Introduction

Urinary tract stones, commonly known as kidney stones, are solid concretions that form in the urinary tract (kidneys, ureters, bladder). They affect about 10% of the population during their lifetime, with a clear male predominance. The most well-known complication is renal colic, an extremely intense lower back pain caused by the migration of a stone in the ureter. Urinary tract stones are increasingly common, linked to modern dietary habits and lack of hydration.

If you experience intense lower back pain, burning during urination, or blood in your urine, first contact your primary care physician. If they are unavailable, Docadom offers an emergency consultation by a doctor at home: call 021 845 45 45 or use our application available on the App Store and Google Play.

Who is at risk?

There are numerous risk factors: personal or family history of stones, insufficient hydration, a diet rich in salt, animal proteins or fast sugars, hot climate, obesity, diabetes, high blood pressure, metabolic syndrome, hyperparathyroidism, certain digestive diseases (Crohn's, bariatric surgery, malabsorption), recurrent urinary tract infections, anatomical abnormalities of the urinary tract, and prolonged immobilization. Certain medications also promote stone formation (indinavir, topiramate, high doses of vitamin C).

Symptoms of Urinary Tract Stones

Stones can be completely asymptomatic and discovered by chance, or they can present with a very painful crisis.

Main Symptoms

• Renal colic: sudden, intense lower back pain, like a stabbing sensation, radiating to the groin and genitals.

• Agitation ("the patient cannot sit still"), inability to find a comfortable position to relieve pain.

• Nausea, vomiting, sometimes reflex constipation.

• Hematuria (blood in the urine), macroscopic or microscopic.

• Burning during urination, pollakiuria, and urgency when the stone approaches the bladder.

• Fever only in case of associated urinary tract infection (obstructive pyelonephritis).

• Bladder stones: dysuria, urinary retention, suprapubic pain.

When to Consult Urgently?

An emergency consultation is required in the following situations:

• Intense lower back pain resisting painkillers.

• Associated fever — risk of obstructive pyelonephritis, an absolute emergency.

• Severe vomiting preventing oral intake.

• Anuria (absence of urine) or oliguria.

• Stones in a single kidney, a pregnant woman, or an immunocompromised patient.

• Signs of sepsis: mottling, hypotension, confusion — call 144.

What should you do before calling Docadom? Drink normally (do not force hydration during the crisis), take the painkillers you have available, and first contact your primary care physician. If they are unreachable or if you need a doctor at home outside of opening hours, call Docadom at 021 845 45 45 or make your request directly from our smartphone application (App Store and Google Play). In case of high fever, anuria, or signs of shock, dial 144 without delay.

Causes and Types of Stones

Stones result from the precipitation of crystals in saturated urine, favored by an imbalance between dissolved substances and crystallization inhibitors.

Main Types of Stones

• Calcium oxalate stones: the most common (70-80%). Favored by a diet rich in oxalates (spinach, rhubarb, chocolate), an excess of salt, animal proteins, and a deficit in dietary calcium.

• Uric acid stones (10-15%): associated with gout, diabetes, obesity, and a diet rich in purines.

• Struvite stones (5-10%): linked to chronic urinary tract infections (urease-producing organisms).

• Cystine stones: rare, of genetic origin (cystinuria).

• Drug-induced stones: indinavir, sulfonamides, topiramate.

Diagnosis of Urinary Tract Stones

The diagnosis combines clinical findings, urine dipstick, and imaging.

Diagnostic Methods

• Anamnesis: history, diet, medications, hydration.

• Clinical examination: search for pain on lower back palpation, Giordano's sign, abdominal palpation.

• Urine dipstick: hematuria, leukocytes, nitrites.

• Urine culture in case of suspicion of associated infection.

• Non-contrast CT scan: the reference examination, which visualizes all stones (size, location, impact).

• Renal and bladder ultrasound: useful in pregnant women and children.

