Urolithiasis is a common disorder characterized by the formation of crystalline concretions anywhere within the urinary tract. Its clinical importance extends beyond an isolated episode of renal colic because stone disease is recurrent, can impair quality of life, and can lead to urinary obstruction, infection, repeated hospitalization, and loss of renal function in selected patients. The burden of stone disease differs substantially across regions and populations, reflecting variation in climate, occupation, dietary patterns, genetic susceptibility, socioeconomic conditions, and access to preventive care. Global studies have documented an increasing occurrence of urinary stone disease, while Asian populations show marked geographic heterogeneity in prevalence and recurrence patterns [1,2]. The clinical spectrum of urolithiasis is broad. Acute flank or loin pain is the classic presentation, often accompanied by hematuria, nausea, vomiting, or lower urinary tract symptoms. Fever in a patient with an obstructing calculus is clinically important because infected obstruction requires prompt assessment and drainage. Stone-related manifestations depend on the size, anatomical location, degree of obstruction, presence of infection, and individual pain response. Metabolic and systemic conditions also influence stone formation. Obesity, diabetes mellitus, hypertension, hyperuricemia, recurrent urinary tract infection, and family history have been linked with stone disease, and Indian data have highlighted inadequate water intake, elevated body mass index, environmental factors, and dietary exposures as relevant contributors [3,4]. Low urine volume is among the most consistent modifiable determinants of stone formation and recurrence. A randomized prospective study demonstrated that higher water intake and increased urinary volume reduced recurrent calcium nephrolithiasis [5]. Dietary sodium is another important factor because higher sodium intake can increase urinary calcium excretion [6]. Dietary prevention therefore emphasizes adequate hydration, restriction of excessive salt and animal protein, and maintenance of appropriate dietary calcium rather than indiscriminate calcium restriction. Controlled dietary studies and systematic reviews support combined dietary and fluid strategies for recurrent stone prevention [7,8]. These observations are particularly relevant in warm climates, where increased insensible fluid loss can reduce urine volume unless fluid intake is sufficient. Modern management is individualized according to stone size, location, composition when known, symptoms, obstruction, renal function, infection, patient preference, and available expertise. Small uncomplicated stones can often be managed with observation, analgesia, hydration advice, and selected medical expulsive therapy, whereas larger or complicated stones commonly require ureteroscopy, shock-wave lithotripsy, or percutaneous nephrolithotomy. Current clinical guidance emphasizes structured evaluation, metabolic prevention in appropriate patients, and minimally invasive intervention when active stone removal is indicated [9-13]. Although these principles are well established, hospital-level data remain useful for understanding the pattern of presentation and treatment burden in specific populations. The present study was undertaken to characterize urolithiasis among patients treated in a tertiary-care teaching hospital in Bangalore. The objectives were to describe the demographic and clinical profile of patients with urolithiasis, document recognized lifestyle, metabolic, and familial risk-factor exposures, characterize stone size, location, laterality, and hydronephrosis, describe management patterns, assess short-term clinical outcomes, and examine the relationship of stone size with intervention requirement, complications, and stone clearance.

