11 Myths about stone diseases and urological problems

At a Glance:

Hydrotherapy can flush out urinary calculi

Myth: Drinking copiously will help promote passage of kidney and ureteral stones. The rationale of this advice is that by hydrating massively, a head of pressure will be created to help passage of a stone present in the kidney or ureter.

Reality: The presence of a stone often causes urinary tract obstruction. Over-hydration in the presence of obstruction will further distend the already bloated and inflated portion of the urinary collecting system located above the stone. This increased distension can exacerbate pain and nausea that are often symptoms of colic. The collecting system of the kidney and the ureter have natural peristalsis similar to that of the intestine and over-hydration has no physiological basis in terms of helping this process along, being pointless and perhaps even dangerous.  Drinking moderately in the face of a kidney or ureteral stone is sound advice.

Barley water is good for preventing and dissolving urinary stones

Myth: Barley water has mediconal properties that can dissolve and prevent urinary stones

Reality: Barley water is no different from regular plain water. The key is to prevent supersaturation of urine.

Everyone must drink 3-4 liters of water a day.

Myth: Many sources of information (mostly non-medical and of dubious reliability) dogmatically assert that humans 3-4 liters of water daily to stay well hydrated and thrive.

Reality: Many people old people drink a lot of water end up in urologists’ offices with urinary urgency, frequency and often urinary leakage. The truth of the matter is that although some urinary issues are brought on or worsened by insufficient fluid intake–including kidney stones and urinary infections–other urinary problems are brought on or worsened by excessive fluid intake. Water requirements are based upon ambient temperature and activity level. If you are sedentary and in a cool environment, your water requirements are significantly less than when in the hot conditions. Heeding your thirst is one of the best ways of maintaining good hydration status, in other words, drinking when thirsty and not otherwise. Another method of maintaining good hydration status is to pay attention to your urine color. Urine color can vary from deep yellow to as clear as water. If your urine is dark yellow, you need to drink more as a lighter color is ideal and indicative of satisfactory hydration.

Beer helps in reducing kidney stones.

Myth: Beer helps in reducing kidney stones.

Reality: It is worse than water. Beer or alcohol may produce more urine by a diuretic effect but this can also be achieved by consumption of other oral fluids or  water. In fact, excess beer intake increases the risk of oxalate renal calculi by increasing oxalate and urate content in urine.

Restriction of calcium in the diet helps to reduce urinary stone recurrence

Myth: Calcium is a major component of 75% of stones hence many people believe that restriction of dietary calcium is a logical means of preventing a recurrence.

Reality: Several studies have shown that severe restriction of calcium in the diet actually increases the recurrence rate of urolithiasis by increasing the oxalate absorption from the intestine. So calcium should be consumed in moderation and should not be restricted.

There are medicines to dissolve urinary stones

Myth: 80% of the urinary stones are composed of calcium oxalate or calcium phosphate. For these there are no medicines available that can dissolve the stones.

Reality: In select patients with small uric acid stones (5 % of stones) or cystine stones (1-3% of stones), medications can potentially be used to help dissolve their stones. However, even in these, surgery may required.

Shock Wave Lithotripsy (SWL) can be used to treat renal calculi of any size and form

Myth: SWL is used to treat only small calculi less than 2 cm.  If ESWL is used to fragment larger renal calculi then these fragments may block the ureter or  some of these fragments may remain in the kidney and lead to a recurrence.

Reality: Thus SWL for large renal calculi has poor success rates and is associated with a high risk of ancillary treatments for the residual calculi. Also it is not ideal for very hard stones. It cannot be recommended as a universal treatment for all renal calculi but must be used selectively.

Staghorn or large renal calculi cannot be treated by endoscopic surgery ie PCNL

Myth: Open surgery for renal calculi is done because the stone was “very large”.

Reality: Percutaneous nepholithotripsy (PCNL) is “the treatment of choice” for large renal calculi, irrespective of the stone size.

Clamp the catheter intermittently to maintain bladder tone

Myth: Patients who have been temporarily catheterised during an acute illness or after surgery have their catheter clamped intermiitently before removal often startiing 24 to 48 hours before removal of the catheter. It has been claimed that the bladder shrinks after it has been catheterised and the  the intention of clamping the catheter is to maintain bladder tone and capacity

Reality: There is no evidence, however, that the cyclical bladder filling produced by intermittent clamping has any effect on bladder capacity except in defunctionalised bladders. Patients undergoing prostatic surgery after several weeks or even months of catheterisation void without difficulty after surgery and maintain normal bladder volumes.

There is pericatheter leak from the sides of the catheter; it must be too small-  “Put in a bigger one”

Myth: leakage of urine around catheters is a common problem and has been reported to occur in 40-70% of catheterised patients. Although it is occasionally due to a blocked catheter, particularly if haematuria is also present, the usual In the catheterised patient these detrusor contractions may be caused by irritation of the bladder by the catheter balloon, by debris or stones within the bladder, or by infection.

Reality: The logical management of this problem is therefore to reduce to a minimum the volume of water in the catheter balloon either by partly deflating the balloon or preferably by using a catheter with 5 ml balloon capacity. Addition of anticholinergic medication may help.

Doing a prostate biopsy will spread any cancer that may be present.

Myth: Using a needle to obtain tissue samples of the prostate allows cancer cells to seed and implant along the needle track, or alternatively, into blood or lymphatic vessels.

Reality: Although this is a theoretical consideration, millions of prostate biopsies performed every yearand incidence of seeding is virtually non-existent and the potential risk can be thought of as being negligible.