Urinary stones are one of the diseases of affluence whose incidence has increased in recent years. They occur when the body is overloaded with the elimination of its toxins.
What are urinary stones?
Schematic diagram showing the anatomy and structure of the urinary bladder. Click to enlarge. Urinary stones are mineral deposits in the body that have combined to form larger structures. They occur in the urinary tract (ureter, bladder and urethra) and in the kidney. The shape and chemical composition can vary. Urinary stones form when salts dissolved in urine precipitate as crystals. Most consist of calcium oxalates, but stones made of cystine, uric acid or phosphate are not uncommon. If the deposits cannot be flushed out naturally, they grow into crystals over time. These can take on rounded or branched shapes. Depending on the localization, a size of up to several centimeters is possible before the first symptoms appear. About one in 20 Germans suffers from urinary stones in the course of his or her life, including twice as many men as women. Those affected usually receive their first diagnosis between their mid-20s and 60s.
Causes
Urinary stones often develop as a result of metabolic diseases or hormonal disorders that make it difficult to break down certain substances. But basically, anyone can get urinary stones. Any behavior that increases the concentration of salt and acid in the urine favors the formation of the crystals. If the daily fluid intake is too low, the urinary tract is not flushed out sufficiently. An improper diet also plays a major role. An excess of meat and coffee causes uric acid levels to rise. Due to the resulting imbalance between water and the substances dissolved in it, the urine takes on a dark yellow color. When this occurs, even in healthy people, there are deposits that can develop into stones. Bladder stones are often the result of insufficient emptying of the bladder, leaving behind residual urine. This particularly affects men with prostate enlargement and people suffering from urethral stricture, paraplegia or multiple sclerosis.
Symptoms, complaints and signs
Urinary stones cause sudden, colicky pain in the abdomen. The pain usually occurs in episodes and may radiate throughout the abdominal region and to the genitals. Accompanying this, the patient experiences a strong urge to urinate and nausea. There is often difficulty urinating and other symptoms that clearly indicate urinary stones. The clearest sign of disease is red discolored urine. In the absence of treatment, complete urinary retention may occur, initially manifested by severe pain and increasing nausea. As the disease progresses, rupture of the urethra may occur, also associated with severe pain, blood in the urine, and malaise. In less severe cases, the ureter merely becomes wedged in the ureter and causes mild pressure pain. In women, burning pain occurs more quickly due to the shorter ureter. Normally, urinary stones are not visible externally. However, there may be typical signs of the disease, such as sweating and pale skin. Particularly in the case of chronic symptoms, external changes are also possible, for example a sickly appearance or inflammation. If urinary stones are removed early, no serious symptoms or late effects occur.
Diagnosis and course
Urinary stones are most commonly recognized when they become wedged in the ureter. When they do, they cause sudden, colicky pain that can be felt throughout the abdominal region and up to the genitals. At the same time, the affected person feels a strong urge to urinate and nausea. The pain of ureteral stones disappears as abruptly as it came, but returns at irregular intervals. Cramping pain, an increased urge to urinate, and difficulty urinating indicate bladder stones. Stones with sharp edges can cause internal injury as they move through the urinary tract. This manifests in red discolored urine and can lead to dangerous infections. Kidney stones are often discovered by chance, as they usually do not show any symptoms.Depending on their chemical composition, the stones can be localized either on X-ray images or during ultrasound examinations. Urinalysis and blood tests also help in the diagnosis. If nothing is done, in bad cases a so-called effusion stone can form. In this case, the entire urinary tract is “poured out” with deposited minerals
Complications
Urinary stones block the urinary outlets, which can have serious consequences. In general, urinary stones cause very severe pain that radiates to the groin. This can severely limit the quality of life of the affected person. On the one hand, urine can build up to the point where it is back in the kidney. As a result, the kidney can become distended (hydronephros) and inflamed. The inflammation can go so far that the kidney fails (renal failure). As a result, the kidney can no longer perform as it once did. Less urine is squeezed out, leaving more volume in the body, leading to high blood pressure. Long-term high blood pressure can lead to occlusion of the vessels as part of an atherosclerotic process. The increased blood volume causes more water to be squeezed out into the tissues, resulting in edema. Furthermore, the kidney can no longer produce enough hormones, resulting in vitamin D deficiency and anemia (due to EPO deficiency). The kidney also experiences disturbances in electrolyte and acid-base balance. It can no longer excrete sufficient protons, so that the pH in the blood continues to drop. As a result, potassium also accumulates in the blood. Increased potassium concentration promotes the development of cardiac arrhythmias, which can be accompanied by sudden cardiac death.
When should you see a doctor?
