Stone Disease

Waste products from the blood are filtered by the kidneys and are added to the urine that they produce. Stone disease is a condition caused by the formation of a mineral deposit (or stone) in the ureter or kidney over time. Stones are likely to form when these waste materials in the urine are not completely dissolved.

Renal stone disease (or nephrolithiasis) is the condition where hardened mineral deposits form calculi (kidney stones) in the kidney. These calculi are created from microscopic particles and develop into kidney stones over time. Most of these stones pass out of the body without any need for surgical intervention.
A kidney stone is formed when there is an imbalance between certain urinary components, which promote crystallization and others substances that inhibit it. The most common kidney stones contain a combination of calcium with phosphate and/ or oxalate.
Kidney stones are occasionally caused by an infection in the urinary tract. These stones are known as infection stones or struvites. Less commonly pure uric acid stones are produced. There are even rarer stones called cystine stones, which are a hereditary type of stone. The rarest stones are those, which are linked to hereditary disorders.
Kidney stones are formed most commonly between the ages of 20 and 40. If an individual forms a stone, there is a strong chance that they will develop more stones in the future.
The usual symptom of a kidney stone is extreme pain, often beginning suddenly as the stone moves in the urinary tract, causing irritation and blockage. There is usually a sharp, cramp-like pain in the back and in the side of the area of the kidney or in the lower abdomen, which often spreads to the groin. There may be blood in the urine (Haematuria), nausea and even vomiting.
Sometimes stones do not produce any symptoms at all. They may be growing and even threatening serious damage to kidney function. Usually if a stone is not large enough to cause major symptoms, it still can produce a dull ache that may feel like intestinal or muscle pain.
If a stone is too large to be passed easily, pain will continue as the ureter wall muscles attempt to squeeze the stone along into the bladder. A stone sufferer may feel that they need to urinate more frequently or even experience a burning sensation whilst urinating. In men the pain may move down to the tip of the penis. If a stone is lodged at the opening into the bladder at the lower end of the ureter, an individual may feel as if they have not fully completed urination.
Kidney stones are sometimes diagnosed when X-rays are taken during a general health examination, and the stones may have caused no symptoms. Often these stones would most likely be passed unnoticed.
If large stones are found treatment should be offered to the patient. Usually kidney stones are found when someone who complains of blood in the urine or sudden pain has an X-ray or sonogram taken to investigate the symptoms. The clinician can gain valuable information from these diagnostic images about the size and location of the stone. Further diagnostic tests on the patient's blood and urine will help detect whether there are any substance present that may promote stone formation.

Management and treatment of stone disease depends on the size, position and number of stones in a patient's system. Fortunately most small stones, which are not causing symptoms, infection or blockage, will be passed naturally if the individual drinks plenty of fluids each day. Drinking extra water increases urine production, which will eventually wash many kidney or other stones out of the system. Once the stones are passed, no treatment is required.
Many stones are composed of calcium and are not responsive to medicine, in which case surgery may be necessary. Surgery may be required if a stone is blocking urine flow; is causing constant bleeding or kidney tissue damage; is causing ongoing urinary tract infection; has grown in size (seen after further X-ray studies); or is causing constant pain and does not pass after a reasonable period of time and is too large to pass on its own. In the past stone removal surgery was very painful and the patient needed a long recovery time (up to six weeks). Now though stone disease management and treatment is vastly improved and in many cases major surgery is not necessary.

Stone disease management and treatment
Extracorporeal shock wave lithotripsy (ESWL)
This is the most frequently used procedure for removing kidney stones. The procedure uses ultrasonic waves created outside the patient's body. The ultrasonic waves break down the dense kidney stones into fine particles, which are easily passed through the urinary tract in the urine. The ESWL method does not cause any damage to the surrounding body tissues and only breaks up the stone. This method is only really effective if there are no blockages to the passage of the stone fragments and the kidney is functioning normally.
Most ESWL procedures use ultrasound or X-rays to allow the surgeon to locate the stone during treatment. Often anesthesia is not needed during the lithotripsy procedure and is done on an outpatient basis. After undergoing the procedure the patient will recover in a very short time and most people can resume normal activities in a few days. If the patient has a stone that is more than one inch in size, extra shock wave lithotripsy sessions may be required.