early forms of bypass surgery for obesity. Other pieces of information that need to be elicited are occupation (possible cause of dehydration), nature of the diet, fluid intake and other medical conditions such as recurrent urinary infections, gout, sarcoidosis and bowel surgery e.g. For example, recurrent stones in a young patient may suggest cystinuria. Firstly, is there a past history of stones? This is important as the recurrent stone-former will require a different pattern of evaluation from the patient presenting with their first stone.
The assessment of a patient with a clinical diagnosis of renal calculi requires a few simple steps. This means that most patients will not need hospitalisation or surgical intervention and can usually be managed without referral to hospital, provided adequate pain relief can be supplied. While the sudden onset of severe renal colic usually leads to the diagnosis of a renal stone, it is important to realise that, in spite of what is usually a dramatic event for the patient, the majority of stones are small and will pass spontaneously. The factors that influence both the need for and the nature of treatment in the acute phase have been established for decades.
However, the changes have been largely limited to the procedures rather than non-interventional management. The treatment of urinary stone disease has undergone dramatic change over the last two decades. Considerable debate still exists as to the most appropriate manner of investigating and treating stone sufferers, particularly those who have calcium oxalate stones. Up to half the patients will develop recurrent stones.Īs many as one in 10 men and one in 20 women will experience an episode of renal colic. Although surgical treatment may be required, the role of diet and increased fluid intake should not be overlooked.
Patients who have stones which result in symptoms should have urine microscopy, renal function tests and imaging of the urinary tract. They may contain uric acid, struvite or cystine, but they are most frequently formed from calcium oxalate. The formation of urinary stones is relatively common.
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