Study design and setting: A hospital-based prospective observational study was conducted at Dr B.R. Ambedkar Medical College, Kadugondanahalli, Bangalore, Karnataka, India. The study was carried out over seven months, from June 2019 to December 2019. Patients presenting with symptoms suggestive of urinary stone disease were evaluated according to routine institutional practice. A total of 80 consecutive eligible patients with imaging-confirmed urolithiasis were enrolled and followed prospectively through treatment and short-term assessment. Study participants: Adults aged 18 years or older with renal, ureteric, or bladder calculi confirmed by ultrasonography and/or non-contrast computed tomography of the kidney-ureter-bladder region were eligible. Patients were included irrespective of whether they were managed conservatively or underwent an intervention. Patients younger than 18 years, those who declined participation, patients without imaging confirmation of urolithiasis, and those whose clinical records were insufficient for assessment of the prespecified study variables were excluded. Consecutive recruitment was used to reduce selective enrolment. Data collection and study variables: A structured case-record form was used to collect age, sex, presenting symptoms, previous stone history, family history, daily fluid intake, dietary salt exposure, obesity, hypertension, diabetes mellitus, hyperuricemia, and recurrent urinary tract infection. Laboratory evaluation included urinalysis, microscopy, urine culture when clinically indicated, and serum creatinine. Imaging findings included maximum stone diameter, anatomical location, laterality, number of calculi, and degree of hydronephrosis. Diagnostic assessment and conservative evaluation followed accepted principles for urinary stone disease [9-12]. Low daily fluid intake and high dietary salt intake were recorded from the clinical dietary history obtained at enrolment; these variables represent reported exposures rather than causal estimates. Management and outcome assessment: Treatment was determined by the treating urologist on clinical grounds, considering stone size and site, obstruction, infection, symptoms, renal function, and feasibility of spontaneous passage. Management categories included conservative or medical expulsive therapy, ureterorenoscopy with lithotripsy, extracorporeal shock-wave lithotripsy, percutaneous nephrolithotomy, cystolitholapaxy, and other surgical procedures, consistent with established minimally invasive management principles [11-13]. Outcomes recorded during short-term follow-up were stone clearance, residual stone or fragments, symptomatic improvement, complications, repeat intervention, readmission, hospital stay, and mortality. Complications were identified from inpatient and follow-up records; recognized procedural complications were interpreted in the context of published endourological experience [14]. Ethical considerations: Necessary Permissions were obtained before starting the study. Written informed consent was obtained from participating patients before enrolment. Patient confidentiality was maintained using coded study records. Statistical analysis: Data were entered and analyzed using standard statistical procedures. Continuous variables were summarized as mean ± standard deviation, while categorical variables were expressed as frequencies and percentages. Stone size was categorized as ≤10 mm and >10 mm for outcome comparisons. The chi-square test was used for categorical comparisons when expected cell counts were adequate, and Fisher's exact test was used for sparse contingency tables. A two-sided p value <0.05 was considered statistically significant. Because the study was observational and descriptive, no causal effect estimates were inferred from the frequency of recorded risk-factor exposures.

A total of 80 patients with confirmed urolithiasis were included in the final analysis. The mean age of the study population was 42.3 ± 13.8 years, with an age range of 18-72 years. Most patients were between 31 and 50 years of age, accounting for 42 (52.5%) participants. Males constituted 52 (65.0%) patients, while 28 (35.0%) were females, giving a male-to-female ratio of approximately 1.9:1. The baseline demographic characteristics are presented in Table 1. Table 1. Demographic characteristics of patients with urolithiasis (n = 80) Characteristic n (%) / Mean ± SD Age, years 42.3 ± 13.8 Age group, years 18-30 16 (20.0) 31-40 22 (27.5) 41-50 20 (25.0) 51-60 14 (17.5) >60 8 (10.0) Sex Male 52 (65.0) Female 28 (35.0) Flank pain was the predominant presenting symptom, reported by 69 (86.3%) patients. Hematuria was observed in 32 (40.0%), followed by dysuria in 29 (36.3%) and nausea or vomiting in 24 (30.0%). Fever was present in 12 (15.0%) patients, while 15 (18.8%) had clinical features suggestive of recurrent urinary tract infection. Regarding laboratory findings, microscopic hematuria was detected in 41 (51.3%) patients, pyuria in 24 (30.0%), and a positive urine culture in 12 (15.0%). Several recognized risk-factor exposures were identified. Low daily fluid intake was the most frequent, documented in 47 (58.8%) patients, followed by high dietary salt intake in 35 (43.8%). A