“Mariánské Lázně must keep up its urology,” says chief physician Pavel Knára
Kidney stones, urinary tract infections, chronic prostatitis or life after a kidney transplant. Why is it the Rudolph Spring that people drink here, what is the curved spout of the spa cup for, and what should you bring to the doctor? Answers from MUDr. Pavel Knára, emeritus chief physician of the Nové Lázně hotel.
You break up the stone, but then you need to flush the fragments out of the body. And spa treatment in Mariánské Lázně is excellently suited to that.
Kidney stones, urinary tract infections, conditions after operations on the kidneys and urinary tract, chronic inflammation of the prostate or life after a kidney transplant. Urology is one of the main fields that have been treated in Mariánské Lázně for more than a hundred years. Why is it the Rudolph Spring that people drink here, what is the curved spout of the spa cup good for, and what should you bring with you to the doctor? Answering these questions is MUDr. Pavel Knára, emeritus chief physician of the Nové Lázně hotel, who has worked in spa medicine for more than 50 years.
Note: the interview was recorded in Czech for the Ensana spa podcast. The full transcript follows below in English.
A hundred years of urology in Mariánské Lázně
Dr Knára, how did urology begin in Mariánské Lázně?
Mariánské Lázně became a public spa in 1818. When I talk about its history, I always say that the 19th century was the century of obesity and the Cross Spring. The twentieth century belonged to urology, that is, to the kidneys and urinary tract, and to the Rudolph Spring.
Just as a matter of interest: one of the first urology departments in Austria-Hungary was founded right here in 1913. And the huge building of today's hotel school was originally meant to be a urological sanatorium.
What is treated here
What urological problems do patients come to you with?
According to the indication list for spa care, three groups are mainly treated here: kidney stones, inflammation of the kidneys and urinary tract, and post-operative conditions. Recently added to them are prostatitis, life after a kidney transplant and also kidney donors.
Among the post-operative conditions, the list includes complicated prostatectomy. In the vast majority of cases, however, the prostate is removed because of a tumour. If the tumour has been confirmed histologically and the patient is in remission, he can come for comprehensive spa treatment under oncology indication I/1.
How has the treatment of kidney stones changed over that time?
I have been working for more than 50 years, and urology has come an enormous way in that time. As a young doctor I assisted at operations where the whole flank was cut open because of a stone. Then the stone had to be found, and often it could not even be found because it was tiny. Today stones are broken up from outside with shock waves, by so-called ESWL.
And this, in my opinion, is where our domain should be. You break up the stone, but then you need to flush the fragments out of the body. And spa treatment in Mariánské Lázně is excellently suited to that.
| Item on the indication list | What it covers | Length of stay |
|---|---|---|
| VIII/1 | recurrent and chronic inflammation of the kidneys and urinary tract resistant to antibiotics (at least 12 months under the care of a urologist), cystic kidney disease | K 21, P 21, repeat P 21 (P 14) |
| VIII/2 | nephrolithiasis (kidney stones) without urinary obstruction, nephrocalcinosis | K 21 (among others, stones in a solitary kidney or in both kidneys if surgery or lithotripsy is not indicated; cystine stones), P 21, repeat P 21 (P 14) |
| VIII/3 | conditions after operations on the kidneys and urinary tract, after complicated prostatectomy, follow-up treatment after ESWL | K 21, P 21 |
| VIII/4 | chronic prostatitis resistant to medication and antibiotics (at least 12 months under the care of a urologist) | P 21, repeat P 21 (P 14) |
| VIII/5 | condition after kidney transplant with stable function, kidney donor | K 21, repeat P 21 (P 14) |
K = comprehensive care paid by the health insurer including accommodation, P = contributory care, the number is the number of days. Source: Annex 5 to Act No. 48/1997 Coll. (applies to Czech public health insurance).
Kidney stones and the drinking cure
If my stone has been broken up with shock waves and I get a spa stay, what will happen to me here?
We build on two things. The first is the drinking cure with the Rudolph Spring. It is a diuretic: you pass more urine after drinking it, and the fragments of the stone are flushed out more easily. The second is treatment with carbon dioxide, that is, carbonic water baths and dry carbonic baths. They improve blood circulation and so support the production of urine.
