Urinary Stones are Common

Stones of the urinary tract will effect about 1 in 10 Australians.  They are particularly common in Queensland, especially males aged 40 – 60.  Many stones pass spontaneously, however stones causing severe ongoing pain, kidney damage, or infection, or stones that are too large to likely pass, require intervention.

Patients with severe pain may require hospitalization for pain relief.  An initial assessment is made after with a CT scan on the size, position, and number of stones, to determine how likely the problem stone is to pass spontaneously. Some patients require further intervention – this can include placement of a small internal drain between the bladder and kidney to relieve blockage (a stent), endoscopic laser fragmentation of a stone, or external shock wave lithotripsy (ESWL). Open surgery is only rarely required.

Up to one half of patients experiencing a stone episode will have a further episode within five years.  General advice includes taking enough fluid to maintain a urine output of around 2 litres a day, and avoiding a high protein diet.  Paradoxically, reducing calcium consumption can worsen stone disease in some patients. Some patients may require a more detailed metabolic assessment, especially if there are multiple stones present.

 

Ureteroscopic lithotripsy.

This is the commonest surgical intervention for a stone in the tube between the kidney and the bladder i.e. a ureteric stone, as shown in the images below, or for stones still in the kidney.  The stone is carefully reached with a very fine instrument passed up though the bladder into the ureter and kidney, then broken with a laser fibre. Great care must be taken not to injure this delicate tube or the kidney during the process of fracturing and removing the stone, which is after all "rock-hard".

 

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Extracorporeal Shock Wave Lithotripsy

Some stones are more suitably treated by breaking them with repeated shock waves generated externally, then transmitted through the body, and focused on the stone. Several thousand shock waves are used to gradually pulverise the stone while not causing damage to surrounding tissue.

 

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