Urinary Stone Disease

Abstract

The incidence of urinary stone disease in the western world is increasing: 6%–15% of males and 4%–5% of females can expect to suffer from the condition at some time during their lives (Ljünghall and Hedstrand 1975; Norlin et al. 1976). In about 80% of cases the stone will pass spontaneously, although hospitalisation may be required for initial management. For the remainder, operative treatment will be required. The surgical options are changing rapidly, with new techniques such as percutaneous retrieval, ultrasound disintegration and contact-free dissolution by electrohydraulic shock-wave lithotripsy challenging traditional operative procedures. Once a stone passes spontaneously or is removed, there is a better than 50% chance of its recurring within the following decade (Ljünghall and Hedstrand 1975; Williams 1976). It is the responsibility of the clinician to diagnose the condition, to decide on its most appropriate management and thereafter to determine the underlying metabolic abnormality in order to prevent its recurrence. Any less a policy is a disservice to the patient and a discredit to the clinician. This chapter discusses the aetiology and management of what is the single most common upper tract cause of obstructive uropathy.