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Kidney stone disease in women and men has a similar pathophysiology; however, due to hormonal, anatomical, and lifestyle differences, it may vary in terms of clinical course and prevalence. While the incidence is reported to be higher in men, an increase has been observed in women in recent years.
Kidney stone formation in men generally occurs more frequently and at earlier ages, and the increase in urinary calcium and oxalate levels due to the effect of testosterone may raise the risk of stone formation. Recurrence rates are higher in male patients, and stone size and the risk of obstruction may affect the clinical course.
In women, the development of kidney stones is associated with hormonal changes, especially the reduction of the protective effect of estrogen, and the risk may increase significantly after menopause. Infection-related stone types are more common in women, and this may lead to differences in clinical findings.
Although the symptoms and treatment approaches of gender-related kidney stones are generally similar, the diagnosis and treatment process may differ in women because they are more likely to be accompanied by urinary tract infections. Early diagnosis and an individualized treatment approach improve prognosis.
Why Do Kidney Stones Form?
Kidney stones are hard, small masses formed by the crystallization of minerals and salts in the kidneys. This condition, medically known as nephrolithiasis or urolithiasis, occurs when stones accumulate in any part of the urinary tract. Under normal conditions, the body excretes excess minerals and waste through urine. However, when the amount of fluid in the urine decreases or when there is an excessive amount of minerals in the urine, these substances crystallize, combine, and eventually form kidney stones over time.
Components such as calcium oxalate, calcium phosphate, uric acid, and cystine play an important role in stone formation. In particular, insufficient water intake, high-protein diets, excessive salt consumption, and genetic predisposition may accelerate stone formation. The size of kidney stones can range from a few millimeters to several centimeters. While small stones can often pass through urine, large stones may block the urinary tract and cause severe pain.
No symptoms are usually felt in the early stages of stone formation. However, when the stone moves into the urinary tract, symptoms such as pain, blood in the urine, nausea, and frequent urination occur. Although kidney stones can occur at any age, they are most commonly diagnosed in adults between the ages of 30 and 50.
How Can You Tell If There Is a Kidney Stone?
The symptoms of kidney stones generally vary depending on the size, location, and mobility of the stone. The most prominent symptom is severe side or back pain. This pain usually begins in the kidney area and radiates toward the groin. In women, this pain may sometimes be confused with menstrual cramps, while in men it may extend to the testicular region.
The pain usually comes in waves and intensifies suddenly. This is caused by the movement of the stone within the urinary tract. In addition, the presence of blood in the urine (hematuria) is also an important finding. Blood appears as a result of the stone irritating the wall of the urinary tract.
Other symptoms may include frequent urination, a burning sensation during urination, nausea, vomiting, and fever. Especially fever and chills may indicate that a urinary tract infection is accompanying the stone, and in this case urgent medical intervention is required. In some patients, the urine may appear brown or pink. This indicates the presence of microscopic blood in the urine.
Although the severity of symptoms varies according to the size of the stone, kidney functions may be damaged in cases where the stone blocks urine flow. Therefore, timely detection of kidney stones and early initiation of appropriate treatment are of vital importance.
How Many Types of Kidney Stones Are There?
Kidney stones are classified into different types according to their chemical composition, and each forms for different reasons. The most common type is calcium oxalate stones. These stones form as a result of excessive calcium and oxalate accumulation in the urine and are generally associated with insufficient water intake and excessive consumption of salt or oxalate-containing foods (such as spinach, beetroot, and chocolate). Another commonly encountered type is uric acid stones. These stones occur when the urine becomes acidic and are generally associated with high-protein diets, gout disease, or excessive meat consumption.
One of the rarer types of stones is struvite stones. They are generally more common in women and form as a result of ammonia produced by bacteria that cause urinary tract infections. Struvite stones can grow rapidly and severely block the kidney. In addition, cystine stones develop due to cystinuria, a genetic metabolic disorder. This type of stone is quite rare but can even appear during childhood.
Since each type of stone is based on a different cause and mechanism, treatment and prevention methods also vary accordingly. For example, salt and oxalate restriction are important in calcium stones, while increasing urine pH is necessary in uric acid stones. Therefore, determining the type of kidney stone through laboratory analysis plays a critical role in creating the correct treatment plan.
