Urinary stones affect many people around the world and in Burkina Faso. In this interview that she gave us, Dr Aïssata Ouédraogo, urological surgeon at the Ouahigouya Regional University Hospital, emphasizes that urinary stones can be responsible for complications which can be severe and can even lead to death. She goes over the causes and symptoms of urinary stones and provides some advice on how to avoid them.
Lefaso.net: What is a urinary stone?
Dr Ouédraogo: A urinary stone is the presence in the urinary tract (kidney cavities, pyelon, ureters, bladder, urethra) of crystalline, mineral, organic or medicinal concretions (solid bodies). It is a multifactorial pathology that can occur at any age.
Do you have an idea of the number of people who suffer from urinary stones in your department?
Yes, many people suffer from urinary stones. Worldwide, 4 to 18% of the world's population suffers from it. In Burkina Faso, Professor Kaboré and his colleagues found a prevalence of 12.5% in Ouagadougou. In the urology department of the Ouahigouya university hospital center, over the last three years, we have operated on 58 patients and some have benefited from medical treatment to expel the stone through the natural urinary tract and others are under surveillance.
What are the causes of urinary stones?
Most stones are linked to a diet that is too rich, poorly balanced and to insufficient diuresis (the total quantity of urine emitted over 24 hours). This disease is said to be eating too much, eating poorly, and not drinking enough.
There are many factors that can influence the formation of a stone in the urinary tract. We have dietary factors, notably a diet rich in dairy products, animal proteins, and salt, promoting hypercalciuria; chocolate, dried fruits, spinach, sorrel, tea, candies which are rich in oxalate; purines (offal, cold meats), fast sugars (fructose); reducing the consumption of dietary fiber (fruits, vegetables, dried beans, rice, etc.).
The reduction in water intake is also a contributing factor, especially in hot countries and when working in an overheated environment with insufficient water intake.
There are also family factors. There are families who do calculations. This is due to a disease called Cystinuria which is a genetic condition causing the accumulation of amino acids in the urine responsible for the formation of stones.
Urinary infections are also another contributing factor. Indeed, certain germs, such as Proteus mirabilis, Klebsielle and Pseudomonas have an enzyme, urease, which degrades urea into a protein matrix on which mineral salts precipitate to form stones.
Added to this are urinary pH abnormalities. Normal urine pH is 5.4. When the urinary pH is around 5 or 7, this can promote the formation of urinary stones.
Certain medications also promote the occurrence of stones. These are Indinavir, Atazanavir which are drugs used in the treatment of HIV, Cotrimoxazol, Allopurinol, Amiodarone, thiazide diuretics, vitamin D.
Congenital anatomical anomalies such as polycystic kidney disease, horseshoe kidneys, calyceal, pyelic, ureteral stenoses, pyelo-ureteral junction syndrome, mega-ureter are also factors favoring the occurrence of urinary stones.
To this must be added acquired factors, notably subvesical obstacles such as bladder neck diseases, prostatic hypertrophies, vesico-vaginal fistulas, utero-vaginal fistulas, acquired calyceal, pyelic and ureteral stenoses.
What are the symptoms of urinary stones?
The symptoms depend on the location of the stone. You can have renal colic which is the most common mode of manifestation. This is lower back pain that radiates downward, along the thighs and to the external genitalia. Lower back pain that stays there, burning during urination (pain when you urinate), hematuria (blood in the urine) are also symptoms of urinary stones. Pollakiuria (increased frequency of urination), pushing efforts, dripping urine and a feeling that one is not emptying one's bladder well, as well as retention of urine which is total or partial impossibility to pass urine, are also symptoms of urinary stones.
What are the complications of urinary stones?
Urinary stones can cause complications that can be severe and even lead to death. There are different types of complications. We have infectious complications, including acute obstructive pyelonephritis, pyonephrosis, septic shock/sepsis and recurrent urinary tract infection.
The complications of urinary stones can also be mechanical such as pain, bladder retention, anuria which leads to severe renal failure in the case of bilateral stones or stones on a single anatomical or functional kidney, rupture of the renal pelvis and/or of the ureter and rupture of the excretory pathway.
How is urinary stones treated?
You should know that the aim of treating urinary stones is to relieve the patient, promote the expulsion of the stone, extirpate the stone, prevent complications and recurrences and avoid recurrences. To do this, several means are available.
First of all, these are hygienic and dietary measures. They are applicable to all patients with urolithiasis disease.
Having a diuresis (quantity of urine emitted per 24 hours) greater than 2,000 ml is the first objective.
The patient is also advised to drink plenty of fluids throughout the day and to avoid pain, as well as a balanced diet.
As for medication, it should be noted that pain is treated with non-steroidal anti-inflammatory drugs. Ketoprofen injection or tablet is prescribed to patients depending on the intensity of the pain.
Antibiotics are sometimes prescribed in cases of urine infection or urinary alkalizers to try to dissolve small stones.
There are also instrumental means. Most often these are means used to relieve the patient while awaiting subsequent radical treatment. This involves the placement of a double J. tube, the placement of a nephrostomy tube or dialysis in cases of severe renal failure.
Urinary stones can also be treated surgically. Surgical treatment has its indications.
This could be:
– Extracorporeal lithotripsy (Fragmentation of stones extracorporeally using shock waves). It is the first-line treatment for stones measuring less than 2 cm;
– percutaneous nephrolithotomy, the principle of which is the extraction of kidney stones through a nephrostomy tunnel created transcutaneously, thus allowing the passage of endoscopic instruments capable of extracting, crushing, or pulverizing the stones. It is the standard treatment for kidney stones > 2 cm, coralliform or complex;
– Ureteroscopy which consists of introducing through the natural channels in a retrograde manner, a urethroscope allowing visualization and work in contact with the stone. Stone extraction using forceps ± laser fragmentation. It is indicated in cases of stones resistant to the LEC and located at the level of the pelvic ureter.
– Open surgery which still retains its indications in our context but has little indication today in developed countries.
If an organic cause is found, it must be treated at the same time as the stone.
How to prevent the occurrence of urinary stones?
To prevent urinary stones from occurring, you must drink enough water to dilute your urine and reduce the risk of urinary stones occurring. It is recommended to drink 2 liters of water spread throughout the day.
You must also have a balanced, normal-sodium diet, that is to say, avoid eating too salty and avoid salty foods, especially not adding salt to the table; a normo-calcium diet, that is to say avoiding a diet rich in calcium. An intake of 800 mg to 1 gram of calcium per day is recommended.
You must have a normal-protein diet, that is to say, avoid excess consumption of meat, fish and eggs. An intake of 100g of meat or 100g of fish or 2 eggs per day.
You should also avoid foods rich in oxalates (dried fruits, dark chocolate, spinach, sorrel, tea, sweets, beets, etc.)
You need a diet rich in citrate (orange juice, lemon, grapefruit, and vegetables) and you need to prevent and effectively treat urinary infections.
Interview conducted by Justine Bonkoungou
Lefaso.net
