Renal calculus are frequent and recurrent, and do not cause symptoms while resting, except when they prevent the exit of urine.
When the calculus moves, it typically causes intense colic pain with haematuria, nausea and vomiting. Urinary infection and obstruction may ensue.
The complications include ascending pyelonephritis and hydronephrosis with atrophy of the renal parenkima.
The treatment will depend on the location of the calculus in the kidney or in the urinary tract, and analgesics, spasmolytics, sedatives and antibiotics will be prescribed to control the symptoms and help expulsion.
Sometimes it is necessary to carry out manipulation with an instrument or surgery to extract the calculus.
Lithotripsy is a good alternative to surgery, when this is indicated.
Obstructive Uropathy (OU)
Blockages affecting the free flow of urine in any part of the urinary tract, from the kidney to the urethra, have consequences that depend on their duration and gravity and whether the obstruction is unilateral or bilateral.
Sustained OU has a destructive effect on the kidney, impairing its function, a situation that can be avoided by providing appropriate treatment.
The intrinsic causes of OU are varied, and include tumours, calculus, myeloma, clots, stenosis, functional defects, and others.
Extrinsic factors causing the condition can be of retroperitoneal, inflammatory, tumoral, infectious, vascular, gynecological, prostatic or gastrointestinal origin.
The pain varies depending on the location and the speed of the obstruction.
In cases of total bilateral urethral obstruction or total unilateral obstruction in patients with one kidney, anuria occurs. If the obstruction is partial, diuresis will continue while kidney failure gradually starts to develop.
Acute obstruction at the neck of the bladder or urethra, produces acute urinary retention with a vesical globe.
Added infections produce urinary symptoms.
Salt retention and water retention trigger arterial hypertension, in the same way as happens when the renin-dependent mechanisms are activated in unilateral obstructions.
Haematuria is produced by the cause of the obstruction itself, that is the distension of the urinary tract or ex-vacuo.
- Lower obstructive uropathy:This requires a visical catheter to be fitted by means of a retrograde urethral catheter or through the suprapubic puncture.
This will lead to the correction of internal malfunctions that the OU may have produced.
Later, when the general condition of the patient allows, a diagnostic study will be carried out, after which a suitable treatment for the cause of the obstruction will be determined.
- Lower obstructive uropathy: If the obstructive uropathy is unilateral and total and accompanied by infection or serious pain, this will necessitate the placement of a drain in the blocked excretor by means of a nephrostomia or retrograde urethral catherisation, or surgery, in combination with antibiotics.
In case of a serious degree of bilateral obstruction or unilateral obstruction when the patient has one kidney, dialysis prior or post instrumental or surgical intervention can be required.
It is recommended that both excretory tracts be derivated.
Advice on Urolitiasis
- During an acute episode of pyeloureteral colic, driving is impossible.
- Spontaneous expulsion of the calculus that is not accompanied by fever or haematuria, means the patient will be able to drive again almost immediately.
- If the patient’s condition improves after the acute episode but he continues to take analgesic and sedative treatments, the doctor should remind him of the side effects the medication can produce, which may affect driving.
- If the process of expelling the calculus is difficult or is accompanied by complications, the doctor will decide when the symptoms have resolved to a sufficient degree to allow the patient to begin driving again, and will inform him when the time comes.
- The mechanical removal of calculus requires the direct evaluation of a specialist, who will inform the patient when he is recovering and no longer suffers from any complications which could interfere with driving.
- Lithotripsy requires a period of rest and expulsion of the stones, which mean driving is impossible. The specialist will decide if the treatment has been effective and it is possible to go back to daily activities, which include driving.
- The surgical extraction of the calculus is a process which varies in complexity, and requires the precise indications of the urologist with regard to the advisability of taking up daily activities such as driving again.
Advice on Obstructive Uropathy
- Urinary retention is a condition that demands urgent medical attention, and which precludes driving.
- Partial symptomatic obstructions caused by infection, hypertension, renal failure, pain, etc, limit driving, so this should be discouraged until the diagnosis has been made and the physician has commenced appropriate treatment and the patient is recovering from the condition.
Advice on Lower obstructive uropathy
- When there is seriously high degree of unilateral obstructive uropathy in cases where the contralateral kidney is functioning but this is not total or accompanied by infection and has not produced important renal lesions, driving can be allowed.
- In other serious cases of obstructive uropathy driving is not advisable until the diagnosis has been made, treatment has been established and the specialist has told the patient that the clinical symptoms have resolved and that he may once again drive.