Who Gets Kidney Stones Most Frequently; Women and Men
Historically, kidney stones were more common in men than in women. However, studies conducted over the last 20 years show that this difference is gradually decreasing and kidney stone cases are also increasing in women. The reasons for this include rising obesity rates in women, Western-style eating habits, and hormonal imbalances.
Men are generally the highest-risk group for kidney stones between the ages of 20 and 50. The main reason for this is the increasing effect of the testosterone hormone on calcium oxalate stone formation. In women, thanks to the protective effect of the estrogen hormone, stone formation is rarer before menopause. However, after menopause, this protective effect disappears as estrogen levels decrease, and the risk of stones increases in women as well.
Kidney stones in women are generally associated with infection. These types of stones are called struvite stones and usually form as a result of ammonia produced by bacteria causing urinary tract infections. In men, calcium oxalate stones are more common. These stones are closely associated with dietary habits and metabolic factors.
As a result, gender differences are related not only to biology but also to lifestyle factors. In men, high-protein diets, alcohol, and low water intake increase risk, while in women hormonal changes, pregnancy, and urinary tract infections play an important role.
What Does a Doctor Do for Kidney Stones?
The course of treatment for kidney stones is determined according to the size and location of the stone and the patient’s general health condition. Small stones (those smaller than 4 mm) can usually pass spontaneously through urine. During this process, drinking plenty of water, using painkillers, and resting are sufficient. However, if the stone is large or blocks the urinary tract, surgical intervention may be required.
In the first stage, doctors generally apply drug therapy. Medications called alpha blockers widen the urinary tract and allow the stone to pass more easily. Analgesics are used for severe pain. The stone passage process may generally take several days or weeks.
There are different treatment options in modern medicine for large stones. With a method called ESWL (Extracorporeal Shock Wave Lithotripsy), the stone is broken into small pieces using sound waves sent from outside the body. These pieces are then expelled through urine. For larger or more complex stones, surgical methods such as ureteroscopy or percutaneous nephrolithotomy are used.
After treatment, the type of stone is analyzed in a laboratory environment. This analysis helps in taking appropriate precautions to reduce the risk of future stone formation. In addition, the doctor recommends a personalized nutrition and fluid intake plan for the patient.
Do Kidney Stones Recur?
Once a kidney stone has formed, the probability of recurrence is quite high. Research shows that approximately half of stone patients develop new stones within five years, and this rate rises to as high as 70% within ten years. The main reason for this is that the metabolic imbalances, genetic predisposition, and lifestyle factors causing stone formation are permanent. In some individuals, the chemical structure of the urine is naturally prone to stone formation; in such cases, stones may recur if lifestyle changes are not made. In addition, factors such as insufficient fluid intake, excessive salt and protein consumption, inactivity, and obesity also facilitate stone recurrence.
Recurring stones are generally of the same type as the first stone. For example, a person who has developed a calcium oxalate stone has a very high probability of developing the same type of stone again. Therefore, laboratory analysis of the composition of the first stone is of great importance. According to the analysis results, a personalized nutrition plan should be created. Measures such as increasing daily water consumption, reducing salt and animal protein intake, and limiting foods rich in oxalate should be taken. In addition, medications that balance urine pH may be used as recommended by the doctor. All these steps significantly reduce the risk of stone recurrence.
While the recurrence of kidney stones in women is mostly due to infection-related struvite stones, the tendency to recur in men results from metabolic factors. In women, urinary tract infections should be treated early, while in men habits such as protein-based nutrition and low water intake should be controlled. In addition, regular medical follow-up is of great importance in both genders. Having an ultrasound or urine analysis at least once a year ensures that stone formation is detected at an early stage. In short, the key to preventing the recurrence of kidney stones is to make balanced nutrition, adequate fluid intake, and regular check-up habits permanent.
Can Kidney Stone Formation Be Prevented?
The most fundamental step in preventing kidney stone formation is maintaining body fluid balance. Drinking a sufficient amount of water daily ensures that the urine is diluted and prevents mineral crystals from combining to form stones. An average adult is recommended to drink at least 2.5–3 liters of water per day. Especially in hot weather and during intense physical activity, water consumption should be increased further due to increased fluid loss. In addition, avoiding salt, sugar, and processed foods reduces the burden on the kidneys and lowers the risk of stones.
