Kidney and urinary stones
We can look back on decades of experience in diagnostics, successful therapy and prevention of urinary stone disease. With almost 1000 patients and over 500 procedures for urinary stones per year, the urological clinic is a central point of contact for patients in and around Munich. Emergency patients (eg with renal colic) are cared for 24 hours a day, even on weekends, by a competent urologist and, if necessary, hospitalized and, if necessary, given interventional therapy.
The necessary diagnostics and conservative therapy (pain therapy) are initiated immediately in interdisciplinary cooperation with radiology and anesthesiologists (pain specialists). Should an emergency intervention (almost always minimally invasive / endoscopic) be necessary, a team is also available around the clock. The main focus of care is on the achievement of immediate pain relief and then in a rapid diagnosis and treatment of stone disease. Taking into account the medical as well as the personal aspects of the patient, it is important to initiate the individual best possible therapy.
In recent years, the incidence of urinary stone disease has increased significantly in the Western industrial nations. More and more people are suffering from urinary stones. The number of new cases has tripled in the last ten years. Today almost every 20th German citizen is affected once or several times in life. About 1.2 million patients have to be treated annually for this condition.
Urinary stones can occur throughout the urinary tract, it differs e.g. kidney stones, ureteral stones and bladder stones. While bladder stones usually arise in bladder emptying disorders, which usually can be well resolved, kidney and ureteral stones occur due to non-optimal eating habits or metabolic disorders. A cause of the increasing incidence of urinary stone disease in the western industrialized countries is seen in the increasing obesity of the population, which also leads to an increase in blood sugar disease, hypertension and lipid metabolism disorders (metabolic syndrome).
Kidney stones themselves initially do not cause any typical symptoms; even large stones are usually not noticed by the patients themselves. If, on the other hand, a stone or a fragment from the kidney falls into the ureter, it usually leads to a urinary tract dysfunction and to a urinary retention. This is very painful and leads to the typical renal colic. The urologist then determines the size of the stone after the pain treatment by means of ultrasound and X-ray examinations and determines its position. The size and position of the stone then determines whether it can go away on its own or if treatment is required.
First, the urologist asks the history of the disease (anamnesis). This survey also includes the family history of the disease. Often found in the person concerned or his relatives previously undergone urinary stone diseases. Dietary habits and living conditions can already provide information on the presence of a possible urinary stone disease. The questionnaire is followed by a physical examination. Here, a pressure pain in the flank can be hint for a urine blockage. Blood can often be detected in the urine and the number of white blood cells is increased (leukocyturia). In a blood test, among other uric acid, calcium and creatinine are determined. Ultrasound examination (sonography) is an important diagnostic method. Sound waves penetrate the body from outside, are reflected and thus generate an image that the urologist can evaluate on a screen. In excretory urography, the patient receives a contrast agent via the vein. CT-scanning can determine the location and type of stones accurately.
There are many treatment options for treating urinary stones. The composition of the stones, their size and condition as well as their location are always decisive for the subsequent best possible treatment. The urologist will discuss the test results and procedures with the patient.
Through medical support and adequate hydration, urinary stones can often be eliminated spontaneously. Physical exercise seems to support this. Chemolitholysis means that urinary stones are dissolved by medication, but this can usually only be done with uric acid stones.
Minimally invasive therapy
The endoscope is inserted through the urethra into the ureter and further into the renal pelvis. In this procedure stones from the ureter or the renal pelvis, with flexible instruments also from the renal calyx, can be removed.
Larger stones can e.g. be previously crushed with a laser.
ESWL (extracorporeal shockwave lithotripsy):
The urinary stones are smashed from the outside by focused energy waves.
PNL / Mini-PNL (percutaneous nephrolitholapaxy):
From the outside of the body, a thin canal is created to the kidney using a puncture needle. Subsequently, an optical instrument is introduced. The urologist can then smash and remove the urinary stones in the kidney.