Published on
Jan 3, 2024
Urinary stones
Introduction
Urinary stones, commonly known as kidney stones, are solid concretions that form in the urinary tract (kidneys, ureters, bladder). They affect about 10% of the population over their lifetime, with a clear male predominance. The most well-known complication is renal colic, extremely intense lower back pain caused by the migration of a stone into the ureter. Urinary stones are becoming increasingly common, linked to modern dietary habits and lack of hydration.
If you experience intense lower back pain, burning during urination, or blood in your urine, first contact your treating physician. If they are unavailable, Docadom offers an emergency consultation by a home doctor: call 021 845 45 45 or use our application available on the App Store and Google Play.
Who is at risk?
There are numerous risk factors: personal or family history of stones, insufficient hydration, a diet rich in salt, animal proteins, or fast-acting sugars, hot climates, obesity, diabetes, high blood pressure, metabolic syndrome, hyperparathyroidism, certain digestive diseases (Crohn's, bariatric surgery, malabsorption), recurrent urinary tract infections, anatomical abnormalities of the urinary system, and prolonged immobilization. Certain medications also promote stone formation (indinavir, topiramate, high-dose vitamin C).
Symptoms of urinary stones
Stones can be completely asymptomatic and discovered by chance, or they can present through a very painful episode.
Main symptoms
Renal colic: sudden, intense lower back pain, feeling like stabs, radiating towards the groin and genitals.
Restlessness ("the patient cannot stay still"), inability to find a comfortable position to relieve pain.
Nausea, vomiting, sometimes reflex constipation.
Hematuria (blood in the urine), macroscopic or microscopic.
Burning on urination, pollakiuria, urgency when the stone approaches the bladder.
Fever only in case of associated urinary tract infection (obstructive pyelonephritis).
Bladder stones: dysuria, urinary retention, suprapubic pain.
When to consult urgently?
An emergency consultation is necessary in the following situations:
Intense lower back pain resisting painkillers.
Associated fever — risk of obstructive pyelonephritis, an absolute emergency.
Severe vomiting preventing oral intake.
Anuria (absence of urine) or oliguria.
Stone in a single kidney, a pregnant woman or an immunocompromised patient.
Signs of sepsis: mottling, low blood pressure, confusion — call 144.
What to do before calling Docadom? Drink normally (do not force hydration during the attack), take the pain relievers you have available, and contact your treating physician first. If they are unreachable or if you need a home doctor outside of opening hours, call Docadom at 021 845 45 45 or make your request directly from our smartphone application (App Store and Google Play). In case of high fever, anuria, or signs of shock, dial 144 without delay.
Causes and types of stones
Stones result from the precipitation of crystals in saturated urine, promoted by an imbalance between dissolved substances and crystallization inhibitors.
Main types of stones
Calcium oxalate stones: the most common (70-80%). Promoted by a diet rich in oxalates (spinach, rhubarb, chocolate), excess salt, animal proteins, and a deficit in dietary calcium.
Uric acid stones (10-15%): associated with gout, diabetes, obesity, and a diet rich in purines.
Struvite stones (5-10%): linked to chronic urinary tract infections (urease-producing bacteria).
Cystine stones: rare, of genetic origin (cystinuria).
Drug-induced stones: indinavir, sulfonamides, topiramate.
Diagnosis of urinary stones
The diagnosis combines clinical presentation, urine dipstick, and imaging.
Diagnostic methods
Anamnesis: medical history, diet, medication, hydration.
Clinical examination: checking for pain on lower back palpation, Giordano's sign, abdominal palpation.
Urine dipstick: hematuria, leukocytes, nitrites.
Urine culture (ECBU) in case of suspected associated infection.
Non-contrast CT scan (Uroscanner): the gold standard examination, which visualizes all stones (size, location, impact).
Renal and bladder ultrasound: useful in pregnant women and children.
Biological assessment: kidney function, calcium levels, uric acid levels, ionogram.
Stone analysis (infrared spectrophotometry) if retrieved.
Metabolic workup in case of recurrences.
Alternative diagnoses
Acute pyelonephritis without stone.
Acute appendicitis, diverticulitis.
Abdominal aortic aneurysm in elderly patients.
Muscular lower back pain or lumbosciatica.
Gynecological pathologies: ectopic pregnancy, adnexal torsion.
Cholecystitis, pancreatitis, renal infarction.
Treatment of urinary stones
Treatment of the acute episode (renal colic)
NSAIDs (ketoprofen): first-line treatment, highly effective.
Paracetamol, antispasmodics (phloroglucinol).
Morphine or oxycodone in case of severe, resistant pain.
Moderate hydration (do not overload).
Filter the urine to retrieve the stone.
Monitoring to detect any infection or blockage.
Elimination or removal of the stone
For stones < 5 mm, spontaneous passage is common (80%). For others:
Alpha-blockers (tamsulosin): facilitate the expulsion of distal ureteral stones.
Extracorporeal shock wave lithotripsy (ESWL): shock waves to fragment the stone.
Ureteroscopy with laser: first-choice endoscopic technique.
Percutaneous nephrolithotomy for large kidney stones.
Emergency drainage (double-J stent or nephrostomy) in case of obstructive pyelonephritis or renal failure.
Preventive treatment
Tailored to the type of stone. In general: abundant hydration (2 to 3 liters of water per day), low-salt diet, moderation of animal proteins, normal dietary calcium intake (do not reduce), citrates (lemon, Vichy water) to increase urinary pH. Uric acid stones can be prevented by allopurinol and alkalinization of urine. Struvite stones require complete treatment of urinary tract infections.
Prevention of urinary stones
Drink 2 to 3 liters of water per day, spread throughout the day and night.
Prefer low-mineral water for daily use.
Limit salt (< 6 g/day).
Moderate animal proteins.
Normal dietary calcium intake (dairy products with meals).
Limit foods rich in oxalates (spinach, rhubarb, beetroot, cocoa) in case of prior history.
Reduce fast-acting sugars.
Regular physical activity, maintaining a healthy weight.
Monitoring of high-risk medications.
Metabolic workup after a recurrence.
Possible complications
The main complications are obstructive pyelonephritis (septic emergency), acute or chronic kidney failure, recurrences (50% at 5 years without prevention), severe hematuria, renal loss in case of prolonged untreated blockage, recurrent urinary tract infections, and chronic pain.
When to contact a doctor for urinary stones
Every episode of renal colic warrants medical advice, even if the pain subsides:
As a first step: contact your treating physician or your urologist, who can organize imaging and a metabolic workup.
If your treating physician is unavailable (evenings, weekends, holidays), Docadom offers an emergency consultation by a home doctor. Call 021 845 45 45 or make your request via our mobile application, available for free on the App Store and Google Play.
In case of serious signs (fever, chills, anuria, unbearable pain, repeated vomiting, low blood pressure), dial 144 without delay.
Conclusion: drink abundantly, prevent recurrences
Urinary stones are a frequent and recurring condition. They are characterized by very painful renal colic, hematuria, or associated urinary tract infection, which can lead to complications such as obstructive pyelonephritis or renal failure. Diagnosis is based on CT scan, and treatment combines pain relief, stone removal, and preventive measures. Abundant hydration and dietary adjustment are the cornerstones of prevention.
In case of renal colic, first contact your treating physician. If they are not available, Docadom provides you with an emergency home doctor 7 days a week: call 021 845 45 45 or use our mobile application (App Store, Google Play) to request an emergency consultation.
