Urinary stones (bladder stones) are salts that crystallize in the urinary tract. These can have different sizes. Depending on their location, they cause different complaints.
- Urinary stones are undesirable deposits in the urinary tract.
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Urinary stones consist of the following stone-forming, poorly soluble substances: calcium oxalate, uric acid, calcium phosphate, magnesium ammonium phosphate, calcium, protein and cystine. Urinary stones can be very small (e.g. kidney semolina), but they can also fill parts or the entire kidney pelvis (e.g. four-centimeter kidney stones).
Stone suffering in humans becomes medically relevant due to the pinching and sudden obstruction of urine outflow in the urinary tract (urinary drainage system). The urinary tract begins at the kidney, passes the urine through the ureters to the bladder and on through the urethra. Urinary stones are also common in cats and dogs.
At a glance:
- Symptoms
- Causes and risk factors
- diagnosis
- treatment
- Prevent
These symptoms occur with urinary stones
The classic symptom of ureter stones is kidney colic due to a pinched ureter stone. The classic symptom is renal colic. With renal colic, patients experience sudden cramp-like pain. This colic-like pain can extend from the flank to the testicles or the large labia. The pain is not caused by the stone itself, as is often assumed, but by the urine build-up and the associated overstretching of the urinary system above the stone.
Often these colic complaints go with other symptoms such as nausea, vomiting, UG | Constipation and wind retention, blood in the urine and urination disorders.If there is colic-like pain, fever – if the immune system heats up the body and / or chills, infection of the urine above the stone can be assumed. This is an emergency situation – immediate medical attention is necessary.
Symptoms of kidney stones
The stone resting in the kidney pelvis or calyx can be without symptoms. It is often discovered accidentally during a routine ultrasound examination. If this stone gets bigger, it can cause dull discomfort and promote or maintain inflammation. If the kidney stone moves and enters the ureter, it typically results in so-called kidney colic.
Symptoms of bladder stones
Bladder stones, which primarily arise in the bladder when there are problems with the discharge from the bladder, usually cause little discomfort, but if there is an inflammation, you must have a strong feeling of urination (urge complaints). Inflammation of the bladder can usually only be effectively treated by removing the bladder stone.
Blood poisoning as the most dangerous consequence
If the infected urine is not discharged to the outside, there is a great risk of kidney suppuration and a general bacterial blood contamination, a condition called uro-sepsis. Since this severe clinical picture can be fatal, every patient with flank pain and fever should immediately seek urological help.
Causes and risk factors for urinary stones
The causes of urinary stones are processes of crystallization in the urine, favored by disturbances in the flow of urine between the kidney cup and bladder.
The urinary stones can consist of the following stone-forming substances:
These stone-forming substances (poorly soluble substances in the urine) are absorbed through food intake. After digestion, they get into the blood – and through the kidneys into the urine. If too many of these substances are ingested, a crystallization process occurs and urinary stones form in the urinary tract.
Another important cause of urinary stone formation is reduced urine flow. In this case, the stone-forming substances remain in the urinary tract for a longer period of time and can also react with one another and crystallize out over a longer period of time.
Risk factors for urinary stones
Despite some unanswered questions, it is now certain that the following factors promote urinary stone formation:
Overeating (this increases protein intake)
low fluid intake (thereby reduced urine flow)
lack of movement (thereby disturbed metabolism and increased amount of stone-forming substances)
recurrent infections of the urinary tract (thereby increased crystallization of magnesium ammonium phosphate: what does the laboratory value say about health? as a result of bacterial changes)
Abnormal urinary tract disorders (which may result in narrowing and reduced urine flow)
Parathyroid disorders (resulting in increased blood and urine calcium levels)
The risk factors for urinary stones include general risk factors such as older age, professions with a lot of stress and belonging to a rather higher social class. Patients with urinary stone problems are common in industrialized countries and hot areas. About six percent of all patients with urinary stones suffer from a genetic predisposition.
Diagnosis of urinary stones
Urinary stones are identified by questioning and examining the patient as well as urine analysis, ultrasound and X-ray diagnostics. The typical medical history (anamnesis) with sudden cramp-like pain and the results of the clinical examination usually allow the symptoms to be assigned to urinary stones. Urine analysis completes this first part of the examination.
Ultrasound examination of urinary stones
The heart of the diagnosis of urinary stones is ultrasound. With ultrasound, a urinary stone in the area of the kidney can be displayed and measured.
A ureteral stone can usually not be visualized directly with ultrasound, because the air-containing intestine often hinders the imaging. In contrast, the build-up of urine in the kidney pelvis caused by the stone can be recognized very well. It is a clear diagnostic sign of a ureteral stone.
X-ray examinations if urinary stones are suspected
The X-ray examination of the entire urinary tract can show all radiopaque urinary stones in the urinary system. Uric acid stones are not radiopaque and therefore cannot be visualized with this examination.
