Treatments — Kidney, Ureter & Bladder
Urinary Stone Disease — Kidney, Ureteric & Bladder Stones
Urinary stones are one of the most common urological conditions — and one of the most painful. Mr. Jesuraj provides expert assessment, rapid investigation and the full range of surgical treatments, from shock wave lithotripsy to ureteroscopy and bladder stone removal.
⚠️ Acute Renal Colic — Seek Help Now
Sudden, severe flank pain radiating to the groin — with or without blood in urine — is classic renal colic. If severe, go to A&E. If symptoms are manageable, contact us for an urgent appointment.
Understanding Stone Disease
What Are Urinary Stones?
Urinary stones (calculi) form when certain substances in the urine — calcium, oxalate, uric acid, and others — become concentrated and crystallise. They can develop anywhere in the urinary tract: the kidneys, ureters (tubes connecting kidney to bladder), or the bladder itself.
Stones vary enormously in size — from a grain of sand to a golf ball. Small stones often pass spontaneously; larger stones require intervention. The location of the stone is as important as the size: a 5mm ureteric stone causing complete obstruction is a urological emergency, while a 15mm kidney stone causing no obstruction may be managed electively.
Stone disease is a recurrent condition — without preventive measures, half of all patients will develop another stone within 10 years. Identifying the type of stone and the metabolic cause is essential to preventing recurrence.
Stone Composition
Most common. Associated with hypercalciuria, hyperoxaluria, low urine volume, and dietary factors.
Associated with gout, high purine diet, dehydration and acidic urine. Unique — can dissolve with urinary alkalinisation.
Form in association with urea-splitting bacteria (e.g. Proteus). Can grow very large — staghorn calculi. Require both stone removal and eradication of infection.
Rare — caused by a genetic disorder of amino acid transport. Recurrent, multiple stones. Requires lifelong specialist management.
Causes & Risk Factors
What Causes Urinary Stones?
Stone formation is usually multifactorial — a combination of dietary habits, fluid intake, metabolic factors and anatomy.
Dehydration
The single most important modifiable risk factor. Concentrated urine allows crystallisation. Many stone formers are chronically under-hydrated — particularly in hot climates or physically demanding jobs.
Dietary Factors
High oxalate foods (spinach, nuts, chocolate), excessive animal protein, high salt intake, and low calcium diet (paradoxically increases oxalate absorption) all contribute to stone formation.
Metabolic Conditions
Hypercalciuria (excess calcium in urine), hyperparathyroidism, hyperuricaemia (gout), renal tubular acidosis, and cystinuria — identified by 24-hour urine collection and blood tests.
Urinary Tract Infections
Recurrent UTIs with urea-splitting organisms (Proteus, Klebsiella) alkalinise the urine and promote struvite stone formation. Treatment requires both stone clearance and infection eradication.
Anatomical Abnormalities
Urinary stasis from pelvi-ureteric junction (PUJ) obstruction, horseshoe kidney, ureteric stricture or medullary sponge kidney predisposes to stone formation and recurrence.
Medications
Calcium supplements (excess), vitamin D excess, loop diuretics, indinavir (HIV medication), topiramate (anti-epileptic), and prolonged immobility all increase stone risk.
Stone Locations
Kidney, Ureteric & Bladder Stones
The location of the stone determines symptoms, urgency, and treatment approach.
Kidney Stones (Renal Calculi)
Stones within the kidney — from small incidental findings to large staghorn calculi
Kidney stones may be completely asymptomatic — discovered incidentally on imaging — or cause loin ache, haematuria, or recurrent infections. Large kidney stones (particularly staghorn calculi filling the renal pelvis) can progressively damage kidney function over time, even without causing acute pain.
Management depends on stone size, location within the kidney, composition, and whether there is obstruction or infection. Options range from watchful waiting and medical management for small stones to shock wave lithotripsy or ureteroscopy for medium stones, and percutaneous nephrolithotomy (PCNL) for larger stones.
Symptoms
- Loin pain or ache (flank pain)
- Blood in urine — visible or microscopic
- Recurrent urinary tract infections
- Often completely asymptomatic
- Rarely — palpable mass (very large staghorn)
Ureteric Stones
Stones passing from kidney into the ureter — the most acutely painful presentation
Ureteric stones cause renal colic — one of the most severe pains known to medicine, often described as worse than childbirth. The pain is caused by the stone obstructing urinary flow and causing the ureter and renal pelvis to distend. It typically radiates from loin to groin, comes in waves, and is associated with nausea, vomiting and haematuria.
