Overview of adult urolithiasis

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Overview of urolithiasis in adults

Kidney stones affect a notable portion of adults in Canada and the United States, with up to one in ten carrying stones without symptoms. Others experience clear, sometimes intense, signs. While it is often assumed that men are at higher risk, clinical evidence shows similar incidence across genders, with age playing a larger role in risk differences.

Most stones form in adults aged 20 to 50, though children and older adults can be affected in rarer cases.

Recognizing kidney stones: typical symptoms

What cues suggest stone presence? Pain in the lower back on one side, occasionally both sides, is common and is frequently described as a sharp, knife-like jolt that is hard to mistake for anything else.

Sometimes a stone remains in the kidney for years and only grows large enough to block urine flow. When this happens, the kidney swells and renal colic develops. If stones press on the lower ureter, pain can radiate to the lower abdomen and groin.

Beyond pain: additional symptoms

Pain is not the only clue. Urinary frequency, nausea, vomiting, slower bowel movements, and reflex anuria may occur. Blood in the urine is also possible.

In some cases, pyelonephritis, an infection of kidney tissue, can develop. Chronic pyelonephritis is a risk tied to urolithiasis, and fever can signal urgent medical attention is needed.

Asymptomatic stones and coral nephrolithiasis

Can someone have kidney stones without renal colic? Yes, though it is uncommon. Large stones can fill much of the kidney’s drainage system and cause subtle fatigue, weakness, and mild lower back discomfort before progressing to infection and reduced kidney function.

Origins and risk factors

The exact causes remain not fully understood, but urolithiasis is considered a metabolic disorder. A sedentary lifestyle can disrupt phosphorus and calcium balance and raise risk. Diet also matters: high protein intake and foods that acidify urine can contribute to stone formation.

High calcium dairy consumption may also raise risk. Inflammatory kidney diseases, infections, and urinary tract infections can promote stone formation. Congenital urinary tract abnormalities, such as having a single kidney, also play a role.

How stones form

Kidney stone development mirrors crystallization seen in school chemistry when a supersaturated solution precipitates. In the kidneys, this crystallization leads to stone formation over time.

Stone types and treatment implications

Stones are commonly categorized as oxalate (calcium salts and oxalic acid), urate (uric acid salts), and phosphate. In practice, stones are rarely pure and are usually mixed. Composition is typically determined after the stone is analyzed biochemically when it breaks off or is removed.

Urate stones may sometimes be dissolved with specific medications, while oxalate and phosphate stones are usually not dissolved by drugs alone.

Location, size, and danger

Danger is more about location and size than composition. Coral-shaped stones can extend along much of the urinary tract and are difficult to remove. Treatment often proceeds in stages to address this challenge.

Dietary adjustments by stone type

Diet changes depend on stone type. For oxalate stones, increasing fluid intake to about 2 to 2.5 liters daily is advised, and many dairy products, salty snacks, sweets, and certain fruits may need limiting.

For urate stones, lean meats, fish, and grains are favored, with periods of high fluids. Meat broths, aged cheeses, and certain legumes may be restricted.

For phosphate stones, moderate meat consumption is acceptable. Many vegetables and fruits have diuretic effects and can aid treatment. Examples include watermelon, eggplant, pear, banana, strawberry, cabbage, cranberry, carrot, lettuce, and others listed in the plan.

Treatment options today

Beyond dietary and medication approaches, surgical methods are used when stones threaten complications or are large. Endoscopic procedures and remote lithotripsy are common distinctions in modern care.

Extracorporeal shockwave lithotripsy is often the first option for stones up to about 15 mm that can be localized and visualized on imaging. It uses shock waves to crush stones without incisions or substantial anesthesia, and fragments pass with urine.

Endoscopic surgery involves guiding an instrument through the urinary tract to reach the stone, which is especially useful for stones in the bladder or ureter. For deep kidney stones, a fiberscope may be employed to reach and fragment the stone from within the kidney.

Percutaneous nephrolitholapaxy is another approach for removing large stones, sometimes up to several centimeters, by creating a small entry through the back into the kidney under imaging guidance and using an optical device to break the stone.

Laparoscopic surgery is another option, with instruments inserted into the abdomen to remove stones from a connected urinary tract segment and then close the incisions. In recent practice, these invasive approaches are far less common due to advances in less traumatic methods.

Recurrence and long-term care

Recurrence is possible after any surgical treatment. No procedure can guarantee that stones will not form again. Urolithiasis is treated as a chronic, relapsing condition, so ongoing lifestyle changes, regular activity, good nutrition, and routine medical follow-up remain important throughout life.

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