previous history of urinary calculi was reported by 26 (32.5%), obesity by 23 (28.8%), and a positive family history by 21 (26.3%). Clinical presentation, laboratory findings, and risk-factor profiles are summarized in Table 2. Table 2. Clinical presentation, laboratory findings, and recognized risk factors (n = 80) Variable n (%) Clinical presentation Flank/loin pain 69 (86.3) Hematuria 32 (40.0) Dysuria 29 (36.3) Nausea/vomiting 24 (30.0) Recurrent urinary tract infection 15 (18.8) Fever 12 (15.0) Laboratory findings Microscopic hematuria 41 (51.3) Pyuria 24 (30.0) Positive urine culture 12 (15.0) Elevated serum creatinine 9 (11.3) Recognized risk factors Low daily fluid intake 47 (58.8) High dietary salt intake 35 (43.8) Previous history of urolithiasis 26 (32.5) Obesity 23 (28.8) Family history of urolithiasis 21 (26.3) Hypertension 18 (22.5) Diabetes mellitus 16 (20.0) Hyperuricemia 14 (17.5) Recurrent urinary tract infection 15 (18.8) Note. More than one symptom or risk factor could be present in an individual patient. Radiological evaluation demonstrated right-sided stones in 41 (51.3%) patients, left-sided stones in 33 (41.3%), and bilateral calculi in 6 (7.5%). Ureteric calculi were the most frequent anatomical presentation, occurring in 43 (53.8%) patients, followed by renal calculi in 33 (41.3%) and bladder calculi in 4 (5.0%). The mean maximum stone diameter was 9.1 ± 4.4 mm. Fifty-five (68.8%) patients had stones measuring ≤10 mm, whereas 25 (31.3%) had stones >10 mm. Hydronephrosis was observed in 47 (58.8%) patients, predominantly of mild or moderate severity (Table 3). Table 3. Radiological and stone characteristics of the study population (n = 80) Characteristic n (%) / Mean ± SD Maximum stone size, mm 9.1 ± 4.4 Stone size ≤5 mm 18 (22.5) 6-10 mm 37 (46.3) 11-20 mm 21 (26.3) >20 mm 4 (5.0) Primary anatomical location Renal 33 (41.3) Proximal ureter 15 (18.8) Mid ureter 8 (10.0) Distal ureter/vesicoureteric junction 20 (25.0) Bladder 4 (5.0) Laterality Right 41 (51.3) Left 33 (41.3) Bilateral 6 (7.5) Single calculus 59 (73.8) Multiple calculi 21 (26.3) Hydronephrosis None 33 (41.3) Mild 25 (31.3) Moderate 16 (20.0) Severe 6 (7.5) Of the 80 patients, 25 (31.3%) were managed conservatively with hydration, analgesia, and/or medical expulsive therapy, while 55 (68.8%) required an interventional procedure. Ureterorenoscopy with lithotripsy was the most commonly performed intervention in 26 (32.5%) patients, followed by extracorporeal shock-wave lithotripsy in 14 (17.5%) and percutaneous nephrolithotomy in 9 (11.3%). At short-term follow-up, complete stone clearance was documented in 70 (87.5%) patients, while 10 (12.5%) had residual calculi or fragments. Complete or substantial symptomatic improvement occurred in 73 (91.3%). Procedure- or disease-related complications were recorded in 7 (8.8%) patients. Six (7.5%) required an additional intervention and three (3.8%) required readmission. There was no mortality. Mean hospital stay was 2.7 ± 1.6 days (Table 4). Table 4. Management and short-term clinical outcomes of patients with urolithiasis (n = 80) Variable n (%) / Mean ± SD Management Conservative/medical expulsive therapy 25 (31.3) Ureterorenoscopy with lithotripsy 26 (32.5) Extracorporeal shock-wave lithotripsy 14 (17.5) Percutaneous nephrolithotomy 9 (11.3) Cystolitholapaxy 4 (5.0) Other surgical intervention 2 (2.5) Outcomes Complete stone clearance 70 (87.5) Residual stone/fragments 10 (12.5) Symptomatic improvement 73 (91.3) Complications 7 (8.8) Repeat intervention required 6 (7.5) Readmission 3 (3.8) Mortality 0 (0.0) Hospital stay, days 2.7 ± 1.6 Among the seven patients with complications, three developed febrile urinary tract infection, two had transient significant hematuria, one developed steinstrasse following lithotripsy, and one experienced ureteric injury that was successfully managed. Stone size showed a significant relationship with treatment burden. Among patients with stones >10 mm, 24 of 25 (96.0%) required an intervention compared with 31 of 55 (56.4%) patients with stones ≤10 mm (p < 0.001). Complications were also more frequent in the >10 mm group (20.0% vs. 3.6%; p = 0.028). Complete stone clearance was numerically lower for stones >10 mm (80.0% vs. 90.9%), but the difference was not statistically significant (p = 0.272) (Table 5). Table 5. Association of stone size with intervention requirement, complications, and stone clearance Outcome Stone ≤10 mm (n = 55) Stone >10 mm (n = 25) p-value Intervention required 31/55 (56.4) 24/25 (96.0) <0.001 Complications 2/55 (3.6) 5/25 (20.0) 0.028 Complete stone clearance 50/55 (90.9) 20/25 (80.0) 0.272 Note. Chi-square or Fisher's exact test was used as appropriate. A p value <0.05 was considered statistically significant. Overall, urolithiasis in this cohort predominantly affected middle-aged males and commonly presented with flank pain. Inadequate fluid consumption, high dietary salt intake, previous stone disease, obesity, and family history were frequently observed. Most patients achieved satisfactory stone clearance and symptomatic improvement; however, larger stones were associated with a substantially greater requirement for procedural intervention and an increased frequency of complications.

