How are kidney stones formed? Greek expert answers all the questions

kidney stones

The term lithiasis refers to the presence of one or more stones in any part of the urinary tract. Mrs. Matina Vlachou, Director of Urology at Metropolitan Hospital, explains the causes of urolithiasis and how to treat them.

A kidney stone is a hard mass initially formed by crystals that settle in the urine in the kidney area.

The term lithiasis refers to the presence of one or more stones in any part of the urinary tract, as stones can be in different places, such as the kidneys, ureters, the bladder itself, or even the urethra.

Stones smaller than 5 millimetres are usually expelled automatically with urination. If they are not expelled or if they are larger, they remain in the ureter and then cause pain, the so-called renal colic.

Stones vary in size from a few millimetres to several centimetres. The so-called "coral stones" also occupy the entire kidney, pelvis, and calyces drainage system, forming a cast.

It is worth noting that lithiasis occurs more often in men between the ages of 20 and 60, while approximately 25% of patients report a history of lithiasis in their family history.

A kidney or ureteral stone is a common condition, as about one in ten people will develop one at least once in their lifetime.

In southern Europe and warmer countries, it occurs even more often, with men having stones more often in a ratio of 3 to 1. This ratio tends to change due to changes in daily life and diet.

What causes contribute to the appearance of lithiasis?

Lithiasis can be caused either by accident or by some unexpected cause. A period of dehydration, prolonged bed rest, or intestinal diseases are common conditions that can cause lithiasis.

Other causes may be:

• Dehydration
• Dietary habits
• Abnormalities of the urinary tract that create obstruction to urine flow, such as ureteral stricture, spongiform or horseshoe kidney, ureterocele and nephrocalcinosis
• Obstructive diseases of the urinary tract, such as prostatic hyperplasia
• Increased substances in the blood and urine, such as calcium, uric acid and cystine
• Diseases of the thyroid and especially the parathyroid glands
• Taking calcium supplements
• Family history of lithiasis
• Urinary tract infection
• Gastrointestinal diseases, such as jejunoileal bypass, intestinal resection, Crohn's disease, malabsorption diseases, diversion of urine
• Sarcoidosis

What are the symptoms of lithiasis?

When a stone is high in the kidney, it usually has relatively mild symptoms, such as a feeling of pain in the area under the ribs in the back.

However, when the stone moves into the ureter, it causes renal colic, which causes severe pain in the kidney area, on the side of the abdomen, or in the genitals.

This pain is accompanied by sweating, nausea or even vomiting, blood in the urine, difficulty or pain in urinating, and even a fever that makes the situation urgent.

When the stone is gone, and the patient urinates, then the symptoms stop.

However, there are times when the pain stops, while the stone remains in the ureter and blocks the kidney. For this reason, it is always recommended that after an episode of colic, the patient undergoes a urological examination to confirm the complete expulsion of the stone.

How do we treat lithiasis?

At the Metropolitan Hospital, we recommend thoroughly investigating the disease to discover the type and location of the lithiasis. We can locate the lithic load quickly and easily with today's new imaging capabilities.

Many patients urinate the stone, especially if small stones up to 3 mm do not cause a particular obstruction and are not accompanied by an infection.

In other cases of larger and wedged stones that cause significant obstruction, especially when accompanied by infection, invasive removal of the obstruction is imperative to avoid permanent damage to the kidney, as well as the morbidity of the condition that can threaten the patient's life.

In this case, we approach the lithiasis wherever it is located using a series of thin, flexible, non-traumatic endoscopes. Then, we can pulverise and absorb it with special high-power lasers that magnetise the stone.

At this point, it is worth emphasising that although lithiasis sounds like a common condition, the stone's location, size and hardness may require particularly complex and individualised manipulations.

We are often asked to use combinations of methods. In addition to digital endoscopes and high-power lasers, with which we can remove stones non-traumatically under vision, the most modern Da Vinci Si robotic system can also be combined, performing minimally invasive and bloodless difficult operations.

* The Metropolitan Hospital has a model, fully equipped, and organised Urology Clinic with experienced and highly qualified scientific and nursing staff and advanced technology equipment. In our clinic, the entire spectrum of urinary lithiasis is successfully treated, but the cause of the lithiasis is mainly approached to reduce the risk of its recurrence significantly.

Matina Vlachou is Director Urologist at Metropolitan Hospital. Translated by Paul Antonopoulos.

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