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Urinary Stones Treatment

Urinary stones, commonly known as kidney stones, are hard deposits that form inside the kidneys. These stones can vary in size and can be as small as a grain of sand or as large as a pearl. They are a result of various factors, including dietary habits, dehydration, and certain medical conditions.

Understanding the types, treatment options, and preventive measures helps those affected by this condition.

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Types of Urinary Stones

Calcium stones

  • Description: Calcium stones are the most prevalent type of kidney stones. They primarily consist of calcium oxalate, but can also be formed from calcium phosphate.
  • Causes: High levels of calcium, oxalate, and phosphate in the urine can contribute to the formation of these stones. Factors such as high doses of vitamin D, certain metabolic disorders, and dietary habits can increase the concentration of these substances in urine. Some fruits and vegetables, as well as nuts and chocolate, have high oxalate content.
  • Prevention: Reducing sodium intake, limiting vitamin D supplements, and drinking plenty of water can help prevent the formation of calcium stones. It’s also beneficial to limit foods with high oxalate content.

Uric acid stones

  • Description: These stones form when there’s a high concentration of uric acid in the urine. They can occur alone or in conjunction with calcium stones.
  • Causes: Factors leading to uric acid stones include a diet rich in purines (found in certain fish and meats), certain genetic factors, and conditions like gout or chemotherapy.
  • Prevention: Alkalising the urine through dietary changes, increasing fluid intake, and certain medications can help prevent uric acid stones. Reducing intake of high-purine foods is also beneficial.

Struvite stones

  • Description: Struvite stones are often larger stones that can form after urinary tract infections (UTIs). They are sometimes referred to as “infection stones.”
  • Causes: These stones are caused by bacterial infections. Some bacteria produce an enzyme that increases urine alkalinity, leading to stone formation.
  • Prevention: Prompt treatment of UTIs and reducing the risk of recurrent infections can help prevent struvite stones. Regular urine tests can detect any changes that might indicate stone formation.

Cystine stones

  • Description: Cystine stones are rare and are a result of a hereditary disorder called cystinuria. This condition causes the kidneys to excrete excessive amounts of the amino acid cysteine into the urine.
  • Causes: Cystinuria is a genetic disorder where the kidneys do not reabsorb cystine efficiently, leading to high levels of this amino acid in the urine.
  • Prevention: Drinking more fluids to dilute the urine, medications to reduce cystine levels in the urine, and dietary salt restriction can help manage and prevent cystine stones.

Treatment Options for Urinary Stones

Small Kidney Stones

Home treatments

  • Description: For smaller stones that are likely to pass on their own, home treatments can be effective.
  • Methods: Increasing fluid intake to help flush out the stone, and monitoring urine to check if the stone has passed.

Non-steroidal anti-inflammatory drugs (NSAIDs)

  • Description: These are pain-relieving medications.
  • Usage: They can reduce pain and inflammation associated with passing a stone. Common NSAIDs include ibuprofen and naproxen.

Anti-sickness medicine

  • Description: These medications help manage nausea and vomiting, which can sometimes accompany a kidney stone episode.
  • Examples: Medications like prochlorperazine or metoclopramide can be prescribed.

Alpha-blockers

  • Description: These are medications that relax the muscles in the ureter.
  • Usage: By relaxing these muscles, alpha-blockers can help stones pass more easily, reducing pain and the time it takes for the stone to pass. Commonly prescribed alpha-blockers include tamsulosin.

Large Kidney Stones

Shockwave lithotripsy (SWL)

  • Description: A non-invasive procedure that uses high-energy sound waves to break up the stone into smaller fragments.
  • Procedure: The patient lies on a table or in a tub of water, and shockwaves are directed at the stone from a machine outside the body.

Ureteroscopy

  • Description: A minimally invasive procedure where a thin tube (ureteroscope) is passed through the urethra and bladder to the stone.
  • Procedure: Small stones can be removed directly, while larger ones are broken up using laser energy.

Percutaneous nephrolithotomy (PCNL)

  • Description: A surgical method used for larger stones or when other treatments are not effective.
  • Procedure: A small incision is made in the back, and a nephroscope is inserted directly into the kidney to remove the stone.
  • Medications: In some cases, medications can be prescribed to treat kidney stones or to prevent them from forming. The type of medication prescribed depends on the kind of kidney stone.

