A Simple Guide To Urinary Stones, Diagnosis, Treatment And Related Conditions

By Kenneth Kee

This book describes Urinary Stones, Diagnosis and Treatment and Related Diseases

The pain of a urinary stone stuck in the ureter (the tube from the kidney to the bladder) is so severe that it has been described as second in severity to pregnancy labor pains.

The pains are usually down the flanks of the abdomen and accompanied by blood in the urine.

Drinking lots of water usually clears the stuck urinary stone.

An X-ray of the abdomen (preferably after passing the feces) will usually show the presence of the stone in 80% of the cases.

Recently I had a patient with a severe right back pain that traveled all the way down to the groin.

There was no blood in the urine but she had frequently passing of urine.

An X-ray of the abdomen showed enlarged right kidney but no evidence of a urinary stone.

The left kidney was normal.

There was definitely a blockage of the urinary tract causing backflow of urine up to the right kidney.

I gave her a painkiller and antibiotic to relieve her pain and sent her for an MRI of the abdomen to exclude the cause of the urinary obstruction on the right side,

The MRI confirms my suspicion of a urinary stone stuck at lower part of the ureter (the tube connecting the kidney to the bladder).

I have at least 1 patient every year with this condition.

All that is needed to prevent this pain and stone is by drinking lots of water (2-3 liters) a day.

Urinary Stones are small, solid masses made of crystals which happen when salts or minerals in the urine become solid crystals inside the kidney.

Urinary stones normally begin in the kidneys, pass down the ureter, bladder and out through the urethra.

Urinary stones are one of the most painful medical disorders.

Urinary Stones are formed normally due to the accumulation of salts and minerals particularly calcium in the urine.

At the same time, the urine may have inadequate substances that prevent crystals from sticking together, producing an ideal environment for urinary stones to develop.

Normally the stones may be so small that they pass out through the urine without the patient knowing.

Some become bigger due to accumulation of the salts and minerals and the concentration of the urine.

The bigger stones may stay in the tubes of the kidney and are termed renal stones.
Some smaller stones may move out of the kidney and passes through the ureters which are the tubes bringing urine from the kidney to the bladder.

These are termed ureteric stones.

If a ureteric stone gets stuck in the ureter, this can induce blockage of the urine and severe pain (urinary colic).

1. Calcium stones forms the most frequent (about 80%) of the urinary stones.
a. Calcium oxalate: envelope or dumbbell-shaped
b. Calcium phosphate: amorphous, wedge-shaped prisms in rosettes
2. Uric acid: rhomboid shaped
3. Struvite stones (infection stones) are produced when there is too much ammonia in the urine mostly in urinary tract infection; normally large and have a horn-like shape
4. Cystine: hexagon-shaped; yellow and crystalline

Symptoms:

1. Severe, sharp pain in the flank and the back, just below the ribs
2. Pain that radiates to the lower abdomen and groin
3. Pain that happens in waves and varies in intensity
4. Pain or burning sensation while urinating

Other signs and symptoms may be:
1. Pink, red or brown urine
2. Cloudy or foul-smelling urine
3. A persistent need to urinate, urinating often or in small amount
4. Nausea and vomiting
5. Fever and chills if an infection
6. Pain caused by a urinary stone may alter, shifting to a different site or rising in intensity as the stone travels through the urinary tract.

Analysis of passed stones is essential for diagnosis and treatment

TABLE OF CONTENT
Introduction
Chapter 1 Urinary Stones
Chapter 2 Causes
Cha

• Language: English
• Publisher: Kenneth Kee
• Release date: Jan 13, 2021
• ISBN: 9781005654528

Kenneth Kee

Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

Book preview

A

Simple

Guide

To

Urinary Stones,

Diagnosis,

Treatment

And

Related Conditions

By

Dr Kenneth Kee

M.B.,B.S. (Singapore)

Ph.D (Healthcare Administration)

Copyright Kenneth Kee 2021 Smashwords Edition

Published by Kenneth Kee at Smashwords.com

Dedication

This book is dedicated

To my wife Dorothy

And my children

Carolyn, Grace

And Kelvin

This book describes Urinary Stones, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

(What You Need to Treat Urinary Stones)

This e-Book is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.

