Accounting approximately for 15 to 20 percent of all urinary calculi, infection stones occur most frequently in women (the ratio of effected females to male is 2:1). Infection stones occur with increased frequency with patients with external urinary diversions or in-dwelling urinary catheters that have been used in a long term basis. Although all infection stones are associated with infection of the urinary tract with urea-splitting organisms, approximately one-half of them originate from an underlying, readily identifiable anatomic or metabolic defect.

A thorough history is essential when evaluating patients with infection stone disease. A history of infection, the voiding pattern of patients should be studied to detect the presence of associated disorders like diabetes mellitus. Assessing the patients for congenital anomalies and/ r a history if urinary tract infection and stones formation is also a must. Apart from evaluation of urine cultures, radiological studies are essential to assess the anatomy of the urinary tract.

Stones removal is usually necessary, provided the patient's medical status permits. This can be carried out by means of various advanced endoscopic treatment options. Urinary tract infections can be suppressed while the stone is present, but the infection will usually recur once antibiotic are discontinued.

Infection stones can be managed with high-tech treatments which include:

PCNL- per Cutaneous-Nephro Lithotripsy also known as 'Key-hole' kidney surgery is minimally invasive surgical method for removal of all types of kidney stones and upper ureteric large 'impacted stone'. This is the first line treatment option for radiolucent stones, lower calyceal stones, diverticular stones and cysteine stones.

URS- (Uretrorenoscopy) is a treatment whereby ureteric stones of all shapes and sizes c be removed. With no incision or cu on the skin, the convalescence is excellent vis-à-vis open surgery.

CYTHOLITHOTRIPSY- Intracorporeal lithotripsy is a procedure through which all types of bladder stones can be removed. The stone is broken into pieces with help of pneumatic lithoclast and then the stone pieces are sucked out.

ESWL (Extracorporeal Shock-wave Lithotripsy)-also known as lithotripsy has its place in stone management despite it having gone into disrepute because of indiscriminate use for removal of all types and sizes of stones and the selection of stone not made by urologist. It is very important to select the stone very carefully and IVP is must prior to ESWL which also help in case selection. Just installing an ESWL machine and subjecting the patients to shock-waves does more harm than good to the kidneys.

Dr. Rajesh Gulia is a senior urologist at kidney centre

SCO 332-334, Sec 34-A,

Chandigarh

+91 98144 66026

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