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STONE DISEASE Urolithiasis is a general term referring to stones anywhere in the urinary tract, ureter, bladder, or urethra. Most stones form in the kidney and are usually silent until breaking loose from the kidney and obstructing the ureter where they produce sever pain known as ureteral colic. The high incidence of adult kidney stone disease in developed countries is reported to be increasing. The reasons for the increase is related to life style with respect to diet (consumption of meat and dairy products), physical activities that are imposed on inherited bases the way the body handles minerals that form stone. Calcuim oxcelate is clearly the dominant stone material found in patients in the United States. The economic costs are not neglegible as between 1 in 100 to 1 in 150 hospital admissions are for stone disease. Many stones do not require hospital care, and the actual incidence of urolethyesis is unknown, but conservative estimates place it at over 1 in 1000 anually in the United States. Prior to 1984 stones either passed or were removed from the urinary tract using an instrument called a cystoscope and a stone basket. Since 1984, shockwave lithotripsy has become the standard. It uses a high energy shock generated in a bath tub type like apparatus using a bell shaped reflector called an ellipsoid to transfer energy to the site of the stone in the body, which then fractures the stone in to small particles which are easily passed. This device changed stone disease from an operation that involved an incision to a treatment wherein the patient can be treated on an outpatient basis. This form of treatment is one of the technical advances that have revolutionized urology during the past decade. |