If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

Thank you for respecting the hard work of this author.

Introduction

I have been writing medical articles for my blog: http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.

My purpose in writing these simple guides was for the health education of my patients.

Health Education was also my dissertation for my Ph.D (Healthcare Administration).

I then wrote an autobiography account of my journey as a medical student to family doctor on my other blog: http://afamilydoctorstale.blogspot.com.

This autobiography account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Disorders into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

From which many free articles from the blog was taken and put together into 800 eBooks.

Some people have complained that the simple guides are too simple.

For their information they are made simple in order to educate the patients.

The later books go into more details of medical disorders.

The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

Since 2013, I have tried to improve my spelling and writing.

As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

My diagnosis and treatment capability has improved tremendously from my continued education.

Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

I apologize if these repetitions are irritating to some readers.

Chapter 1

Urinary Stones

The pain of a urinary stone stuck in the ureter (the tube from the kidney to the bladder) is so severe that it has been described as second in severity to pregnancy labor pains.

The pains are usually down the flanks of the abdomen and accompanied by blood in the urine.

Drinking lots of water usually clears the stuck urinary stone.

An X-ray of the abdomen (preferably after passing the feces) will usually show the presence of the stone in 80% of the cases.

Recently I had a patient with a severe right back pain that traveled all the way down to the groin.

There was no blood in the urine but she had frequently passing of urine.

An X-ray of the abdomen showed enlarged right kidney but no evidence of a urinary stone.

The left kidney was normal.

There was definitely a blockage of the urinary tract causing backflow of urine up to the right kidney.

I gave her a painkiller and antibiotic to relieve her pain and sent her for an MRI of the abdomen to exclude the cause of the urinary obstruction on the right side,

The MRI confirms my suspicion of a urinary stone stuck at lower part of the ureter (the tube connecting the kidney to the bladder).

I have at least 1 patient every year with this condition.

All that is needed to prevent this pain and stone is by drinking lots of water (2-3 liters) a day.

What are Urinary Stones?

Urinary Stones are small, solid masses made of crystals which happen when salts or minerals in the urine become solid crystals inside the kidney.

Urinary stones normally begin in the kidneys.

They can develop anywhere along the urinary tract, which comprises these parts:

1. Kidneys

2. Ureters

3. Bladder

4. Urethra

Urinary stones are one of the most painful medical disorders.

How are Urinary Stones formed?

Urinary Stones are formed normally due to the accumulation of salts and minerals particularly calcium in the urine.

At the same time, the urine may have inadequate substances that prevent crystals from sticking together, producing an ideal environment for urinary stones to develop.

Normally the stones may be so small that they pass out through the urine without the patient knowing.

Some become bigger due to accumulation of the salts and minerals and the concentration of the urine.

The bigger stones may stay in the tubes of the kidney and are termed renal stones.

Some smaller stones may move out of the kidney and passes through the ureters which are the tubes bringing urine from the kidney to the bladder.

These are termed ureteric stones.

If a ureteric stone gets stuck in the ureter, this can induce blockage of the urine and severe pain (ureteric colic).

What are the types of Urinary Stones?

Different kinds of Urinary stones develop from different salts inside the urine.

1. Calcium stones forms the most frequent (about 80%) of the urinary stones.

50% are composed of calcium oxalate while the rest are formed from calcium phosphate.

Most urinary stones are calcium stones, normally in the form of calcium oxalate.

Oxalate is a substance made daily by the liver or absorbed from the diet.

Certain fruits and vegetables, and nuts and chocolate, have high oxalate content.

