A guide to kidney, ureteric, and bladder stones

Urinary stone disease involves the formation of hard mineral deposits, or stones, in the kidneys, ureters, or bladder, causing pain, and urinary issues, and sometimes requiring medical treatment for removal. Distinguished consultant urological surgeon Mr Ken Anson covers everything you need to know about the condition, including its symptoms, treatment options, and lifestyle changes that can help reduce the risk of developing stones.

What are kidney, ureteric, and bladder stones, and what symptoms do they typically cause?

Urinary stone disease affects various anatomical areas. Stones formed in the kidney are called kidney stones, those in the ureters are known as ureteric stones, and those in the bladder are referred to as bladder stones.

The causes of these stones are the same: crystallisations of urine into stone or crystal aggregates. They can range from very soft to very hard and cause varying levels of discomfort. Patients might experience severe pain when a stone moves from the kidney to the ureter, intense bladder or kidney pain, or sometimes no symptoms at all. With the increasing number of imaging procedures for other conditions, incidental stones—stones that are not causing any problems—are being detected more frequently. Other symptoms can include blood in the urine and urinary infections.

In severe cases, stones in both kidneys or ureters can impair kidney function.

How are kidney, ureteric, and bladder stones diagnosed, and what tests are typically used to confirm their presence?

The most important aspect is the patient's story or history. In 90% of cases, we can establish a working diagnosis based on this information alone. We then supplement this with tests, starting with a urine test to check for traces of blood and signs of infection.

We also use blood tests to identify any predisposing factors for stone disease, such as elevated calcium or uric acid levels. Additionally, we rely heavily on our uro-radiology colleagues and their imaging technology. This ranges from traditional X-rays to advanced low-dose CT scans and sometimes MRI imaging, which help us diagnose the condition and assess kidney function in response to the stones.

What treatment options are available for kidney, ureteric, and bladder stones, and how are they chosen based on the size and location of the stones?

The majority of kidney stones don't actually require treatment. If they're not causing any issues and are discovered incidentally, they often only need monitoring. However, if they're causing problems or are likely to due to their size and location, we would recommend treatment.

Treatment options include an advanced technology called extracorporeal shockwave lithotripsy, where shockwaves are focused on the stone from outside the body to break it into smaller pieces that can be passed naturally. We're fortunate to have access to excellent lithotripsy facilities in London, yielding fantastic results. This non-invasive outpatient procedure requires no anaesthesia.

Additionally, we have a range of endoscopic treatments that utilise the patient's natural orifices. For example, we can access the bladder through the urethra and then use telescopes to reach and treat stones in the ureter, bladder, or kidney. For stones too large to be removed through the ureter, we may perform percutaneous renal surgery, accessing the kidney through the back.

What lifestyle changes or preventive measures can help reduce the risk of developing kidney, ureteric, and bladder stones in the future?

Preventing further stones is the ultimate goal for urologists specialising in stone diseases. Unfortunately, despite advancements, our understanding of why stones form remains limited even in 2024.

Our approach is therefore pragmatic. While complex biochemical tests can help analyse stones and identify predispositions, most patients have idiopathic stone disease, meaning no specific cause is found. For these patients, we assume that the urine has a tendency to form stones, and the best way to reduce this risk is to dilute the urine, minimising the chances for stones to form and aggregate.

We focus on urine output rather than fluid intake. We recommend regular production of dilute urine. Using a wine analogy, if urine resembles the colour of Pinot Grigio or light champagne, it's ideal. If it looks like Lucozade or a dark dessert wine, it indicates concentration, and the patient needs to increase their fluid intake.

Another key advice is to cook with salt but avoid adding it at the table. Salt increases calcium in the urine, leading to stone formation. Reducing salt intake at the table is crucial. Lastly, a balanced diet is essential. While much is written about oxalate-containing foods, balance is key, and extreme diets should be avoided. A Mediterranean diet is often recommended.

In summary, the most important lifestyle factors to reduce stone risk are regular production of dilute urine, reducing salt intake at the table, and maintaining a balanced diet.

If you would like to book an appointment with Mr Anson, simply visit his Top Doctors profile here today