Treatment of Urinary Stones in Paris & Neuilly
Dr Adam Vardi - Urological surgeon
What is a urinary stone?
Treatment of urinary lithiasis in Paris
Urinary lithiasis, a pathology characterized by the formation of mineral concretions within the excretory system, represents a frequent reason for consultation in urology. These stones result from a complex process of saturation of the urine by certain mineral salts, leading to the crystallization and then aggregation of these crystals. The role of the urological surgeon consists of establishing a precise diagnosis, treating the obstruction where applicable and putting in place a prevention strategy to limit recurrences.
Mechanisms of formation and typology of stones
Urological surgery in Paris & Neuilly
The formation of a stone is rarely the result of a single isolated cause. It depends on the balance between promoters of crystallization, such as calcium, oxalate or uric acid, and the natural inhibitors present in the urine. Insufficient hydration remains the predominant risk factor since it increases the concentration of these solutes. Metabolic factors, specific dietary habits, or anatomical anomalies of the urinary tract may also favor this pathology.
From a biochemical perspective, morpho-constitutional analysis allows several types of stones to be distinguished. The most frequent are composed of calcium oxalate, but there are also uric acid stones, often linked to metabolic syndrome, or struvite stones, of infectious origin. Identifying the exact nature of the stone is an essential step in adapting future dietary recommendations.
Renal colic: diagnosis and emergency
Doctor Adam Vardi - Urologist in Paris
Renal colic constitutes the acute manifestation of stone disease. It occurs when a stone moves from the kidney towards the ureter, causing a sudden obstruction of urinary flow. This pressurization of the renal cavities generates intense pain, classically lumbar with radiation towards the external genital organs.
The diagnosis relies on a rigorous clinical examination, systematically supplemented by imaging. The non-injected abdomino-pelvic CT scan is the reference investigation owing to its high sensitivity. It allows the size of the stone (measured in millimeters), its exact location, and its density (expressed in Hounsfield units) to be specified. These technical parameters are decisive in choosing between simple monitoring while waiting for spontaneous expulsion and a surgical procedure.
Certain situations require emergency surgical management. This is the case for febrile renal colic, which indicates a urinary infection above the obstacle, anuric renal colic (in a single kidney) or pain refractory to intravenous analgesic treatments.
Treatment of urinary stones
Urological surgeon in Paris
Therapeutic options and minimally invasive surgery
The therapeutic strategy is dictated by the probability of spontaneous expulsion of the stone. In the absence of warning signs and for small stones, ambulatory medical management is often preferred. It is based on the use of non-steroidal anti-inflammatory drugs (NSAIDs) to reduce oedema of the ureteral wall and to facilitate the passage of the concretion.
When the stone is too voluminous or impacted, several surgical techniques may be considered. Extracorporeal shock wave lithotripsy (ESWL) uses acoustic shock waves to fragment the stone through the tissues. However, for greater efficacy, digital flexible ureteroscopy has become the reference technique. It consists of introducing a small-diameter endoscope through natural channels, without any incision. The use of a laser fiber (Holmium or Thulium) then makes it possible to pulverize the stone under direct visual control. The fragments are then removed using a micro-extraction basket or left as dust to be eliminated naturally.
For more complex or voluminous kidney stones, exceeding two centimeters, percutaneous nephrolithotomy may be necessary. This technique consists of creating direct access to the kidney through a millimetric lumbar puncture to fragment and extract significant stone masses.
Secondary prevention and metabolic assessment
The risk of recurrence of stone disease is estimated at 50% in five years. Management therefore does not stop at the elimination of the stone. A metabolic assessment is recommended at a distance from the acute phase to understand the etiology of crystal formation. This assessment is based on a blood test and a 24-hour urine collection aimed at measuring the excretion rates of calcium, oxalate, uric acid, and citrate.
The preventive measures are pragmatic and are based on effective dilution of the urine. A diuresis (urine volume) greater than two liters per day is the main objective. Dietary balance, including moderate consumption of salt and animal proteins as well as a normalized calcium intake, allows the urinary environment to be stabilized and the long-term crystallization process to be limited.