Urology
Urolithiasis
요로결석
Crystalline stones in the urinary tract causing pain and obstruction
- How common
- Lifetime 10%
- Typical age
- Men 30–60 most common
What is it?
Urinary supersaturation causes crystal formation, aggregation, and stone growth (mostly calcium oxalate).
Commonly affected: Renal pelvis, ureter, bladder
How it develops
- SupersaturationConcentration of Ca/oxalate; dehydration
- NucleationCrystal nuclei adhere to mucosa
- Stone growthAggregation by further deposition
- Ureteral obstructionObstruction at narrow points → renal colic
Symptoms
- Renal colicCrampy flank pain radiating to groin
- HematuriaMicroscopic or gross hematuria
- Nausea/vomitingAccompanies severe pain
- LUTSFrequency/urgency if near bladder
- Fever (rare)Indicates infected obstruction; emergency
How it is examined
- CVA tendernessAffected flank
- UrinalysisHematuria; pH (acidic in uric acid stones)
- Stone analysisChemical analysis of passed stone
Imaging
Non-contrast CT (low-dose) is standard; KUB only sees calcium stones.
- Hyperdense stone
- Pelvicaliceal dilation
- Ureteral edema
Renal US in pregnancy to assess hydronephrosis.
- Hydronephrosis
- Stone may not be visible
Non-surgical care
- Hydration + analgesiaNSAIDs (ketorolac) preferred over opioids
- Medical expulsive therapyTamsulosin 0.4 mg qd aids passage
- Observation (<5 mm)80% pass spontaneously in 4–6 weeks
- Stone strainerStrain urine; analyze passed stones
- Prevention2.5 L/day water, low salt/protein, adequate calcium
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Stones >5 mm, persistent pain, obstruction, infection
Procedures that may be discussed
- ESWL (extracorporeal shockwave)
- Ureteroscopy + holmium laser
- PCNL (>2 cm stones)
Outlook
50% recur within 5 years; prevention is critical.