Urinary stones affect one in 10 Australians. The majority of stones pass spontaneously, but some conditions, particularly ongoing pain, renal impairment and infection, mandate intervention.
This article explores the role of the general practitioner in the assessment and management of urinary stones.
The assessment of acute stone disease should determine the location, number and size of the stone(s), which influence its likelihood of spontaneous passage. Conservative management, with the addition of alpha blockers to facilitate passage of lower ureteric stones, should be attempted in cases of uncomplicated renal colic. Septic patients require urgent drainage and antibiotics. Other indications for referral and intervention include ongoing pain, renal impairment and stone size unlikely to pass spontaneously. There are
many ways to eliminate stones, but laser lithotripsy is being
used with increasing frequency. Up to 50% of people with a first presentation of stone disease will have a recurrence within 5 years. General advice for stone prevention consists of increasing fluid intake, especially water (sufficient to maintain dilute urine output), avoiding added salt and maintaining a well balanced low oxalate diet. Some patients may require a more detailed metabolic assessment and specific dietary advice.
Data from the Australian Institute of Health and Welfare showed an annual incidence of 131 cases of upper urinary tract stone disease per 100 000 population in 2006–2007.1 An upper urinary tract stone is the usual cause of what is commonly called ‘renal colic’, although it is more technically correct to call the condition ‘ureteric colic’.
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