How long does this kind of “flushing” take?
A stay under this indication lasts three weeks. How quickly someone gets rid of a stone, however, differs from person to person.
The springs are also prescribed according to the type of stone. How does that work?
That would take an hour-long lecture. There are many kinds of stones, and only some can be dissolved, the so-called urate stones. For those, the Forest Spring helps, with its high content of hydrogen carbonates, which makes the urine alkaline. For calcium oxalate stones, and where we do not know the composition of the stone, I recommend the Caroline Spring. For struvite and phosphate stones, it is the turn of the Ambrose Spring.
Most of the time, though, we do not know what the stone is made of. When we see small stones of around 2 to 3 millimetres on ultrasound, which are not suitable for breaking up, I recommend the Caroline Spring during the day and a little Rudolph in the evening. The calcium from the Rudolph Spring binds to oxalic acid and leaves the body in the stool, not in the urine.
How much should you actually drink?
I always get that question at lectures. And I answer: I don't know. I don't know your age, your weight, your blood pressure or the medication you take. A young, healthy man can drink up to 20 millilitres of the Rudolph Spring per kilogram of body weight, but never more than two litres a day. To a grandmother with three stents who takes two kinds of blood pressure medication, I say: careful, just two cups. The drinking cure is a complicated thing, and you have to know how to do it.
The Rudolph Spring has a special place in Mariánské Lázně. Why?
It has a lot of calcium and magnesium, in a ratio of roughly 2 : 1. That is why it is traditionally suitable for older people too, for example with osteoporosis. And today you can buy it in bottles in the shops. I still remember the green glass bottles that were sold in pharmacies, even in what was then East Germany. Then there was a long break, and now Rudolph is back. I consider that a very good thing.
According to the analysis on the packaging of the Rudolph Spring, a litre of the water contains 300 mg of calcium and 147 mg of magnesium. Which spring to drink, how much and when is always decided by the spa doctor.
The prostate, the bladder and transplants
You are the author of a treatment procedure for chronic prostatitis. How did it come about?
When I was still working full time, the Pilsen urologist Dr Rosenberg used to come here, and Nové Lázně specialised directly in chronic inflammation of the prostate. It used to be called chronic prostatitis; today it is chronic pelvic pain syndrome. And when a disease has a lot of names, it usually means we don't know much about it.
These patients are called migratory birds. They go from urologist to urologist, each one gives them antibiotics, and the antibiotics don't work. I can recognise a prostate patient as soon as he comes through the door: he is stressed, he is in pain and he feels that nobody can help him. We devised a special treatment procedure for them and presented it successfully at the world balneology congress in Hévíz, Hungary.
What does it consist of?
Carbonic water baths and dry carbonic baths, peat wraps on the lower back, but above all ultrasound and paraffin wraps on the prostate area. In this way, the periods in which patients were free of symptoms grew longer. They kept coming back to us and stayed for at least two to three weeks. Covid broke that tradition, and now we are trying to revive it.
Bladder infections in women are similarly persistent.
Yes. What prostatitis is for men, bladder infections are for girls and women. They come back after every cold, and the women are unhappy about it. Here we use heat, peat wraps in the shape of a kind of “briefs”, treatments with carbon dioxide and above all the drinking cure with the Rudolph Spring, which has the longest tradition for this diagnosis.
And how do you help patients after a kidney transplant?
One kidney has to do the work of two, and it adapts to that slowly. That is why here, too, we use carbon dioxide treatments to support blood circulation. And it is also a psychological matter. For someone who has been on dialysis for a long time and has received a new kidney, it is something wonderful.
The secret of the spa cup
You talk about cups. How much is one cup, actually?
You've set me up nicely there. Together with colleagues I wrote a book about the mineral springs of Mariánské Lázně, and it is still sold today in four languages. A proper spa cup holds 220 millilitres, which is roughly seven troy ounces. Today, though, cups are sold for their looks: all sorts of kittens, squirrels and little cows. The doctor says one cup three times a day, someone buys a kitten the size of a shot glass, and the result is completely different. If your cup has no measuring marks, measure it.
