Ureteral Stones: Long-Term Solutions for Kidney Health

Ureteral stones

Dear Dr.
Chen,
My brother is currently 38 years old.
Since he experienced ureteral stones two years ago, he has been hospitalized multiple times for lithotripsy treatment, which only temporarily alleviated his pain.
However, last month his condition worsened.
A day or two before the onset of symptoms, he took pain medication prescribed by the hospital, but it was ineffective and the discomfort became severe, leading to a fainting episode.
An X-ray examination revealed that his kidney is swollen and there is scarring in the urethra, causing a narrowing that results in discomfort even from particles that a healthy person would normally pass without issue.
Currently, the physician has placed a ureteral stent to temporarily address the situation, but this stent cannot remain in the body for an extended period.
Once removed, the stones may block the ureter again, causing recurrent pain and swelling.

I am concerned whether this recurring issue will affect kidney function.
I believe Dr.
Chen can provide information on a permanent solution that can effectively cure the problem and prevent recurrence.
I look forward to your prompt response.
Thank you!

SUSAN, 40~49 year old female. Ask Date: 2002/11/11

Dr. Chen Xiuyi reply Urology

Hello! Based on the described situation, the patient has two main issues:
1.
Recurrence of urinary stones: Urinary stones are a condition with a high recurrence rate, with more than 50% of patients experiencing recurrence within five years.
For prevention, in addition to specific medical treatment targeting the different stone compositions, general preventive measures include increasing fluid intake to enhance urine volume, thereby diluting solutes in the urine and reducing the formation of urinary crystals.
It is generally recommended to consume more than 2000 cc of fluids daily, especially at night, and to drink water before bed to minimize urine retention during the night.
If there is a urinary tract infection, antibiotic treatment should be administered to prevent the occurrence of infectious stones.
Any obstructive lesions should also be addressed to reduce urine retention.
It is advisable for the patient to have the expelled stones analyzed for their composition and to undergo a metabolic evaluation to identify risk factors contributing to stone formation, which can then be addressed.
This approach can help minimize the recurrence rate of stones.
2.
Regarding the treatment of ureteral strictures, it is essential to consider the extent and severity of the stricture.
Different degrees of severity require different treatment approaches.
It is recommended to arrange a detailed examination at a urology clinic to assess the severity of the stricture and to choose the best treatment option.
Wishing you and your family peace and happiness.

Sincerely,
Dr.
Hsiu-Yi Chen,
Director of Urology, Taoyuan Hospital, Department of Health, Executive Yuan.

Reply Date: 2002/11/11

More Info

Ureteral stones, commonly known as kidney stones, can significantly impact kidney function, especially when they recur frequently. The situation you described regarding your brother's condition is concerning, particularly with the history of multiple hospitalizations for stone fragmentation and the recent complications, including hydronephrosis (swelling of the kidney due to urine buildup) and ureteral stricture (narrowing of the ureter).
When stones obstruct the urinary tract, they can lead to increased pressure in the kidney, which may cause damage over time. If left untreated, this can result in chronic kidney disease or even kidney failure. The repeated episodes of obstruction and the presence of scar tissue can exacerbate these risks. Therefore, it is crucial to address both the immediate symptoms and the underlying causes of stone formation to protect kidney health in the long term.

To achieve a long-term solution for ureteral stones and to prevent recurrence, several strategies can be employed:
1. Stone Composition Analysis: After any stone is passed or surgically removed, it is essential to analyze its composition. Different types of stones (calcium oxalate, uric acid, struvite, cystine) have different causes and require specific preventive measures. Understanding the type of stone can guide dietary and medical interventions.

2. Hydration: Increasing fluid intake is one of the most effective ways to prevent stone formation. It is generally recommended to drink enough water to produce at least 2.5 liters of urine daily. This dilution helps prevent the concentration of stone-forming substances in the urine.

3. Dietary Modifications: Depending on the type of stones, dietary changes may be necessary. For instance, reducing sodium intake can help lower calcium excretion in urine, while limiting foods high in oxalate (like spinach, nuts, and chocolate) can be beneficial for calcium oxalate stones. Increasing dietary calcium can also help bind oxalate in the gut and reduce absorption.

4. Medications: In some cases, medications can help prevent stone formation. For example, thiazide diuretics can reduce calcium excretion in urine, while potassium citrate can help alkalinize the urine and prevent uric acid stones.

5. Regular Monitoring: Regular follow-up with a urologist is essential for individuals with a history of kidney stones. This may include imaging studies to monitor for new stone formation and adjustments to treatment plans as necessary.

6. Surgical Options: If ureteral strictures or recurrent stones are a significant issue, surgical intervention may be warranted. Options include ureteroscopy, percutaneous nephrolithotomy, or even open surgery in severe cases. These procedures can help remove stones and address any anatomical issues contributing to obstruction.

7. Lifestyle Changes: Encouraging a healthy lifestyle that includes regular exercise can also aid in preventing stones. Physical activity helps maintain a healthy weight and can influence metabolic factors that contribute to stone formation.

In summary, while the immediate placement of a ureteral stent can provide temporary relief, it is crucial to develop a comprehensive long-term management plan to prevent recurrence and protect kidney function. Engaging with a healthcare provider who specializes in urology and nephrology can provide tailored strategies based on your brother's specific situation.

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