Renal Stone Disease: Treatment For The 21st Century

Main Category: Urology / Nephrology
Article Date: 09 Aug 2008 - 1:00 PDT

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UroToday.com - Renal calculus disease is one of the most ancient afflictions of mankind and remains a common cause for both office and emergency room urologist's visits. Approximately one of eight Caucasian patients forms a urinary tract stone within their lifetime.

The recurrence rate for these patients is about 50% in the ensuing decade. Men and patients with a family history of stone disease are three fold more likely to have a stone than the general population. The differences between genders may be diet, activity or gender related. Men have been shown to excrete more oxalate in their urine while women excrete more citrate accounting for some of the differences in stone production. Residents in more affluent Western societies with diets high in animal protein are at highest risk for renal calculi.

With the development of ESWL, small caliber endoscopes and safe percutaneous access to the upper urinary tract, the entire urinary tract can be accessed, visualized and treated with minimally invasive techniques. While treatment options continue to improve, many patients require advanced techniques for difficult stone management issues caused by stone type, location, size, and patient anatomical differences.

With the increased obesity in the Western world, more difficult stone situations are encountered by urologists. Recent evidence based guidelines have bee introduced to assist in selecting the most effective treatment for individual renal calculus patients. Thus, the open renal surgery of 2 decades past has been largely replaced by newer less morbid treatment options. The understanding of the pathogenesis of stone disease has also progressed, and has led to prophylactic dietary measures and medications to prevent stone recurrence. Most stone-formers can now be offered prophylactic measures, if not definitive treatment, for their recurrent stone disease.

Presented by: Culley C. Carson, MD, at the Masters in Urology Meeting - July 31, 2008 - August 2, 2008, Elbow Beach Resort, Bermuda

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