The effect of calculi on renal and ureteric function is the result of a complex sequence of pathophysiological events triggered by obstruction. The degree of impairment of renal function resulting depends on whether the obstruction is partial or complete, is unilateral or bilateral, is complicated by infection or not and how and when it is relieved. This review will look at these interacting factors and particularly on the effects of various treatment modalities ranging from open techniques to minimally and non-invasive interventions.
Urinary tract calculi have plagued humans since the beginning of recorded history. Archaeologists have discovered urinary stones in the mummified remains of Egyptians estimated to be over 7000 years old. Stones can cause a broad array of adverse effects on the urinary tract, from mild symptoms to severe renal damage from chronic obstruction. Obstruction of the urinary tract is a common cause of both renal and ureteric dysfunction. There are varying degrees of obstructive uropathy and a myriad of a etiologies, both congenital and acquired, in which urinary calculi ar a major factor. Irrespective of the aetiology or type of stone, the effect that calculi exert on normal and ureteric physiology is dependent on whether the obstruction is complete or partial, unilateral or bilateral.
Symptoms from the urinary tract also vary widely depending on the nature and location of the stone. Pain is typically stimulated by acute obstruction, which leads to renal capsular distention combined with severe colicky pain from renal pelvic and ureteric muscle spasm. The severity and the colicky nature of this pain are caused by the hyperperistalsis and spasm of this smooth muscle organ as it attempts to rid itself of the obstructing stone. If