist in order to avoid complications.

Urolithiasis