Urology insights with Dr Akhbar pt 3

Kidney Stones: A Urologist’s Perspective on Prevention, Diagnosis, and Treatment


Kidney stones are one of the most common urological conditions we see in practice. They affect about 1 in 10 people during their lifetime, and for many, the pain is unforgettable. As a urologist, I often meet patients during some of their most painful moments — when a stone is stuck, the pain is intense, and they need answers fast.


Let’s break down what matters most: why kidney stones form, how we diagnose them, and the best ways to treat and prevent them.





What Are Kidney Stones?



Kidney stones are hard mineral and salt deposits that form in the kidneys. The most common types are:


  • Calcium oxalate (most common)
  • Calcium phosphate
  • Uric acid
  • Struvite (infection-related)
  • Cystine (rare, genetic)



Most stones form when urine becomes concentrated, allowing minerals to crystallize and stick together. Low fluid intake, high sodium diets, and metabolic factors are all culprits.





Symptoms: When Pain Becomes a Diagnosis



The classic symptom is severe flank pain that can radiate to the groin. Patients often describe it as worse than childbirth. Other symptoms may include:


  • Blood in the urine (hematuria)
  • Nausea and vomiting
  • Urinary urgency or frequency
  • Fever (if there’s infection)



Pain is often the first sign. But not all stones cause symptoms — some are silent until they start moving.





Diagnosis: Imaging Is Key



We diagnose kidney stones using imaging:


  • Non-contrast CT scan is the gold standard — fast, accurate, and detailed.
  • Ultrasound is useful, especially in pregnant patients or those avoiding radiation.
  • X-rays (KUB) may help track stones if they’re radiopaque.



Lab tests for blood and urine also help identify underlying causes like high calcium or uric acid.





Treatment: Size, Location, and Symptoms Drive the Plan



Not all stones need surgery. The treatment depends on the size, location, and severity of symptoms:


  • <5 mm stones often pass on their own. We manage pain, hydration, and may prescribe alpha blockers (like tamsulosin) to help.
  • 5–10 mm stones may pass, but need close follow-up.
  • >10 mm stones usually require intervention.



Surgical options include:


  • Ureteroscopy with laser lithotripsy: For stones in the ureter or kidney, using a scope and laser to break and remove them.
  • Shock wave lithotripsy (SWL): Non-invasive, best for small stones in the kidney.
  • Percutaneous nephrolithotomy (PCNL): For large or complex kidney stones, requiring a small incision in the back.
  • Stents may be placed temporarily to relieve obstruction.



Infected stones are emergencies. We drain first, treat the infection, and remove the stone later.





Prevention: The Most Overlooked Step



Preventing kidney stones is just as important as treating them. After a first stone, the recurrence rate is over 50% within 5–10 years if nothing changes. Prevention starts with:


  • Hydration: At least 2.5–3 liters of fluid daily.
  • Dietary changes: Reducing salt, limiting animal protein, and moderating oxalate-rich foods (like spinach, nuts, chocolate).
  • Citrate-rich foods (like lemons and oranges) help inhibit stone formation.
  • Medications: Thiazide diuretics, potassium citrate, or allopurinol depending on stone type and metabolic profile.



A 24-hour urine analysis helps guide personalized prevention plans. We also analyze passed or removed stones for composition.





Final Thoughts



Kidney stones are common but preventable. The key is understanding risk factors, acting early, and staying on top of long-term management. As urologists, our job is to treat the acute episode — but more importantly, to help patients stay stone-free for good.


If you’ve had one stone, consider it a warning sign. Prevention isn’t optional — it’s essential.


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