Dietary factors, high doses of vitamin D, intestinal bypass surgery and several metabolic disorders can raise the concentration of calcium or oxalate in urine.

a. Calcium oxalate: envelope or dumbbell-shaped

Calcium oxalate is the primary constituent of the majority of stones.

They are often made of calcium oxalate even though they may comprise of calcium phosphate or maleate.

Eating fewer oxalate-rich foods can decrease the risk of developing this type of stone.

High-oxalate foods are:

1. Potato chips

2. Peanuts

3. Chocolate

4. Beets

5. Spinach

Even though some urinary stones are made of calcium, getting enough calcium in the diet can prevent stones from forming.

They normally happen in the situation of hyper-calciuria, hyper-oxaluria, hypo-magnesuria, hyper-cystinuria, hypo-citraturia.

b. Calcium phosphate: amorphous, wedge-shaped prisms in rosettes

Calcium stones may also happen in the form of calcium phosphate.

This type of stone is more frequent in metabolic disorders, such as renal tubular acidosis.

It may also be linked with certain medicines used to treat migraines or seizures, such as topiramate (Topamax, Trokendi XR, Qudexy XR).

They are spiky or large and smooth

2. Uric acid: rhomboid shaped

These stones are typically idiopathic.

They happen in patients whose diets are high in protein, which acidifies urines pH (<7), allowing for uric acid stone formation.

Uric acid stones are caused by the accumulation of excess amounts of uric acid which can be due to eating a lot of meat.

They are smooth, brown and soft

This type of urinary stone is more frequent in men than in women.

Uric acid stones can form in people who lose too much fluid due to chronic diarrhea or malabsorption, those who eat a high-protein diet, and those with diabetes or metabolic syndrome.

They can happen in people with gout or those going through chemotherapy.

Certain genetic factors also may increase the risk of uric acid stones.

This type of stone develops when urine is too acidic.

A diet rich in purines can increase urine’s acidic level.

Purine is a colorless substance in animal proteins, such as fish, shellfish, and meats.

3. Struvite stones (infection stones) are produced when there is too much ammonia in the urine occurring particularly in urinary tract infection.

Infections with bacteria produce urease such as Proteus mirabilis, Klebsiella pneumonia, Enterobacter, and Pseudomonas aeruginosa.

The urease produces ammonia and CO2, which creates basic pH urine (>7).

The bacteria that cause these urinary infections can generate ammonia.

They are normally large and have a horn-like shape and cause urinary obstruction

This kind of urinary stone is most often found in women with urinary tract infections (UTIs).

They result from a urinary infection.

Struvite stones develop in reaction to a urinary tract infection.

These stones can develop rapidly and become quite large, occasionally with few symptoms or little warning.

Treatment of an underlying infection can stop the formation of struvite stones.

4. Cystine: hexagon-shaped

Cystine stones are rare.

They happen in both men and women who have the genetic defect in the transport of the amino acid cystine, resulting in hyper-cystinuria.

With this type of stone, cystine (an acid that happens naturally inside the body) passes from the kidneys into the urine.

Cystine stones happen when there are high levels of cystine in the urine.

They are yellow and crystalline

Who is at risk of Urinary stones formation?

Risk factors

Factors that increase the risk of developing urinary stones are:

1. Family or personal history

If someone in the family has had urinary stones, the person is more likely to develop stones, too.

If the person already had one or more urinary stones, the person is at higher risk of developing another.

2. Dehydration or Low fluid intake

Not drinking enough water each day can increase the risk of urinary stones.

People who reside in warm, dry climates and those who sweat a great deal may be at higher risk than others.

3. Certain diets

Eating a diet that's high in protein, sodium (salt) and sugar may increase the risk of some types of urinary stones.

This is especially true with a high-sodium diet.

Too much salt in the diet raises the quantity of calcium that the kidneys must filter and significantly raises the risk of urinary stones.

Higher enteric oxalate absorption, normally due to malabsorption, leads to higher production of calcium oxalate crystals.

4. Obesity

Overweight, high body mass index (BMI), large waist size and excess weight have been