And why does it have that curved spout?
I didn't know that for about 48 years. All the springs of Mariánské Lázně contain a lot of iron. As long as the water is in the ground, the iron is divalent and the body can absorb it. In the air it oxidises to trivalent iron, the water turns cloudy and a sediment forms. That is why I categorically recommend drinking the springs right at the spring.
Our ancestors were clever. They knew that the surface oxidises, so they drank through the spout from the bottom of the cup. And there is one more thing: from a glass you drink over your teeth, from the spout only behind them. The iron that settles on the teeth stains them dark. When I asked patients at their final check-up whether they had drunk the springs as I had prescribed, I said: show me your teeth. Whoever had white teeth hadn't been drinking. Don't worry, the staining disappears again.
You can buy a cup like that right here in Mariánské Lázně.
Yes, Mariánské Lázně has its own cups holding 220 millilitres. At lectures I always ask whether anyone has a cup. People pull out all kinds of 100 ml and 200 ml glasses. And when I finally rejoice over the right one, with 220 millilitres, and borrow it, it says Karlovy Vary on it. That always hurts me a little.
Ultrasound, a urologist and two litres a day
What is new at Nové Lázně?
The spa bought an ultrasound machine, and every Wednesday the urologist, chief physician Umer, holds a surgery here. I work with him as a balneologist. We examine patients together, estimate the weight of the prostate, look at the bladder and kidneys. The prostate patients are slowly coming back to us, even though it is a long haul. And at my age I have learned to recognise kidney stones on ultrasound, which pleases me very much.
Recently a client came to us from Qatar. On ultrasound we found three small stones in the left kidney and three in the right. I prescribed a drinking cure, the Caroline Spring and a little Rudolph. At the follow-up examination only one small stone could still be seen. She has since come back to us twice.
What should a patient bring to the spa doctor?
Insured patients coming under the indication list have a report from their own doctor. For self-paying guests it would be ideal if they had an analysis of a stone they had already passed. On ultrasound you only see a shadow; you cannot tell the composition. In someone who has had renal colic, the stone usually passes unnoticed. They would have to urinate through a sieve to catch it and have it analysed. And it is precisely knowing the composition that helps us most in choosing the right spring.
Your final piece of advice?
Anyone prone to stones must drink enough to pass about two litres of urine a day. That also answers the eternal question of how much everyone should drink, because it is different for each person. And the night is important. Stones form mainly at night, when the urine is highly concentrated. That is why it is good to get up twice in the night to go to the toilet and drink again.
My father had oxalate stones, my sister has them and so does my son. Only I don't, and, with tongue in cheek, that is because I dutifully had a beer in the evening and then had to get up in the night. Mariánské Lázně has a great tradition in urology; it was treated here throughout the whole of the 20th century. So I think it must keep it up.
Inclusion in the treatment plan, the choice of spring and the amount of the drinking cure are always decided by the spa doctor. The full episode of the Ensana spa podcast (in Czech) is available on YouTube and Spotify.
Sources
Studies and official documents this article relies on. Our content does not replace medical advice.
- Interview with MUDr. Pavel Knára, emeritus chief physician of the Ensana Nové Lázně hotel — Ensana spa podcast (in Czech), November 2026 — Primary source of the article; MUDr. Pavel Knára authorised the Czech text of the interview.
- Czech indication list for spa treatment (Annex 5 to Act No. 48/1997 Coll.), group VIII — diseases of the urinary system — Official list of diagnoses, type of care and length of the stay covered by Czech public health insurance.
- Bartoš J., Nečasová D., Knára P. 2018 — Mineral springs in Mariánské Lázně for the drinking cure (Minerální prameny v Mariánských Lázních k pitné léčbě; FORNICA graphics, ISBN 978-80-87194-54-6) — The book the chief physician mentions in the interview; source for the traditional use of the springs and their analyses.
- Rudolph Spring — analysis printed on the packaging of the bottled water — 300 mg of calcium and 147 mg of magnesium per litre (the label figure quoted in the article).
Health claims last reviewed:
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