The big picture above is a general summary of stone disease and its management. At the center is the stone itself, what it is. Branching off like the four winds are their presence, getting them out, what they do, and their prevention.
It complements the more detailed site map which focuses on prevention and therefore on the efficient causes of stones.
The site map is the guide to the articles, this brief article a guide to the general construction of the whole field of medicine and research we dwell in.
WHAT STONES ARE
Large numbers of articles concern the material cause of stones – crystals, crystal analysis, matrix, and means of formation in tissues – this latter a mix of what they are and their formal and efficient causes.
ARE STONES PRESENT
Seemingly a trivial issue it is not. Pain can arise from a lot of causes, hematuria, too, and obstruction. Generally things are simple: renal colic, hematuria, obstruction, a stone on ultrasound or CT. But we can be confused. A critical aspect of this general question concerns whether new stones are forming. Problems of radiographic interpretation, the issue of nephrocalcinosis, use of intra – operative visualization all are important.
WHAT STONES DO
Stones produce illness. By illness I mean a departure from health as evidenced by symptom and signs. The main signs of stones are passing stones in the urine, finding stones by radiography or ultrasound techniques, urinary obstruction, urinary bleeding, and urinary infection. The main symptom is pain, as we all know. Large numbers of procedures for stones and many episodes of obstruction can injure kidneys and uncommonly kidneys are lost. Kidney failure itself is rare.
GET STONES OUT
How bold! In three words sum up the vast complex of modern stone urology. There are two main divisions – management of stone passage, and removal. The latter concerns both removal of obstructing stones and of non obstructing stone burden.
The purpose of this site is prevention of new stones, and therefore all of the articles aim to further that goal.
To me, prevention means reduction of supersaturation with respect to the crystals in stones being actively formed by a patient. This is my general postulate. It rests upon bed rock. The force that drives crystal formation and growth is supersaturation, and stones are crystals mixed with matrix materials. Supersaturation is not to stones as hypertension to stroke. The latter is a seemingly true, but complex biology. The former is physics and, if complex at the molecular level it is not complex within biological systems. The multitides of crystal modifiers in tissue and urine alter the kinetics of crystallization, certainly, and even the phases of crystals formed. But reduce supersaturation and you reduce the fundamental force for crystallization altogether.
This gives rise to my primary hypothesis: In a person forming new stones supersaturation is too high with respect to the crystals in those stones. Therefore prevention is to lower that supersaturation in whatever manner is least impractical.
WHERE WE ARE GOING AND WHAT DO WE WISH
This brief text, the detailed site map, the tables of article links, and the Table of Contents tell all.
This page will reflect our progress as will the Table of Contents.