Urinary Stone Disease

Kidney stones or renal calculi are common and affect up to 1 in 10 Australians.

They form in the urine from deposits of crystals and minerals. The main risk factors for stone formation include dehydration, prior kidney stones, family history of stones, hot climate, male sex and certain medical conditions (e.g. gout, inflammatory bowel disease, bariatric surgery).

Kidney stones are often detected by chance or incidentally on a scan that may have been performed for another reason. When the stone is in the kidney, they often are completely asymptomatic however can cause infection and occasionally pain. If a stone passes into the tube that drains the kidney called the ureter, this results in severe pain which can be felt in the flank and radiates around to the groin. This can be associated with nausea, vomiting and occasionally infection.

The treatment of urinary stones needs to be individualised and depends largely on the size and position of the stone, pre-existing medical conditions and overall kidney function.  The main treatment options are:

• Surveillance – Small stones (<5mm) within the kidney can often safely be observed. Many of these stones will not grow and remain asymptomatic however close observation is needed.
• Ureteroscopy and laser stone fragmentation – this is the most common treatment for stones within the ureter and kidney. It involves passing a small telescope into the ureter and kidney under general anaesthetic. A fine laser fibre is used to break the stone into small fragments and dust. Many of these fragments will pass however larger pieces can be retrieved.
• Percutaneous nephrolithotomy (PCNL) – This treatment is reserved for patients who have larger stones typically greater than 2cm. It involves accessing the kidney through the flank to create a channel by which a larger telescope can be passed. This allows better fragmentation of larger stones with varying energy sources.

In an emergency setting where a kidney is blocked by a stone a stent may need to be placed. This is a narrow tube that is inserted via a telescope to bypasses the obstruction and allows the kidney to drain. This often alleviates the symptoms of the stone and blockage and in the setting of infection, allows the infection to settle down.

Stents are also used after ureteroscopy to allow stone fragments to pass and to prevent blockage from swelling of the tube after the procedure. In this setting they can generally safely be removed the following week.

As they are a foreign body, stents can cause irritation to the kidney, ureter and bladder. This may result in painful and frequent urination, flank discomfort, and blood in the urine. These symptoms are very common and can be successfully managed with medications in most patients.

Sydney Urology Group offers comprehensive diagnosis, treatment and follow-up for patients with kidney and ureteric stones. outcomes. Compassionate care is given to all our patients at Sydney Urology Group and our specialised team guide patients to determine the best treatment option for them.