A ureteric stone causing complete obstruction with infection (fever, rigors) is a urological emergency requiring immediate decompression — either by ureteric stent or nephrostomy — before stone treatment.
Most stones <5mm will pass spontaneously within 4 weeks. Stones 5–10mm have a lower chance of spontaneous passage and may require intervention. Stones >10mm rarely pass without treatment.
Symptoms
- Severe loin-to-groin pain — renal colic
- Nausea and vomiting
- Blood in urine — almost universal
- Urinary frequency / urgency (distal stones)
- Fever — if obstruction with infection (emergency)
Bladder Stones
Stones forming in or descending to the bladder — often associated with voiding problems
Bladder stones are less common than kidney or ureteric stones in the UK. They most often occur as a complication of incomplete bladder emptying — due to BPH, urethral stricture, neurogenic bladder, or bladder diverticula. Urine stasis allows crystallisation of solutes in the bladder. They can also descend from the kidney and become trapped in the bladder.
Bladder stones cause lower urinary tract symptoms — difficulty urinating, frequency, pain, haematuria, and interrupted urinary stream (the stone blocks the bladder neck during voiding). Treating the underlying cause of incomplete emptying is as important as removing the stone — otherwise recurrence is virtually certain.
Symptoms
- Difficulty or pain passing urine
- Interrupted urinary stream
- Blood in urine — haematuria
- Urinary frequency and urgency
- Recurrent urinary tract infections
- Suprapubic pain — especially at end of urination
Surgical Treatments
Surgical Options for Stone Disease
Modern stone surgery is minimally invasive — most procedures are performed endoscopically without any skin incision.
Shock Wave Lithotripsy (ESWL)
Non-invasive · No anaestheticESWL uses focused acoustic shock waves — generated externally — to fragment stones within the kidney or ureter into small pieces that can pass naturally in the urine. It is the least invasive stone treatment, requiring no anaesthetic and no incision.
The patient lies on a treatment table while a machine delivers thousands of focused shock waves to the stone — guided by X-ray or ultrasound. Multiple sessions may be needed. Best results for stones <20mm in the kidney and <10mm in the ureter, with good drainage.
ESWL is arranged via referral to a lithotripsy centre. Mr. Jesuraj coordinates this and manages follow-up.
Ureteroscopy & Laser Stone Fragmentation (URS)
★ Gold Standard · Ureteric & Kidney StonesUreteroscopy involves passing a thin, flexible or semi-rigid telescope up the urethra, through the bladder and into the ureter — without any incision. Under direct vision, a holmium laser is used to fragment the stone into dust or small fragments, which are either left to pass or extracted with a stone basket.
Flexible ureteroscopy (FURS) — using a steerable flexible scope — can reach stones anywhere within the kidney. This technique has transformed kidney stone management, allowing access to stones previously requiring percutaneous surgery. Stone-free rates of 90%+ for stones <20mm are achievable in a single session.
Cystolitholapaxy — Bladder Stone Removal
Bladder StonesCystolitholapaxy is the endoscopic treatment for bladder stones. Under general or spinal anaesthetic, a cystoscope is passed into the bladder through the urethra. The stone is fragmented using mechanical lithotripsy, laser, or ultrasonic energy — and the fragments are washed out of the bladder. No incision is required.
Very large or hard bladder stones may require open cystolithotomy — a surgical incision into the bladder to remove the stone intact. This is uncommon with modern endoscopic techniques.
The underlying cause of bladder stone formation — usually incomplete bladder emptying from BPH or stricture — must be addressed simultaneously or at a planned second procedure to prevent recurrence.
Ureteric Stent Insertion (JJ Stent)
Emergency & PlannedA ureteric stent (JJ or double-J stent) is a thin flexible tube placed inside the ureter to maintain drainage from the kidney to the bladder — bypassing an obstructing stone. It is used in two settings: as an emergency to relieve obstruction and treat infection before definitive stone treatment, and as a temporary measure after ureteroscopy to allow healing and drainage.