• Biological evaluation: kidney function, calcium levels, uric acid levels, electrolyte panel.

• Stone analysis (infrared spectrophotometry) if recovered.

• Metabolic evaluation in case of recurrence.

Alternative Diagnoses

• Acute pyelonephritis without stones.

• Acute appendicitis, diverticulitis.

• Abdominal aortic aneurysm in elderly subjects.

• Muscular lower back pain or lumbosciatica.

• Gynecological pathologies: ectopic pregnancy, adnexal torsion.

• Cholecystitis, pancreatitis, renal infarction.

Treatment of Urinary Tract Stones

Treatment of the Crisis (Renal Colic)

• NSAIDs (ketoprofen): first-line treatment, highly effective.

• Paracetamol, antispasmodics (phloroglucinol).

• Morphine or oxycodone in case of severe pain resistant to other treatments.

• Moderate hydration (do not overload).

• Filter urine to recover the stone.

• Monitoring to detect any potential infection or blockage.

Elimination or Removal of the Stone

For stones < 5 mm, spontaneous passage is frequent (80%). For others:

• Alpha-blockers (tamsulosin): facilitate the expulsion of distal ureteral stones.

• Extracorporeal shock wave lithotripsy (ESWL): shock waves to fragment the stone.

• Ureteroscopy with laser: endoscopic technique of choice.

• Percutaneous nephrolithotomy for large kidney stones.

• Emergency drainage (double-J stent or nephrostomy) in case of obstructive pyelonephritis or kidney failure.

Preventive Treatment

Tailored to the type of stone. In general: abundant hydration (2 to 3 liters of water per day), low-salt diet, moderation of animal proteins, normal dietary calcium intake (do not decrease), citrates (lemon, Vichy water) to increase urinary pH. Uric acid stones can be prevented by allopurinol and alkalinization of the urine. Struvite stones require complete treatment of urinary tract infections.

Prevention of Urinary Tract Stones

• Drink 2 to 3 liters of water per day, distributed throughout the day and night.

• Prefer low-mineral water for daily consumption.

• Limit salt (< 6 g/day).

• Moderate animal proteins.

• Normal dietary calcium intake (dairy products with meals).

• Limit foods rich in oxalates (spinach, rhubarb, beetroot, cocoa) if you have a history of stones.

• Reduce fast-acting sugars.

• Regular physical activity, maintaining a healthy weight.

• Monitoring of high-risk medications.

• Metabolic evaluation after a recurrence.

Possible Complications

The main complications are obstructive pyelonephritis (septic emergency), acute or chronic kidney failure, recurrence (50% at 5 years without prevention), severe hematuria, kidney loss in case of prolonged untreated blockage, recurrent urinary tract infections, and chronic pain.

When to Contact a Doctor for a Urinary Tract Stone

Any renal colic merits medical advice, even if the pain subsides:

• First step: contact your primary care physician or your urologist, who can arrange imaging and a metabolic evaluation.

• If your primary care physician is unavailable (evenings, weekends, holidays), Docadom offers an emergency consultation by a doctor at home. Call 021 845 45 45 or make your request through our mobile application, available for free on the App Store and Google Play.

• In case of warning signs (fever, chills, anuria, unbearable pain, repeated vomiting, low blood pressure), dial 144 without delay.

Conclusion: Drink Abundantly, Prevent Recurrence

Urinary tract stones are a common and recurrent condition. They are characterized by highly painful renal colic, hematuria, or associated urinary tract infection, which can lead to complications such as obstructive pyelonephritis or kidney failure. Diagnosis relies on a CT scan, and treatment combines pain relief, elimination of the stone, and preventive measures. Abundant hydration and dietary adjustments are the pillars of prevention.

In case of renal colic, first contact your primary care physician. If they are not available, Docadom provides an emergency doctor at home 7 days a week: call 021 845 45 45 or use our mobile application (App Store, Google Play) to request an emergency consultation.