Urinary lithiasis is, following urinary infections, the most frequent problem of the urinary tract. The disease is characterized by the formation and progressive growth of stones (calculi) in the urinary tract, which may be single or multiple and affect only one or both kidneys. Initially silent, this pathology becomes problematic if left untreated and can cause severe pain (renal colic), recurrent or persistent urinary tract infections, blood in the urine, and loss of kidney function.
What is the risk of having stones in urinary tract?
The risk of a person developing stones in the urinary tract throughout their life is estimated to be 10 to 15%. Men are affected two to three times more often than women.
What are the main causes and symptoms?
Despite tremendous advances in the diagnosis and treatment of stones, their cause remains somewhat obscure. Multiple theories have emerged over time, however, none of them satisfactorily explains the disease. It is surely a multifactorial problem, resulting from the imbalance between factors promoting and inhibiting the deposition of crystals in the urine.
How is the diagnosis made?
The imaging is crucial for the confirmation of the presence of stones and for their location and measurement, as well as identification of possible complications. The best procedure for the diagnosis of UL is, currently, computed tomography. However, simple radiography of the urinary tract, renal ultrasound and bladder ultrasound are also very useful. Whenever possible, the urinary calculi should be collected so that it can be analyzed. Blood and 24-hour urine clinical analisys are the second component of the diagnosis, which allows the identification of diseases that facilitate the formation of stones.
How can it be prevented?
Prevention is one of the components of the treatment of this pathology. It is recommended that adequate hydration be maintained to urinate about 2L per day. It is also recommended a balanced diet, rich in fiber and vegetables and with salt and animal protein restriction. Lifestyle changes such as increased physical activity, loss of excess weight, and reduced stress are also important.
What impact can it have on quality of life?
This disease may be highly recurrent and may cause a significant decrease in quality of life. Recurrent renal colic, often complicated repetitive urinary infections, multiple hospitalizations, and the need for multiple surgical interventions may heavily condition personal, professional, and psychic life. On the other hand, there may be progressive loss of kidney function, which can lead to end-stage renal failure, with a concomitant increase in mortality.
What treatments are available?
The treatment of lithiasis depends on the location, composition and dimensions of the stones, as well as the anatomy, associated diseases, profession, etc.
- Ejection of ureter stones
- Medication to dilute certain stones
- Extracorporeal shock wave lithotripsy (LEOC)
Minimally invasive treatments:
- Ureterorenoscopy with LASER
- Intrarenal retrograde surgery with LASER (RIRS)
- Percutaneous renal surgery
- Laparoscopic Surgery
And, in the last case, open surgery.
Minimally invasive surgeries have had a remarkable development in the last years, solving, at the moment, the great majority of the cases. Ureterorenoscopy and intra-renal retrograde surgery are the last major advances in the treatment of urinary tract stones. These techniques allow the elimination of calculus without injury of the kidney, without hemorrhage, practically without postoperative pain and with very low rates of complications. These are surgeries that can be performed on an outpatient basis, without hospitalization.
Is there access to the best and latest treatments in Portugal?
In Portugal, it is now possible to treat the litíase according to the state of the art, with all the techniques and technologies available. Virtually all calculations, regardless of their size, type and location, can be treated with minimally invasive procedures, and invasive surgeries are reserved for very exceptional cases.
What are the chances of a cure?
After treatment of the stones, about half of the patients have a recurrence of lithiasis within 10 years. Of these, about half have only one recurrence, while 10% have highly recurrent disease.
The combination of surgical and medical treatments are mandatory for disease control as well as proper surveillance with serial imaging.