Disease Description (Causes and Symptoms)
- Definition and pathophysiology: A condition in which certain solutes in the urine, such as calcium, oxalate, uric acid, and cystine, become supersaturated, crystallize, and aggregate to form stones in the urinary tract (kidneys, ureters, bladder, and urethra). When a stone partially or completely obstructs the urinary tract, impaired urine flow, increased pressure in the kidneys, and inflammation may occur.
- Main causes: Genetic predisposition, inadequate fluid intake, high-salt or high-protein diet, excessive oxalate intake, metabolic abnormalities (hypercalciuria, hyperuricosuria, hypocitraturia), chronic urinary tract infections, and certain medications.
- Main symptoms: Severe, continuous or wave-like pain in the flank (lateral abdomen) or renal area (renal colic), hematuria (gross or microscopic), frequent urination, a feeling of incomplete emptying, and painful urination (with bladder or urethral stones), nausea and vomiting, and fever (when infection is present). Symptoms vary depending on the stone’s size and location and whether urinary tract obstruction is present.
Treatment Methods
- Conservative (symptomatic) treatment
- Pain control: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line choice (additional analgesics or injections may be used in severe cases).
- Fluid replacement: It is recommended to maintain urine output at 2 L or more per day.
- Observation (monitoring passage): When the stone is approximately ≤ 5 mm, spontaneous passage is highly likely, so conservative treatment and observation (activity, hydration, and pain management) are used.
- Medication treatment
- Ureteral smooth-muscle relaxants (e.g., tamsulosin, an α-blocker) may help the stone pass through the ureter (considered in certain situations).
- When infection is present, appropriate antibiotics are administered (according to culture results).
- Medications to prevent recurrence: Thiazide diuretics for hypercalciuria, potassium citrate (K-citrate) for hypocitraturia or citrate deficiency, and allopurinol for uric acid stones, among others — determined according to the stone composition and metabolic test results.
- Procedures/surgical treatment
- Extracorporeal shock wave lithotripsy (ESWL): Uses external shock waves to break the stone into fragments and promote spontaneous passage — suitable for small to medium-sized stones in certain locations in the kidney or ureter.
- Ureteroscopic stone removal (endoscopic removal of ureteral or kidney stones, including laser fragmentation): The stone is directly fragmented and removed using an endoscope inserted into the ureter or renal pelvis.
- Percutaneous nephrolithotomy (PCNL): Suitable for large kidney stones (such as staghorn or necrotic stones), which are removed through direct access through the skin.
- Open/laparoscopic surgery: Used relatively rarely and considered when other methods cannot resolve the condition.
- Emergency treatment
- When urinary tract obstruction is accompanied by a bacterial infection (fever or signs of sepsis), immediate drainage (urinary diversion: ureteral stent insertion or percutaneous nephrostomy) and antibiotic administration are necessary.
- Precautions and self-care
- Risk of complications: Worsening kidney function due to urinary tract obstruction, urinary tract infection and sepsis, and possible chronic kidney disease due to recurrent stones.
- When medications are used, the doctor should monitor kidney function and electrolytes (e.g., electrolyte changes when taking thiazides).
- High-dose vitamin C (≥2 g/day) should be used with caution because it may increase oxalate production in the urine.
- After surgery or a procedure, it is important to analyze any passed stone and establish prevention strategies according to its composition.
Checklist Before an Outpatient Visit (Including Preparation Items and Example Questions)
- Items to prepare (recommended to bring)
- A list of all medications and supplements currently being taken (including dosage and administration times)
- Previous test results (blood tests, urine tests, urine cultures, and, if available, imaging files or CDs such as previous CT scans or abdominal X-rays)
- History of urinary stones (when they occurred, treatment methods received, and any passed stones that have been kept)
- Symptom record: time pain began, intensity (pain scale), presence of hematuria, fever/chills, nausea or vomiting, and changes in urination
- Notes on fluid intake and eating habits (usual amount of water consumed, whether a high-protein or high-salt diet is being followed, etc.)
- Warning signs that should be reported to the doctor in advance during an outpatient visit (report immediately)
- High fever or chills, inability to urinate (anuria), uncontrolled pain, and persistent vomiting (dehydration) require emergency treatment.
Examples of General Questions to Ask the Doctor
- What are the size and location of this stone (or suspected stone)? How likely is it to pass spontaneously?
- Which imaging tests (CT, ultrasound, etc.) are recommended, and how urgently should they be performed?
- What medications are prescribed to control pain or reduce the risk of infection? What are their side effects?
- What lifestyle or dietary adjustments do you recommend to reduce recurrence?
- Can the composition of a passed stone be analyzed? Based on the analysis results, which preventive medication should be used?
Examples of Disease-Specific Questions
- Can the composition of my stone (calcium-based, uric acid, cystine, etc.) be identified? What tailored preventive medications or dietary guidelines are recommended based on the results?
- Considering the current stone size (e.g., X mm) and location, which treatment do you recommend (conservative observation, ESWL, ureteroscopy, PCNL, etc.)? What are the risks and expected benefits?