Diet also greatly affects the risk of kidney stones. Completely eliminating calcium intake is not the correct approach; on the contrary, calcium obtained from natural sources such as milk and dairy products combines with oxalate in the intestine and prevents stone formation. However, calcium supplements should not be used without a doctor’s recommendation. In addition, excessive consumption of foods containing high amounts of animal protein, such as red meat, organ meats, and seafood, may cause uric acid stones. Instead, plant-based protein sources such as lentils, chickpeas, and beans should be preferred.
Finally, maintaining the pH balance of urine is also an important factor in preventing stone formation. An acidic urine environment especially prepares the ground for the formation of uric acid stones. Therefore, regular consumption of citrus fruits such as lemon juice, oranges, and grapefruit increases citrate levels in the urine and reduces stone risk. Avoiding excessive consumption of caffeinated and carbonated beverages helps the kidneys function more healthily. In addition, lifestyle habits such as regular exercise, sufficient sleep, and stress management support kidney health. In general, balanced nutrition and a healthy lifestyle can largely prevent kidney stone formation.
Which Foods Cause Kidney Stones?
One of the most important factors triggering kidney stone formation is dietary habits. Foods rich in oxalate play a critical role in stone development. Foods such as spinach, beetroot, chocolate, cocoa, hazelnuts, almonds, tea, and sweet potatoes contain high amounts of oxalate. When these substances combine with calcium in the urine, they may lead to the formation of calcium oxalate stones. In addition, excessive salt and sodium consumption also increase the risk of kidney stones. Salt increases the amount of calcium excreted through urine, creating an environment favorable for stone formation. Processed foods, pickled foods, chips, and processed meats should especially be limited due to their high sodium content. Likewise, excessive consumption of foods rich in animal protein (especially red meat, seafood, and organ meats) causes the urine to become acidic and facilitates the formation of uric acid stones.
Sugary and carbonated beverages also play an important role in kidney stone formation. Fruit juices containing fructose, sweetened beverages, and acidic sodas increase uric acid production and raise stone risk. In addition, excessive caffeine consumption increases fluid loss in the body due to its diuretic effect and causes urine to become concentrated. This facilitates the combination of crystals and the formation of stones. Likewise, excessive vitamin C supplementation may increase oxalate production in the body and raise the risk of stones. To protect kidney health, it is of great importance to avoid excessive consumption of such foods, drink sufficient water, and establish a balanced diet. Especially individuals with a history of stones should have their nutrition plan personalized under the supervision of a doctor or dietitian.
Different Course of Kidney Stones in Women and Men: Hormonal, Genetic, and Lifestyle Effects
Hormonal differences between female and male bodies have a major effect on the course of kidney stones. In men, increased testosterone raises oxalate production and accelerates stone formation. In women, the estrogen hormone forms a protective barrier by regulating calcium and oxalate levels in the urine. However, after menopause this effect disappears and the risk of stones increases.
Genetic factors also play an important role. The risk is significantly higher in individuals with a family history of kidney stones. Some genetic mutations disrupt the mineral balance in the kidneys and facilitate stone formation.
Lifestyle habits also create differences between genders. In men, high-protein diets, alcohol consumption, and low water intake are the main risk factors. In women, pregnancy, urinary tract infections, and hormonal birth control methods may be effective. In addition, the more frequent occurrence of infections accompanying kidney stones in women may make the course of the stone more complex.
As a result, kidney stones are a disease that can occur in both genders but develops for different reasons. While hormonal and infection-based stones are prominent in women, metabolic and nutrition-based stones are dominant in men. Therefore, treatment and prevention strategies must be planned according to the individual and gender.
Prof. Dr. Berkan Reşorlu, born in Ankara in 1979, completed his medical education at Ankara University between 1997 and 2003, and his specialization in urology at Ankara University Faculty of Medicine between 2003 and 2008. Academically, he received the title of associate professor in 2013 and professor in 2022.
He has conducted extensive case series studies in the field of endoscopic stone surgery, contributed surgeries performed on children under the age of 1 to the literature, and has gained international recognition with his stone scoring system and experimental surgical models.
