Stone etiology, symptoms and diagnosis

  Urinary stones, also known as urolithiasis, include kidney stones, ureteral stones, stones in the bladder and urethra. The incidence of urinary stones in China is 1% to 5%, and as high as 5% to 10% in the south; the annual new incidence is about 150-200/100,000 people, of which 25% of patients need hospitalization. In recent years, the incidence of urinary stones in China has increased, and it is one of the top 3 areas in the world with a high incidence of stones. There are many factors affecting stone formation, age, gender, race, genetics, environmental factors, dietary habits and occupation have a great impact on stone formation. Metabolic abnormalities in the body, obstruction of the urinary tract, infection, foreign body and drug use are common causes of stone formation. Attention to these issues can reduce stone formation and recurrence. If the kidneys are not treated in time due to bilateral upper urinary tract stone obstruction, the kidney parenchyma will shrink and lead to uremia. In this case, even if the stones are removed, it is impossible to restore the function of both kidneys, and one can only rely on regular hemodialysis to maintain life.  Smaller stones tend to move into the ureter and often induce renal colic. The renal colic is characterized by severe pain in the lower back, or abdominal pain on one side of the body, which is unbearable, accompanied by pallor, profuse sweating, nausea, vomiting, etc. Sometimes it is accompanied by flesh-eye hematuria. When stones are combined with infection, there are symptoms such as fever, painful urination, frequent urination, and urgent urination. If acute ureteral obstruction is caused by stones on both sides at the same time, it may manifest as acute anuria leading to acute renal failure, which requires emergency surgery.  The most common method to check urinary stones is ultrasound. Ultrasound is easy, economical, non-invasive, and can detect both positive and negative X-rays of stones above 2 mm. In addition, ultrasound examination can also provide information about hydronephrosis. However, due to the influence of intestinal contents, ultrasonography is less sensitive in diagnosing stones in the middle and lower ureter, and some ureteral stones cannot be detected by ultrasound. CT examination is more sensitive than ultrasound in diagnosing stones, and is especially suitable for the diagnosis of patients with acute renal colic. CT urography (CTU) can show the extent of hydronephrosis and the thickness of the renal parenchyma, and can diagnose most urinary stones and is useful in the selection of treatment options.