A doctor should be consulted if there is unusual urinary behavior, blood in the urine, or fever. Urinary stones, like any other type of stone, require a comprehensive medical diagnosis. Larger stones must be crushed using shock wave therapy, while the development of smaller stones must be monitored by a physician. In addition, urinary stones always require comprehensive follow-up care. Therefore, urinary retention, pain in the kidney region and other complaints should be taken to the family doctor or urologist. A visit to the doctor is indicated at the latest if the symptoms persist for more than five days or increase in intensity as they progress. If the symptoms occur together with fever or circulatory problems, it is best to call an emergency physician. Patients with urinary tract infections, children, pregnant women, the elderly and people who regularly consume alcohol or coffee are among the typical risk groups. The same applies to people with a congenital narrowing of the urinary tract or chronic kidney disease. These should talk to a medical professional promptly if they experience any of the symptoms mentioned above, in order to avoid serious complications.
Treatment and therapy
In acute colic, the patient is given analgesics and anti-inflammatories, as well as antispasmodics. In most cases, the urinary stones then slide on by themselves and are excreted after a short time. However, drinking a lot without antispasmodic measures does not help. Because of the pain, the patient’s insides are so cramped at this point that the urinary tract becomes constricted and the stones become stuck. Above a certain size, urinary stones cannot be excreted at all. In these cases, surgery may be necessary. It is also possible to break up the stones with shock waves. In this case, the stones are bombarded with energy waves from the outside after they have been precisely localized, causing them to shatter into small pieces. They are crushed until they can be flushed out. In the case of uric acid stones, the patient is given medication that chemically dissolves the stone. When all gentler methods are exhausted, crushing is done with forceps or lasers. The risk of developing urinary stones again is very high for affected people. A quarter of patients have to be treated for this at least four times in the course of their lives. With the appropriate measures, the re-formation of urinary stones can be slowed down or completely prevented.
Outlook and prognosis
People who have urinary stones get a favorable prognosis in most cases. With early treatment, there are good therapeutic options, so that relief of symptoms and, at the same time, cure of the disease are possible.In the case of small urinary stones that cause only a few symptoms, drug treatment is often sufficient. Optimally, the urinary stones are removed from the organism via the natural excretions due to the given active substances and recovery occurs. In the case of larger urinary stones, the foreign bodies are crushed or surgically removed. Subsequently, the crushed small parts are also transported out of the body via the excretions. Recovery is given after a few weeks. In a control examination, imaging procedures are used to finally check whether all foreign bodies have been removed. Due to social developments, an increase in the number of diseases caused by urinary stones has been documented in recent years. It is also not uncommon for the stones to recur in the course of life. If the foreign bodies are detected and diagnosed in time, the prognosis remains favorable even if they recur. If medical treatment is not sought, deterioration of health is to be expected. In severe cases, there is a threat of an acute condition requiring emergency medical care. Otherwise, the individual’s premature demise is imminent.
Prevention
Drinking at least two liters of water a day dilutes the urine so that fewer deposits are formed. Deposits and smaller stones that are already present can be flushed out naturally. Physical activity supports this process. A change in diet makes sense if the person concerned has already had problems with urinary stones. The foods he must avoid depend on the composition of the stones that were removed. The patient should use test strips to check his urine at home and adjust his drinking and eating habits accordingly.
Follow-up care
To prevent recurrence, proper follow-up after treatment is essential. The amount of fluid ingested should be increased so that the amount of urine produced is more than two liters per day. This leads to a dilution of the urine and a general reduction in stone formation. A change in diet adapted to the individual case can also prevent renewed stone formation through targeted ph-value changes. Ideally, a urinary stone analysis could be performed by the treating physician as part of the treatment. The majority of those affected have calcium oxalate stones, the formation of which is promoted by oxalate-containing foods. These include rhubarb, celery, parsley, soy, beet, spinach, cocoa, nuts and black tea. Oxalates, which cannot be sufficiently diluted and excreted due to insufficient fluid intake, attach themselves to calcium and form urinary stones. Consequently, aftercare would consist of increasing the amount of fluid drunk and, ideally, abstaining from these foods. Uric acid stones form when the urine is acidified, which occurs as a result of a diet rich in protein and purine. Avoiding purine-rich foods such as meat, sausage, offal, alcohol, legumes and certain fish, as well as a low-protein diet, will reduce the acidity in the urine. In consultation with a physician, this effect can be enhanced by the selective intake of alkalizing foods.
What you can do yourself
Against urinary stones, affected persons can take some measures themselves. Above all, warmth, exercise (especially hopping and climbing stairs) and plenty of fluids are important. In addition, dietary steps apply: a low-purine diet and avoidance of milk and dairy products as well as chocolate, nuts, beans, spinach and stimulants such as alcohol and caffeine. Beer in particular should be avoided because of its high purine content and negative effects on uric acid levels. Strict diets are not recommended, however, because they may lead to further urinary stones. Dragees or herbal drops containing birch leaves, horehound or horsetail can help. Effective herbal remedies are also teas made from bedstraw, dandelion roots or orthosiphon. With lemon juice, apple cider vinegar and celery juice, there are also some household remedies that help with the pain and promote the passage of urinary stones. Once the stones have been flushed out, regeneration of the damaged tissue can be aided by vitamin A. In the long term, the cause of the kidney stone must also be determined and remedied in order to prevent recurrence of the symptoms.If there is severe pain, cramping or urinary retention, urinary stones should be taken to a doctor.
