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Lithiasis

Renoureteral lithiasis is the third most frequent disorder of the urinary tract. The annual incidence in Spain exceeds two million affected, and 10% of them will have symptoms. In our Lyx Urology Centre in Madrid we offer diagnosis and treatment of this pathology, including all the following options:

  • Remark: treatment of renal colic and follow-up until the spontaneous expulsion of the lithiasis
  • Ureteral catheterization under sedation. Antegrade and retrograde pyelography
  • Using Extracorporeal Shock Wave Lithotripsy (ESWL) on an ambulatory basis under sedation
  • Rigid and flexible ureteroscopy. Litofragmentacion with Holmium-Yag Laser
  • Endoscopic percutaneous nephrolithotomy
  • Laparoscopic ureterolithotomy

Renal lithiasis is among the most common and painful urologic disorders. Fortunately, most of the stones are eliminated from the body without any need for an intervention.

The urinary system comprises the kidneys, ureters, bladder and urethra. The kidneys are two bean-shaped organs that are located below the ribs on the back of the torso (area between the ribs and the hips). They are responsible for maintaining the balance by eliminating excess water and waste from the blood and converting them into urine. The kidneys maintain a stable balance of salts and other substances in the blood. They also produce hormones that build strong bones and help form red blood cells. Urine is transported by the ureters from the kidneys to the bladder, which is a reservoir with a triangular form in the lower part of the abdomen. Like a balloon, the bladder walls stretch and expand to store urine. The bladder deflates when the urine goes through the urethra to the outside of the body.

What is a renal lithiasis (stone)?

Imbalance between certain urinary components of the kidney – chemical compounds such as calcium, oxalate and phosphate – promotes or inhibits the crystallization, a stone is formed. The most common stones contain calcium in combination with oxalate and/or phosphate.

There is a less common type of stone that is caused by urinary tract infections. This type of stone is called struvite or infectious lithiasis. Pure uric acid stones are much less common. Even less frequent is hereditary lithiasis that produces so-called cystine stones. And even less common is lithiasis linked to inherited disorders.

Who develops kidney stones?

Although stones occur more often in men, the number of women who develop stones has increased over the past 10 years, which has altered the relationship. Kidney stones are most common between 20 and 40 years of age. If a person develops a stone, there is a 50% chance that they will develop another.

What are the causes of the lithiasis?

While certain foods promote the formation of stones in susceptible people, researchers do not believe that the intake of any specific food promotes lithiasis in people who are not vulnerable. They are also sure that some factors – such as personal or family history of renal lithiasis and other infections or urinary tract diseases – have a connection with the problem. Climate and water intake can also have a part in the formation of stones. It is also possible that stones are formed because of an obstruction of the urinary ducts like when there is a prostate enlargement or stenosis. The formation of stones also has been linked to hyperparathyroidism, which is an endocrine disorder that results in higher levels of calcium in the urine.

What are the symptoms of kidney stones?

Normally, the symptom of a kidney stones are extreme pain that has been described as worse than labour pain. The pain often begins suddenly when the stone is advancing in the urinary tract, which causes irritation and blockage. Typically, the person will feel a sharp pain similar to a cramp in the back and on the side of the area of the kidney or in the lower abdomen, and may extend to the groin. Also, sometimes the person can urinate blood and have nausea and/or vomits. Occasionally, stones don’t cause any symptoms at all. But even if they are “silent”, they may be growing and pose a threat that can even cause damage to the renal function.

If the stone comes to pass easily, pain continues as the muscles in the walls of the ureter try to push it into the bladder. The person may feel the need to urinate more frequently or have a burning sensation when urinating. In men, the pain may radiate to the end of the penis. If the stone is near the lower end of the ureter at the opening of the bladder, the person often feels that they did not complete the urination.

Stones of only 2 mm have caused many symptoms while others, the size of a pea have passed quietly. If these symptoms are accompanied by fever or chills, then there may be an infection. You should contact your urologist immediately.

How is renal lithiasis diagnosed?

Sometimes stones are “silent” – they don’t cause any symptom – and they are found on x-rays incidentally. If they are large, then they need a treatment. If your doctor suspects that there is a stone but cannot make the diagnosis with a simple x-ray, you can perform a scan of the urinary system with a CT scan of the Abdomen/Pelvis without contrast, which is a extremely useful diagnostic tool that can detect almost all types of ureteral stones.