“ but in pissing there came from me two stones, I cold feel them, and caused my water to be looked into, but without nay pain to me in going out”
Prognosis
With adequate therapy complete return to normalcy, but recurrences common upto 50% within 5 years.
General Measures
It is doubtful increased fluids, I.V. or oral, will ‘push’ stones down the ureter. Usually the pain gets excerbated. But in general all cases should ensure a urinary output of to 2.5 liters daily, by liberal intake of fluids and avoiding dietary excesses.Hypercalcurics (type II) will be helped by reducing calcium intake to 400mg a day.
Advice to Patient
Dietary intake as advised depending upon the nature of stone. Calcium oxalate stone: Restrict Protein to 0.8 – 1.0 Gm/kg/day//. 800mg/day of calcium, 300-500 mg of which comes from diary products (125 mg of milk contains 125 mg calcium) // Avoid oxalate rich foods like spinach, hubatrb, beet root, and restrict cocoa, black chocolate. // Avoid purine rich foods like meat, sausage, soya, alcoholic beverges especially beer // increase intake of fibre in diet. Uric acid stone: avoid purine rich sardines, herrings, shell fish, and restrict meat, fish sausages, beans nad mushrooms // Prefer eggs, dairy products, fruits vegetables, cereal products. Calcium phosphate stone: Avoid hard chesse, prefer yoghurt, fresh cheese, // Controlled intake of protein to 150 gm, day of meat, fish and sausages, increase fibre // in case of phosphaturia avoid, nuts cocoa, liver, cheese, legumes C. Strain urine through cloth until the stone is passed, and collect the stone for analysisFor quantum of fluid, see under ‘prevention’.
Follow Up
Plain X rays of KUB in cases with delayed passage of stone at intervals of 1-2 weeks.
Prevention
If No medical treatment is provided after surgery, 50% will have stone recurrence with 5 years. The most important measure is increased fluid intake. Broadly, double previous intake i.e more fluid during meals, bet ween meals and before going to sleep. This result in waking at night for passing when more fluids should be ingested.
