Episode 114. Renal Stones with Dr Paul Manohar
Renal stones are common, at least 10% of our population will develop stones in their lifetime. One of the consequences of ureteric colic, which is the formation of stones, is reported in 3 out of every 1000 Australians per year, with a male predominance and a curious increasing incidence. Stones form when urine becomes supersaturated by minerals. Most stones contain calcium but there are many other constituents including oxalate, phosphate, uric acid, cystine and ammonia.
The Australian stone belt, encompassing northern and central Australia, is well known for its increased presentations of urinary colic. No doubt dehydration is a significant factor explaining this heightened prevalence. Conditions such as gout, hyperparathyroidism and some malignancies may also underlie an increased stone prevalence in some patients. Additionally, anatomical abnormalities such as calyceal diverticula and an obstructed pelvi-ureteric junction may reflect underlying factors, leading to increased stone formation.
The classic presentation of renal colic coupled with haematuria is well described and I was interested in understanding the decisions behind urgent intervention or expectant management in stone disease. To discover how one may judge if a stone is likely to pass spontaneously and the value, if any, of using alpha-adrenergic receptor blockers. When is a nephrostomy favoured over ureteroscopy and stenting? How is shockwave lithotripsy used and what are the standard techniques for stone rupture and removal? I was also interested in reviewing the risk of future stone development, currently estimated at 10% per year - what advice should we give to a patient who has experienced calculus disease?
To explore this topic further it was a great privilege to invite Dr Paul Manohar to this conversation. Paul undertook training, both locally in Australia and internationally, with a focus on minimally invasive laparoscopic and robotic urological surgery and pain management. He also has a strong research interest and holds a position within the Monash University Prostate Cancer Laboratory.
Please welcome Paul to the podcast.
References:
Paul Manohar: paulmanoharurology.com.au
Diets higher in calcium and potassium may help prevent recurrent symptomatic kidney stones: newsnetwork.mayoclinic.org
Medical and Dietary Therapy for Kidney Stone Prevention-NCBI: www.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au.
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne, Australia, and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.