By giving contrast medium through a vein, the urinary drainage disorder can be exactly represented – this examination is also called urogram. The injected contrast medium is distributed in the blood and reaches the urine directly through the kidneys. This makes the kidney pelvis and the ureter visible – urinary stones are shown on the X-ray images as a contrast medium recess.
After clarification and exclusion of allergies and an untreated thyroid disease, an X-ray overview is first taken. The urologist or radiologist then injects a contrast medium over the vein. This contrast medium is then excreted into the urinary tract via the kidneys. This excretion is documented with x-rays after different times (after five to seven and ten to 15 minutes). If there is a stone-related urinary drainage disorder, so-called late shots after 30, 60 or even 120 minutes are often necessary.
In very rare cases, special urological X-ray procedures are necessary for the stone detection – so-called retrograde ureter imaging with contrast agent or ureter reflection.
Treatment of urinary stones: what therapies are there?
The treatment of urinary stones is divided into measures for pain relief and measures for stone removal.
Pain therapy
Kidney colic is an emergency situation. Immediate pain therapy is required. This includes the administration of pain relieving and antispasmodic medication. As a rule, it is possible to control the pain situation. After the diagnosis has been confirmed, further medical therapy is determined.
General procedures for urinary stone removal
Urinary stones up to about seven millimeters are generally considered to be spontaneously capable of leaving, i.e. you try to reach a stone exit without surgery. This is achieved by drinking or infusing large amounts of fluids. In addition, medication to expand the ureter is given. In almost 80 percent of all patients, the urinary stone can be removed within a few days. However, colic may occur again and again in the meantime.
Special urinary stone removal procedures
Modern methods of stone destruction and removal today include extracorporeal shock wave lithotripsy (ESWL – non-contact stone crushing in the area of the kidney, ureter, bladder), the so-called percutaneous nephrolitholapaxy (minimally invasive stone removal from the renal pelvic system using a special instrument) and the endoscopic stone removal via stone removal Bladder and ureter using a special endoscope). If stone refurbishment is not possible with these minimally invasive methods, the indication for an open operation must be critically examined.
Diet and drink: Use these tips to prevent urinary stones
Since urinary stones are ultimately a public health problem (around four million people in Germany suffer from urinary stones), general preventive measures should be taken into account. These general measures include:
Abundant hydration with beverages: At least two and a half liters of fluid (e.g. mineral water or fruit tea) are recommended within 24 hours in order to flush the urinary tract sufficiently.
Varied, high-fiber and low-fat diet: It makes sense, for example, to eat five different types of fruit or vegetables daily (an example of a daily ration: an apple, a banana, a kiwi, a pepper, a kohlrabi). High-fiber foods are: oatmeal, muesli, lentils, beans and other legumes: healthy protein packages – plus a list and recipe, but also fresh fruits and vegetables. Low-fat foods are all types of fruit and vegetables.
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Cutlet, cabbage and co .: Be careful, these delicacies can lead to an uncomfortable bloat!
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Abundant physical activity (for example, twice a week for 30 minutes walking, running or swimming) and the reduction of excess weight (with a BMI over 30) are recommended, as this can change the human metabolism positively – for example, fewer stone-forming substances are obtained in the urinary tract.
Diet and Co.: Individual measures against urinary stones
Because of the high rate of recurrence of urinary stones (it is around 60 percent if there is no follow-up care), besides regular follow-up care by the urologist, individual preventive measures are also important. Knowing the patient about the composition of the removed urinary stone can be important for individual nutritional adjustment.
People who have been diagnosed with the following urinary stone composition (calcium oxalate stone, uric acid stone, calcium phosphate stone) could consider the listed nutritional advice.
However, radical compliance with these nutritional guidelines has been abandoned today. It is particularly important to have a balanced diet, exercise and, if necessary, weight loss.
People with magnesium-ammonium-phosphate stones (infection stones) and cystine stones should take medical aftercare particularly seriously, because these stones in particular are likely to come back.
For information, some of the strict nutritional guidelines that were used in urinary stone prevention until the early 1990s are listed.
People with calcium oxalate stones
- Reduction of animal foods such as meat and sausages
- Reduction of calcium-rich foods such as cheese, milk and curd cheese
- Refrain from foods rich in oxalate, such as rhubarb: eleven facts about the healthy sticks, spinach and tomato
- Reduction of salt consumption, if possible completely dispensing with the salt shaker
- Avoid purine-containing food, for example contained in the offal of meat, sausage, lentils, sardines
People with uric acid stones
- Body weight reduction
- Refraining from food containing purine, for example contained in the offal of meat, sausage and lentils, sardines (the purine content of the food should be below 300 milligrams of purine per day)
- Reduction of animal foods, such as meat and sausages
- Refrain from alcohol
People with calcium phosphate stones
Reduction of
- animal foods such as meat and sausages
- calcium-rich foods such as cheese, milk and curd cheese
- Foods high in phosphates such as cheese, milk, curd cheese, meat, wheat bran and nuts.
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