“Preventing and Treating Urinary Stones: Advice from a Urology Expert”

[서울부민병원 비뇨의학과 이정구 과장] As the weather gradually warms up and the season of sweating returns, more patients visit the hospital for urinary stones. Urinary stones are a representative disease that causes acute pain in the urogenital system. It is known that 2% of the population in Korea develops urinary stones, and those who have had urinary stones once have recurred more than twice in their lifetime.

In urine, there are various inorganic substances such as sodium, calcium, oxalic acid, ammonia, and phosphoric acid, which are components of stones. When there is a lack of water in the body due to factors such as not drinking a lot of water or sweating a lot, the concentration of stone-causing substances in the urine increases, and inorganic substances aggregate to form small crystals and gradually grow to form stones. In addition, temperature, humidity,

Stones can also be caused by environmental factors such as eating habits, genetic factors, medications, and urinary tract infections. Calcium oxalate stone, the most common form of urinary stones, accounts for 80%. In addition, there are ammonium carbonate stones caused by urinary tract infections, and uric acid stones formed when uric acid levels are high.

The most common symptom of urolithiasis is sudden onset of flank pain. If there is a stone in the right upper ureter, severe pain in the right flank lasts for several minutes to several hours, then stops and repeats again. Symptoms such as nausea, vomiting, and diarrhea are sometimes accompanied, which is due to the connection between the autonomic nerve reflexes of the urinary tract and the gastrointestinal tract, resulting in gastrointestinal symptoms and a visit to the gastroenterology department.

When a ureteral stone descends, pain appears in the bladder, scrotum, or testicles, and urinary discomfort is also complained of. Stones in the bladder or urethra can cause pain, hematuria, and difficulty urinating when urinating. Bacterial infections caused by stones may cause high fever. There are several methods for diagnosing urinary stones, but most of them can be confirmed by performing an abdominal CT scan that can observe the kidneys, ureters, and bladder.

Depending on the symptoms, natural discharge expectancy therapy and extracorporeal shock wave lithotripsy are used for treatment.

The expected treatment for natural discharge is that most stones are small stones less than 5 mm in size, so if you drink 2 liters of water a day and exercise appropriately, they will be discharged naturally. In addition, there are cases of drinking beer, but it is better to refrain from alcohol because it can aggravate the pain due to edema caused by the vasodilation reaction in tissues. Within 1 month of the initial diagnosis, a CT scan is performed to check whether the stones are naturally excreted. If the stones are not excreted after 1 month, or ureteral obstruction due to stones causes hydronephrosis, or urinary tract infection or pain persists, active treatment is required. do.

Extracorporeal shock wave lithotripsy (ESWL) is a popular treatment that can be performed as an outpatient treatment as soon as symptoms appear without the hassle of hospitalization or anesthesia. However, it may be difficult to apply to children, pregnant women, people with blood coagulation disorders, or severe physical deformities or deformations. Importantly, small stones embedded in the renal parenchyma of the kidney do not respond to treatment, so extracorporeal shock wave lithotripsy is not recommended.

In endoscopic surgery, if the stone is not removed even with extracorporeal shock wave lithotripsy, the stone is destroyed by shooting a laser through a ureteroscope or a nephroscopic endoscope. For this, hospitalization and anesthesia are required. After removing the stone, a stent is inserted into the ureter and removed one week later.

Urinary stones are one of the diseases with a high possibility of recurrence even after treatment. To prevent the recurrence of stones, it is important to manage your daily life well, such as drinking water, controlling your diet, and controlling your weight. It is recommended to consume about 2 liters of water per day, and drinks containing citric acid such as lemonade are helpful for prevention. An excessively high-protein diet can promote stone formation by affecting the excretion of calcium oxalate and citric acid. Recently, there are many cases where young people eat a lot of processed foods such as simple instant food and stored food, but these foods contain a large amount of salt, so it is not good for preventing absenteeism, so it is good to limit it as much as possible.

If you are overweight, controlling your weight can help prevent absenteeism. To prevent calcium oxalate stones, the most common form of stones, it is good to limit your intake of peanuts, tree nuts, chocolate, and spinach. However, calcium intake rather promotes the excretion of oxalate in the body, so there is no need to limit it. Eat plenty of fruits (tangerines, lemons, oranges, grapefruits, plums, tomatoes) and vegetables that contain citric acid.

When the first side pain occurs, there are cases where you do not receive medical treatment and then go to the hospital after the urinary stones block the flow of urine and later the kidneys become swollen and function deteriorates. Receiving is a shortcut to preventing complications from stones and maintaining kidney function well.