Uretic stones have become very common in the past few years. The hard mass develops in the ureter when certain chemicals in the urine, such as calcium, oxalate or uric acid, form crystals. They vary in size and texture, and become painful as they cause blockage in the ureter leading to obstruction in urine discharge. Increasingly, urologists have been coming across a type of stones, called âlifestyle stonesâ which are formed in the kidney and then pass into the ureter. They then get stuck in the ureter causing unbearable pain. This obstruction of the urinary tract by calculi is known as âUreteric colicâ. These stones are smaller in size than the traditional kidney stones and measure less than 5-8mm. Multiple stones can develop at the same time and the pain is almost always accompanied by severe nausea. In recent times, there has been a growing percentage of ureteric colic as opposed to traditional kidney stones. Almost 80-90% of cases are now seen to be of ureteric colic.
Dr. Bibhas Ranjan Kundu, Senior Consultant Urologist, Calcutta Medical Research Institute shares his life-long experience of treating kidney stones. He says, â19 years ago when I first joined the Calcutta Medical Research Institute (CMRI), we used to operate on 2-3 cases of prostates a day. With the advent of new medication for the problem, the mid years of my career saw fewer cases of prostate. This personal experience matches the global data which shows that the number of prostate cases have gone down by almost 30 â 35%. However, simultaneously we have seen increasing incidents of renal/uretic stones. Numerous patients are now coming to us with lower abdominal and lower back pain connected to âRenal uretic stonesâ. In fact, the intensity of pain that these patients suffer has been proven to be second only to labour pains during child birth.â
It is already well known that the cases of stones increase during summer season , due to the lack of urination resulting in concentration of salts in the urine. However, now the lack of water and concentration of salts may not be the only reason behind these stones.
Causes and Symptoms
The rise and prevalence of kidney stones are now linked to many other factors such as poor diet, lack of physical exercise and reduced water intake. There are several symptoms of kidney stones – severe pain in abdomen and back. The pain may spread to the groin and genital area. Other symptoms include blood in the urine (hematuria), excruciating pain or frequent urination (dysuria), and nausea and vomiting. Related infection, inflammation and spasm of the smooth muscles in the wall of urinary tract may also be present.
Plan of treatment
Uretic colic is treated in two pronged approach. First, the pain is taken care of with a non-steroidal anti-inflammatory drug. Once the pain is under control then urine test and blood test will be done. After that, the patient will go under various imaging studies such as abdominal X-rays, ultrasound, intravenous urography or CT scan to identify the location of the stone. In the initial stage, smaller stones are likely to pass spontaneously through urine, so treatment usually consists of observation and pain control with medications. Medication may also be prescribed to decrease inflammation, prevent or treat infection or reduce muscle spasm so that the stone may be easily expelled. NSAID, Diclofenac 75 mg (3 mL) injection, Oral or rectal diclofenac, Morphine are usually used for managing the pain.
Surgical or radiological intervention is suggested depending on the size, position, impaction and obstruction of the stone. If the stone is big, does not pass during urine discharge and has been retained for greater than 4-6 weeks, then it can result in kidney damage. Surgery usually involves drainage of the urine by placing a stent within the ureter or making an incision through the skin. The stone is then shattered with the use of a laser beam or a Holmium laser.
Prevention
The alarming numbers of patients have triggered questions on why there are so many cases of renal/ uretic stones. The doctors unanimously point to the changes in peopleâs lifestyles. Constant consumption of junk food, carbonated drinks, fatty foods, alcohol etc. increase the amount of uric acid and calcium oxalate/phosphate in the system. These stones are found to be mostly composed of uric acid â and uric acid is directly linked to dietary habits. Therefore, it is imperative for people to change lifestyle choices and dietary intake. Increase in water intake while eliminating animal protein and oxalate is recommended. Completely eliminating oxalate-containing foods such as beets, chocolate, coffee, cola, nuts, rhubarb, spinach, strawberries, tea, and wheat bran will help in keeping uretic colic away.
Suggested by Dr. Bibhas Ranjan Kundu, Senior Consultant Urologist, CK Birla Hospitals _CMRI
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