Prevention of Urinary Stones

Adequate Hydration for Stone Passage

Staying well-hydrated is one of the most effective ways to prevent the formation of kidney stones. Aim to drink at least 2 to 3 litres of water daily. The goal is to produce clear or pale yellow urine. Hydration helps dilute waste products in urine, reducing the chances of crystallisation and stone formation.

Reducing Salt Intake

Excessive sodium in the diet can lead to increased calcium in the urine, which can contribute to calcium stone formation. Limit processed foods, canned foods, and restaurant/fast food, which often have high sodium content. Opt for natural, whole foods and cook at home when possible.

Limiting Animal Protein

Consuming large amounts of animal-based proteins can increase the amount of uric acid in the urine and reduce levels of citrate, a chemical in urine that helps prevent stones. Balance your diet with plant-based proteins and limit the intake of red meat, poultry, eggs, and seafood.

Avoiding Stone-Forming Foods

Some foods are known to increase the risk of certain types of stones. If you’re prone to forming calcium oxalate stones, foods high in oxalates such as spinach, rhubarb, nuts, and beets should be consumed in moderation. Pairing calcium-rich foods with oxalate-rich foods during meals can help reduce oxalate absorption.

Maintaining Healthy Calcium Intake

While calcium stones are common, it’s not advisable to reduce calcium intake unless recommended by a doctor. Adequate calcium intake can bind with oxalate in the intestines, reducing its absorption. Aim for dietary sources of calcium like dairy products, fortified foods, and green leafy vegetables rather than supplements.

Medications

In some cases, doctors may prescribe medications to prevent certain types of stones from forming. Some examples of these medications are Thiazide diuretics, which can help prevent calcium stones, Allopurinol for uric acid stones, and Potassium citrate which increases citrate levels in the urine, helping prevent calcium and uric acid stones.

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Conclusion

Urinary stones, while common, can cause significant discomfort and health complications. Recognising the types of stones and understanding the available treatment options can aid in timely intervention. Adopting preventive measures can significantly reduce the risk of recurrence.

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Dr Lee Fang Jann image

Dr Lee is a urologist and kidney transplant surgeon with a broad-based expertise of all urological disorders

He has subspecialty focus on men’s health and male infertility, and special interest in minimally invasive prostate enlargement therapy and kidney stone treatment. Dr Lee has received numerous awards for service excellence such as the Service With A Heart Award (2006-2008, 2011) and the Singapore Health Quality Service Award (2016).

  • Bachelor of Medicine and Bachelor of Surgery (Singapore)
  • Membership of The Royal College of Surgeons (Edin)
  • Master of Medicine (Surgery) (Singapore)
  • Fellowship of the Academy of Medicine (Urology)
  • Clinical fellowship at Oxford Transplant Centre in the UK
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Prior to entering private practice, Dr Lee served in the public sector for 16 years at SGH, where he initiated dedicated clinics evaluating and treating patients with complex men’s health and fertility issues. He also led the Renal Transplant Program and laparoscopic donor nephrectomy service as Surgical Director.

Apart from clinical work, Dr Lee is active in academia and believes in the importance of grooming the next generation of doctor. He was Senior Clinical Lecturer at NUS’ Yong Loo Lin School of Medicine and currently, Adjunct Assistant Professor at the Duke-NUS Medical School. Dr Lee is also regularly invited to share his experiences locally and regionally through lectures, workshops and surgical demonstrations.

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    Frequently Asked Questions

    How are urinary stones diagnosed?
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    Through imaging tests like X-rays, CT scans, ultrasounds, and urinalysis.

    Are there any complications associated with urinary stone treatments?
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    Possible complications include blood in urine, infections, bruising, and, rarely, organ damage.

    How can I prevent urinary stones in the future?
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    Stay hydrated, reduce salt, balance calcium intake, and maintain a healthy diet.

    How do genetics influence the likelihood of developing urinary stones?
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    Family history and inherited conditions can increase risk.

    How do urinary stones impact kidney function in the long term?
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    Recurrent or untreated large stones can lead to infections and kidney damage.

    Are there any specific age groups or demographics more prone to urinary stone formation?
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    Adults between 30 and 60, especially men, are more susceptible.

    Is there a correlation between urinary stones and other medical conditions or diseases?
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    Yes, conditions like hyperparathyroidism, urinary tract infections, and certain medications can increase risk.