Urinary calculi (urinary lithiasis)
Introduction
Urinary lithiasis, or “urinary calculi”, refers to the formation of small crystals or stones in the urinary tract (kidney, ureter, bladder). These stones can be silent or become highly symptomatic when they move or obstruct the flow of urine.
Dr Dominique specializes in diagnosis, minimally invasive treatment and recurrence prevention in urology.
⚠️ If an attack of renal colic occurs, or blood appears in the urine, prompt consultation is recommended to avoid renal or infectious complications.
Symptoms and warning signs
Clinical signs may vary according to stone location and size. Here are the main reasons for consultation:
1️⃣ Severe back pain or renal colic
- Pain often comes on suddenly, in the form of renal colic, radiating to the groin, abdomen or even genitals.
- It is often paroxysmal, suggesting a "blockage" of urinary flow.
- Sometimes accompanied by nausea, vomiting or restlessness.
2️⃣ Blood in urine (hematuria)
- Rubbing or damaging the wall of the urinary tract by the stone can cause blood in the urine.
- Hematuria can be microscopic (visible only in the laboratory) or macroscopic (pinkish, reddish or brownish urine).
- In the absence of major pain, isolated hematuria should also be investigated.
3️⃣ Imaging renal, ureteral or bladder calculi
- Imaging (non-injected CT scan, ultrasound, X-ray, depending on the case) may reveal the presence of stones in the kidney (renal calculi), ureter (ureteral calculi) or bladder (bladder calculi).
- The location is important in determining the treatment strategy.
4️⃣ History of stone recurrence
- Some patients present recurrences: it is essential to know their history (types of stones, location, frequency).
- Recurrences warrant metabolic evaluation (urinalysis, blood tests) and more stringent preventive measures.
Diagnosis
Diagnosis is based on a combination of clinical elements and paraclinical examinations:
1️⃣ Clinical examination
- Interrogation (description of pain, history, risk factors)
- Physical examination to look for signs of complicated lithiasis (fever, lumbar tenderness, hypertension, etc.).
2️⃣ Biological tests
- Urea, creatinine: to assess renal function
- context-sensitive metabolic workup
- Cytobacteriological examination of urine (ECBU) to check for associated infection
- Microscopic hematuria
3️⃣ Imaging
- Non-injected CT scan (Uro-CT without contrast): reference examination for locating calculi, measuring their density, size and anatomical relationship.
- Renal and bladder ultrasound: particularly useful for pregnant women or to limit radiation exposure.
- Standard radiography (ASP): still useful for certain types of radiopaque calculi.
- Intravenous urography / retrograde ur ography in certain complex cases.
Care and treatment
The choice of treatment depends on the size and location of the stone, kidney function, the presence of infection, pain and previous history.
1️⃣ Medical and "conservative" treatment
- Abundant hydration: encourage water consumption to dilute urine.
- Analgesics / anti-inflammatories: used to relieve pain (depending on tolerance and contraindications).
- Alpha-blockers or drugs facilitating passage: in certain cases, to promote spontaneous expulsion of small stones (particularly in the ureter).
- Monitoring: if the stone is small (< 5 mm, with no significant obstruction), follow-up with monitoring may suffice.
2️⃣ Medical and "conservative" treatment
When the stone is too large, poorly located, cannot be expelled or is accompanied by complications, various techniques are available:
- Extracorporeal lithotripsy (ECL / extracorporeal shock waves) Fragmentation of the stone without incision (good option for some small kidney stones without major anatomical obstacles).
- Ureteroscopy / endoscopic ureterolithotomy Endoscopic procedure (introduced into the ureter via the bladder) to break up or remove the stone, often assisted by laser.
- Percutaneous nephrolithotomy (PCNL ) For large or complex kidney stones: percutaneous mini-route or standard route.
- If the stone is in the bladder, it can be fragmented or removed by transurethral endoscopy (cystoscopy).
- Ureteral stenting Sometimes necessary to maintain urine flow after surgery or in inflammatory situations.
📌 Each technique has its own advantages, limitations and risks. Dr Dominique offers personalized care based on each patient’s profile.
Recurrence prevention
Prevention is an essential part of management in order to limit recurrence:
- Lithogenic metabolic panel: analysis of urine and blood to identify risk factors (hypercalciuria, hyperoxaluria, hyperuricosuria, inhibitor deficiency, etc.).
- Dietetic adaptation:
- Increased water consumption (≥ 1.5 to 2 L/d depending on tolerance)
- Moderation of salt intake
- Control of animal protein and dietary oxalate intakes according to context
- Adjusting calcium intake (to avoid both excess and deficiencies)
- Increased water consumption (≥ 1.5 to 2 L/d depending on tolerance)
- Prophylactic drug treatment depending on type of stone (thiazides, citrates, allopurinol, etc.).
- Regular monitoring: follow-up imaging, urological and metabolic monitoring.
Why consult a specialist urologist?
A consultation allows :
- To confirm the diagnosis and precisely locate the calculus(es)
- To choose the most suitable technique (the least invasive possible)
- To minimize the risk of complications (obstruction, infection, impaired renal function)
- To obtain a metabolic assessment and set up a personalized prevention strategy
- For long-term follow-up to detect possible recurrences
Do you suffer from urinary stones?
Requirements
How to prevent recurrence of urinary calculi?
In this video, I explain how to effectively reduce the risk of recurrence of urinary calculi. I share with you the essential habits to adopt on a daily basis, the mistakes to avoid and the importance of a metabolic assessment to understand the origin of your stones. My aim: to help you prevent a new attack and protect your kidney health for the long term.
Do you suffer from urinary stones?
Dr. Sébastien Dominique manages emergency lithiasis crises, as well as the follow-up of patients prone to kidney stones.
📍 Cabinet Urologie Paris Opéra – Paris 17ème
📅 Face-to-face consultation or teleconsultation
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