The present prospective study describes the clinical pattern, recognized risk-factor exposures, radiological characteristics, management, and short-term outcomes of 80 patients with urolithiasis. The mean age was 42.3 years, and more than half of the participants were between 31 and 50 years. Men represented 65.0% of the cohort. This age and sex distribution is consistent with the established epidemiology of stone disease, in which the burden is prominent during economically productive adult years and has historically been higher among men. Considerable geographic variation is nevertheless recognized, particularly across Asian populations [1,2]. Flank or loin pain was the dominant presenting symptom, affecting 86.3% of patients, while hematuria, dysuria, nausea or vomiting, fever, and urinary infection occurred less frequently. This pattern reflects the typical symptomatic consequences of stone migration and urinary obstruction. Microscopic hematuria was detected in approximately half of the cohort, and pyuria or positive urine culture identified a subgroup with inflammatory or infectious features. The coexistence of urolithiasis with metabolic disorders is clinically relevant; obesity, hypertension, diabetes mellitus, and hyperuricemia were recorded in the present series. Contemporary reviews consider nephrolithiasis a systemic disorder linked to metabolic and cardiovascular risk states rather than an exclusively local urinary tract condition [9]. Low daily fluid intake was the most frequently documented recognized risk factor, followed by high dietary salt intake. These findings are biologically plausible and align with Indian evidence linking insufficient water consumption and environmental or lifestyle exposures with renal calculi [3]. Higher body weight is also associated with increased stone risk [4]. The preventive relevance of hydration is supported by randomized evidence demonstrating reduced recurrence with increased urine volume [5]. Likewise, dietary sodium can enhance urinary calcium excretion [6], while a normal-calcium, low-sodium, lower-animal-protein dietary pattern has reduced recurrence in hypercalciuric stone formers [7]. Systematic review evidence further supports high fluid intake as a core secondary-prevention strategy [8]. Ureteric calculi were the most frequent anatomical presentation, and hydronephrosis was present in 58.8% of patients. Nearly one-third were managed conservatively, whereas more than two-thirds required active intervention. Ureterorenoscopy was the most common procedure, followed by shock-wave lithotripsy and percutaneous nephrolithotomy. This distribution is compatible with the shift toward minimally invasive, endourological treatment described in major urolithiasis guidelines [10-13]. Importantly, 96.0% of patients with stones >10 mm required intervention compared with 56.4% of those with smaller stones. Larger stones also had a higher complication frequency, reinforcing the clinical relevance of stone burden in treatment planning. Short-term outcomes were favorable: complete stone clearance was achieved in 87.5%, symptomatic improvement in 91.3%, repeat intervention was required in 7.5%, and no mortality occurred. Complications affected 8.8% and included febrile urinary tract infection, hematuria, steinstrasse, and ureteric injury. These events fall within the recognized spectrum of stone-treatment complications, and careful patient selection, infection control, procedural expertise, and follow-up remain central to reducing morbidity [14]. The findings support a combined strategy of early clinical assessment, risk-factor modification, and size- and site-directed treatment. Limitations This study was conducted at a single tertiary-care center with a modest sample size and a seven-month recruitment period, limiting external generalizability. Risk-factor exposures such as fluid and salt intake were based on patient history and were not quantified using validated dietary instruments. Stone composition and complete 24-hour metabolic urine profiles were not available for all participants. Follow-up was short and therefore did not evaluate long-term recurrence.

Urolithiasis in this hospital-based cohort predominantly affected middle-aged men and most often presented with flank or loin pain. Low fluid intake, high dietary salt consumption, previous stone disease, obesity, and family history were frequently recorded recognized risk factors. Ureteric stones constituted the largest anatomical group, and hydronephrosis was common. Most patients required an active procedure, particularly those with stones larger than 10 mm. Overall stone clearance and symptomatic improvement were high, with a low short-term complication and readmission burden and no mortality. These findings emphasize adequate hydration, dietary risk reduction, timely imaging, and individualized treatment based on stone size, location, obstruction, infection, and overall clinical status in routine urological practice.

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