Urinary calculus disease refers to stones that form in the urinary tract from crystalloids around an organic matrix. Males are more commonly affected than females. Calcium, uric acid, struvite, and cystine stones can form for various reasons including hypercalciuria, hyperuricosuria, urinary tract infections, and genetic defects. Stones may cause colicky pain, hematuria, and complications like hydronephrosis. Evaluation involves medical history, radiology exams, and urine and blood tests. Treatment depends on the size and location of stones but may include medications, increased fluid intake, or urological procedures. Prevention focuses on drinking plenty of water, moderate dietary changes, and medications in some

1. Urinary calculus disease

2. Basics
 Urinary calculi are aggregates of
crystalloids around tiny organic matrix
 Males > Females (3:1)
 Common in 2nd
-3rd
decades
 Common in hot & humid areas
 Commonly cause colicky pain radiating
towards groin & hematuria, urgency,
frequency

3. Types
 Calcium stones- radiopaque
 Oxalate- commonest
 Phosphate (hydroxyapatite)
 Uric acid stones- radiolucent
 Struvite stones- MgNH4PO4
 Common in females
 Due to UTI with urea splitting bacteria, mostly P.mirabilis
 Can form ‘staghorn’ calculi
 Cystine stones- due to a genetic (AR) defect,
causing cystinuria

4. Causes
 Calcium stones
 Hypercalciuria-
idiopathic, hyperparathyroidism,
immobilization, sarcoidosis,
Calcium/vitamin D excess
 Hyperuricosuria-
non-vegetarians
 Hyperoxaluria- ileal
disease or resection/bypass,
vitamin C excess,
primary hyperoxaluria
 Uric acid stones
 Gout
 Acidic pH
 Colonic disease/resection
 Lesch-Nyhan syndrome
 Struvite stones
 Alkaline pH, due to urea splitting
bacteria
 Cystine stones
 Cystinuria- hereditary
 Drugs
 Indinavir, Sulfadiazine

5. Majority <6 mm will pass spontaneously
Why treat?

6. Complications
Colic
Hydronephrosis
Post-renal azotemia

7. Evaluation
 History- of colicky pain
 Radiology- to confirm/localize stone
 X-ray- proper preparation, radiopaque stones
 IVP- anatomical & functional
 US- localization & hydroureter/nephrosis
 CT-scan- gold standard for detection, cost & radiation
 Other-
 Urine- routine analysis & culture
 24-hour urine analysis
 CBC, Creatinine, calcium, uric acid

8. Treatment
NSAID/opioids
Double water intake
Urological procedures

9. Prevention
 Plenty of water- habitually
 Adequate calcium- ?
 Moderate protein intake
 Fruit juices-
 Orange- oxalate stones
 Black currant- uric acid stones
 Cranberry- struvite stones
 Drugs-
 Calcium stones- thiazides with Na restriction
 Uric acid stones- alkalinise urine & allopurinol

10. Prevention
 Plenty of water- habitually
 Adequate calcium- ?
 Moderate protein intake
 Fruit juices-
 Orange- oxalate stones
 Black currant- uric acid stones
 Cranberry- struvite stones
 Drugs-
 Calcium stones- thiazides with Na restriction
 Uric acid stones- alkalinise urine & allopurinol