![]() Urinary tract infections play an important role in stone formation and thus need a special clinical attention and management. Some anatomical abnormalities of the urinary tract are also associated with lithogenesis and comprise: horseshoe kidney, ureteropelvic junction obstruction, medullary sponge kidney, calyceal diverticulum and vesicoureteral reflux. Nephrolithiasis might be an effect of other systemic diseases such as: inherited and acquired renal tubular acidosis, primary and secondary hyperparathyroidism, gout, various neoplasms, primary hyperoxaluria, gastrointestinal diseases, sarcoidosis, recurrent/persistent urinary tract infection, metabolic syndrome and cystinuria. It seems that diet and lifestyle play an important role in disease development. Metabolic diseases such as obesity and diabetes are strongly associated with urolithiasis. A disease considered previously as male ailment is now gender blind. Over the last centuries a significant shift in stone location has been observed from the lower to the upper urinary tract. However, only in 20% of the patients a systemic disease predisposing to stone formation can be identified. This group requires thorough metabolic evaluation and a close follow-up. Urolithiasis promoting factors as patients’ age, recurrent stone formers, familial urolithiasis, calcium hydrogenphosphate (brushite), uric acid, cystine, and so called infection stones have to be analysed and appropriately considered for the further management. After every urolithiasis treatment, the patients should be stratified and accordingly assign to low or high risk group of stone recurrence. In patients with more than one stone diagnosed during their first renal colic this ratio might increase to 75%. The risk of recurrent renal colic after the first stone episode is roughly 15% during the first 3 years and grows up to 50% for the next 7 years. Urolithiasis manifest itself clinically mostly between 30 and 50 years of patients’ age. African-American females develop least likely urinary stones, while other races are in-between. The most commonly afflicted are white males. Men are afflicted more frequently than women (10.6% vs 7.1%). It has recently been shown that the real prevalence might even be higher reaching 8.4%. Similarly in countries of Western Europe like Germany, Spain and Italy its prevalence has also been rising. In United States its prevalence has doubled since the sixties being now between 2% and 7%. It has been reported in various medical writings since antiquity. Nephrolithiasis is one of the most common diseases afflicting mankind. Physicians should share decisions regarding treatment modalities with patients. Open surgery (pylolithotomy and anatrophic nephrolithotomy) are almost obsolete techniques. Extracorporeal shockwave lithotripsy is feasible in paediatric patients with acceptable stone free rates. Less invasive retrograde intrarenal surgery is also less effective, but burdened with lower complication rate. Percutaneous lithotripsy is still considered treatment of choice with more than 95% efficacy. It is crucial for patients and physicians to find a golden mean. ![]() All treatment methods are characterized by their efficacy and safety which are usually inversely proportional. On the other hand many experienced endourologic centres choose other modalities from their armamentarium. European and American Associations of Urology has published guidelines on Urolithiasis and presented the most effective tools to treat large stones. Kidney stones over 2 cm in diameter are the common urologic problem. The prevalence of urolithiasis has been observed to increase during last decades.
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