Stents are generally well tolerated but can cause bladder discomfort, frequency, and loin ache. They are removed endoscopically — usually at 1–4 weeks — under local anaesthetic or brief sedation.
Prevention & Medical Treatment
Preventing Stone Recurrence
Stone disease is a recurrent condition. Prevention is as important as treatment — and highly effective when properly implemented.
Fluid Intake — The Most Important Preventive Measure
Adequate hydration is the single most effective preventive measure for all stone types. Dilute urine reduces the concentration of stone-forming substances and prevents crystallisation.
2–2.5 litres of urine per day — this requires drinking approximately 2.5–3 litres of fluid.
Water is best. Citrus juices (lemon, orange) provide citrate which inhibits calcium stone formation. Tea and coffee in moderation are acceptable.
Aim for pale straw-coloured urine at all times. Dark yellow urine means you are not drinking enough.
Drink a glass of water before bed and when waking at night — urine becomes most concentrated overnight.
Increase intake significantly in hot conditions or when exercising — sweating dramatically reduces urine output and concentrates urine.
Dietary Modifications
A high-sodium diet increases calcium excretion in the urine. Aim for <6g salt per day — avoid processed foods, ready meals, and adding salt to food.
High meat intake increases uric acid and calcium excretion and reduces urinary citrate. Limit red meat, poultry and fish to moderate portions.
Contrary to intuition, a low-calcium diet increases stone risk by increasing oxalate absorption. Maintain normal dietary calcium (3 portions of dairy per day). Only restrict if advised by a specialist.
For calcium oxalate stone formers: limit spinach, rhubarb, beetroot, nuts, chocolate, and strong tea.
For uric acid stone formers: limit red meat, organ meat, shellfish, anchovies, sardines and beer.
Obesity increases stone risk — particularly uric acid stones. Weight loss improves urine chemistry significantly.
Supplements & Medical Treatment
The most widely used preventive supplement for calcium stone formers. Citrate inhibits calcium crystal growth and alkalinises urine. Available on prescription. Also dissolves uric acid stones when urine is alkalinised to pH 6.5–7.
Hydrochlorothiazide or indapamide reduce urinary calcium excretion in patients with hypercalciuria — a common cause of recurrent calcium stones.
Reduces uric acid production — used in uric acid stone formers and calcium oxalate formers with hyperuricosuria. Equivalent to gout prevention.
Medical expulsive therapy — relaxes the ureteric smooth muscle to assist spontaneous passage of ureteric stones <10mm. Increases passage rate by approximately 65%.
High-dose vitamin C (ascorbic acid) supplements metabolise to oxalate and significantly increase stone risk. Maximum 500mg/day for stone formers.
Supplement only if genuinely deficient. Excess increases urinary calcium and stone risk significantly.
Investigation
How We Investigate Stone Disease
Proper metabolic evaluation identifies the cause — essential for preventing recurrence.
Blood Tests
Renal function, serum calcium, phosphate, urate, parathyroid hormone (PTH if calcium high), bicarbonate, and full blood count.
Urine Tests
Dipstick and MSU (exclude infection). 24-hour urine collection for calcium, oxalate, urate, citrate, creatinine, and volume — the definitive metabolic assessment for recurrent stone formers.
Stone Analysis
If a stone is passed or retrieved surgically, it should always be sent for compositional analysis by infrared spectroscopy. This identifies the stone type and directly guides prevention.
CT KUB
Non-contrast CT of kidneys, ureter and bladder — the gold standard imaging for urinary stones. Identifies all stone types (including radiolucent uric acid stones), size, location and any obstruction.
Renal Ultrasound
Radiation-free — useful for initial assessment, follow-up of known stones, and detecting hydronephrosis (kidney swelling from obstruction). Less sensitive than CT for ureteric stones.
KUB X-Ray
Plain X-ray of kidneys, ureter and bladder — useful for follow-up of radio-opaque calcium stones (80% of all stones). Cannot detect uric acid stones (radiolucent).
Expert Stone Management — Rapid Access
New stone diagnosis, recurrent stone former, or discharged after an acute episode? Get specialist assessment and a structured prevention plan. Appointments within 7 days at Best Life Clinic, Stockton-on-Tees.