Leave no stone unturned

By Roshan Peiris

Last week Dr. Anura Wijewardane spoke about a very common affliction-urinary tract infection and its causes.

This week he deals with renal urinary stones. He says stones are formed when the concentration of certain substances in the urine exceeds their saturation point.

Poor intake of water and dehydration due to climatic conditions are some of the causes, he said.

Some of the common substances that constitute stones are calcium and oxalate.An increase in calcium in the blood stream due to various diseases also causes urinary stone formation- a very painful condition.

The commonest symptom associated with this condition, the doctor said, was loin pain extending to the groin. Sometimes the pain radiates to the testes in men and the labia in women. Symptoms related to urinary tract infection can also be associated with stones.

Passing blood with urine is also a symptom together with pain that is sometimes accompanied by sweating and vomiting.

Dr. Wijewardane said a urine microscopy usually shows blood cells, pus cells and crystals. He said crystals are apparent even in 'normal' people. "But a patient with stones has more crystals and they are larger," he said.

Blood tests and renal function tests which include serum cretin tests are also done to investigate the condition.

If patients are suspected of having high calcium levels in the blood and recurrent stone formations, further tests are necessary, he said.

X-rays and scans are also necessary to assess the size of the stone or stones and any other abnormality in the urinary tract.

The treatment consists of primarily trying to remove the existing stone and secondly preventing the recurrence of stone formations.

The doctor says one must increase fluid intake and maintain an average of 2.5 to 3.5 litres of urine output a day. He also advocated a modest reduction in the calcium and oxalate intake in one's diet. A majority of the small stones in the ureter pass out on their own.

But surgical treatment is a must when it comes to large stones, which obstruct the passing of urine - causing a lot of pain. This obstruction could cause recurrent urine infection, therefore, the stones have to be removed, he said.

Lithotripsy a treatment using electro hydrolic energy is used to blast these stones into small particles.

There is also the option of minimal invasive surgery where stones can be removed by using telescopic camera equipment. If these two options fail then open surgery is necessary.

Dr. Wijewardane kept stressing the importance of the intake of fluid, regular emptying of the bladder, good hygiene and adjustment in the diet .He also said when stones are detected not to waste time but seek treatment.

In conclusion Dr. Wijewardane said: "It is important to take all necessary measures to prevent recurrent urinary infections, because if untreated they could lead to permanent kidney damage. Symptoms like passing blood with urine may also be an initial symptom of more serious conditions like malignancy in the urinary tract."

Next week: Passing blood with urine and urinary tract malignancy.

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