The majority of urinary tract stones will pass spontaneously and if there is good pain control most patients will not need any other treatments. Dietary measures can be very important for the prevention of recurrent stones. 

The urinary system is made up of two kidneys with a long narrow tube draining the urine from the kidneys into the bladder (ureter). Urine then passes out of the bladder via the urethra. Most stones are formed in the kidney and some travel down the ureter and into the bladder. If the stone is too large it may become lodged in the kidneys or ureter. This can cause blockage of urine flow which may cause pain.

About 90% of stones will pass through on their own and not all patients require hospital admission. Smaller stones (less than 5mm) have the best chance of passing and so long as any pain can be controlled, patients can often be safely monitored for a few weeks, if necessary, to see if the stone will pass spontaneously. Stones which are not progressing and larger stones (greater than 5mm) will usually require some intervention.

The first choice for intervention is shock wave treatment known as lithotripsy (ESWL Extra-Corporeal Shockwave lithotripsy). This uses vibrating sound wave energy which is focused onto the stone so that it breaks-up. The procedure can be performed as a day-case and patients usually require simple pain relief only. Not all stones are suitable, but this procedure has very good results and it does depend on the size and site of the stone. Successful stone fragmentation usually requires at least 2 treatments.

If a stone is not suitable or has not broken up, using lithotripsy then Ureteroscopy maybe carried out. This uses a long narrow telescope which can be passed internally via the urethra and bladder, up into the ureter and kidneys. The stone can be extracted or may need to be broken up directly, using energy sources such as laser. The procedure requires a general anaesthetic, sometimes performed as a day-case.

Larger kidney stones (greater than 1.5cm) may require Percutaneous Nephrolithotomy (PCNL). This involves passing a narrow tube (tract) directly into the kidney via a small wound in the loin area. A telescope is passed directly down the tract allowing fragmentation and removal of the stone fragments. This is a more complicated but highly successful procedure performed under general anaesthetic and patients are usually in hospital for 3-4 days.

Ipswich Urology is able to provide all of the procedures described and one of the consultants has a specialist interest in treatment of complex stones.

Diet Advise to Prevent Stones

The most important message is to drink good volumes of fluid each and every day, especially in hot weather. There are also some dietary modifications which maybe helpful.

In Summary

• Drink sufficient fluid to keep the urine dilute (more than 2 litres per day)
• Avoid excessive intake of foods containing oxalate. This includes: strawberries, beetroot, spinach, nuts, chocolate, rhubarb and black tea.
• Avoid a low calcium diet (dairy products) as this can actually increase stone formation. A normal calcium diet is advised.
• There is also some evidence of benefit from lower salt intake, increased fibre intake (fruit and vegetables) and eating less meat.