Urolithiasis
The presence of stones in the urinary tract is defined as urolithiasis or nephrolithiasis. Stones form when minerals that are normally present in urine concentrate and aggregate to form crystals that can then solidify into stones. This is a very common condition, especially among individuals aged 30 to 60 years.
RISK FACTORS
Various factors can increase the risk of developing kidney stones:
- Dehydration: Not drinking enough water can lead to a high concentration of minerals in the urine.
- Diet: A diet particularly rich in protein, Vitamin C, and sugar increases the risk. Conversely, a balanced diet of fruits and vegetables may have a protective role.
- Family History
- Medications: The abuse of certain medications, such as aspirin, some antibiotics, and antiretrovirals, has been shown to increase the risk of stone formation.
- Metabolic Disorders: The formation of stones is more common among people suffering from specific disorders, such as hyperparathyroidism or sarcoidosis.
- Urinary Infections
Stones differ from one another in terms of size, composition, and shape: about 85% of these stones are composed of calcium; the others may consist of various substances, such as uric acid, cystine, or struvite. Struvite stones, composed of magnesium, ammonium, and phosphate, are also known as infectious stones, as they develop exclusively in conditions of infected urine.
SYMPTOMS
When kidney stones are small, they can be expelled through urine without causing any symptoms. However, the presence and movement of larger stones can lead to renal colic, characterized by sharp pain radiating from the lumbar region to the groin, and may also involve the scrotum in men and the labia majora in women. Often, painful symptoms are accompanied by other symptoms such as nausea, vomiting, sweating, dysuria, and hematuria. In more severe cases, a stone may cause complete obstruction of the ureter, resulting in urine accumulation in the kidney (hydronephrosis), leading to bacterial proliferation and possible infection of the affected kidney (pyelonephritis).
DIAGNOSIS
When a patient presents symptoms suggestive of nephrolithiasis, the first step is always to gather a thorough medical history that includes information about medical, family, pharmacological history, and lifestyle. It is also advisable to request a urine test with a urine culture to check for the presence of infection. Imaging diagnostics allow us to accurately identify the stone:
- Non-contrast CT: This represents the gold standard. It not only allows for the identification of the stone but also evaluates the degree of obstruction in the urinary tract.
- X-ray: This exposes the patient to less radiation; however, it provides less accurate images and pertains only to calcium stones.
- Ultrasound: This is certainly a less invasive technique compared to the previous two; however, it does not allow for the detection of small stones.
TREATMENT
The treatment for stones varies depending on the type, size, location, and especially the severity of the symptoms. Among the main therapeutic strategies, we find:
- Hydration
- Medications: Pain associated with renal colic can be managed with NSAIDs or, in more severe cases, with opioids. Spontaneous passage of the stone can be facilitated by the administration of alpha-blockers.
When stones are too large to be expelled spontaneously, intervention can be made by:
- Extracorporeal Shock Wave Lithotripsy: This non-invasive and safe procedure uses shock waves generated by a lithotripter. These waves, passing through the tissues, break the stone and facilitate its expulsion.
- Surgery: Currently, surgery offers a wide range of techniques, some of which are more invasive than others, for the removal of stones. Approaches may be endoscopic or open. In emergency cases, “rescue” surgery may be considered with urinary diversion techniques aimed at quickly removing the obstruction.
However, the first step in combating kidney stones is to prevent their formation. The best way to do this is to consume large amounts of fluids to ensure that urine is always well-diluted. Other preventive measures depend on the type of stone.