Kidney and Urinary Tract Treatment in Mariánské Lázně
Mariánské Lázně (Marienbad) is listed in the Czech indication list as a spa for diseases of the urinary system, and spa physicians have treated urological patients here since the 19th century. The foundation of care is the drinking cure from the local bicarbonate springs, complemented by baths, wraps and exercise under medical supervision.
This article explains which diagnoses belong here, how the drinking cure works, what the research says about it and what to expect realistically from a stay. It does not replace the advice of a urologist or nephrologist: whether spa treatment is suitable for you is decided by your treating doctor and then by the spa physician at the initial examination.
Which Diagnoses Are Treated Here
The Czech indication list (Decree No. 2/2015 Coll.) places diseases of the urinary system in group VIII. The following are treated in Mariánské Lázně:
- VIII/1 — recurrent and chronic non-tuberculous inflammations of the kidneys and urinary tract that do not respond to antibiotics and other treatment, in the systematic care of a urologist for at least 12 months; cystic kidney disease.
- VIII/2 — nephrolithiasis (kidney stones) without congestion in the urinary tract; nephrocalcinosis.
- VIII/3 — conditions after kidney and urinary tract surgery, after complicated prostatectomy and nephrolithotripsy, after-treatment following shock wave lithotripsy.
- VIII/4 — chronic prostatitis or prostatovesiculitis that does not respond to medication and antibiotics, in the care of a urologist for at least 12 months.
- VIII/5 — conditions after kidney transplantation with stable graft function; kidney donors.
For each item the list also specifies the type and length of the covered stay. For kidney stones (VIII/2), for example, the basic stay is 21 days in both comprehensive and contributory care, and a repeat stay in contributory care is 21 days (14 in justified cases). The exact conditions for each diagnosis can be found on the page indications and contraindications.
Spa treatment is intended for periods when the disease is quiet. Acute inflammation, stones with urinary congestion or uncompensated kidney disease are reasons to postpone the stay; this is assessed by the treating doctor in the referral and by the spa physician on arrival.
The Drinking Cure — the Foundation of Urological Treatment
The drinking cure means drinking mineral water regularly, directly at the spring, in the doses, timing and quantity prescribed by the spa physician according to your diagnosis, urine results and other conditions. It is not casual sipping: the composition of the water, the daily volume and the time of day are adjusted during the stay according to check-up examinations.
Why Bicarbonate Springs in Particular
The springs used for urological patients in Mariánské Lázně belong to the waters with a high bicarbonate content and varying proportions of calcium and magnesium. Three effects matter for the urinary tract, and all three are well described in the literature:
- Urine volume. According to the European Association of Urology guideline, adequate fluid intake is the basis of preventing recurrent stones; the target is usually at least 2–2.5 litres of urine per day (Skolarikos et al., 2024, Eur Urol). The drinking cure is a way of adopting such a regimen under supervision.
- Urinary pH and citrate. Bicarbonate raises urinary pH and the excretion of citrate, which inhibits the formation of calcium oxalate crystals. In a crossover study in healthy men, water with a high bicarbonate content had an effect similar to potassium citrate, the standard medication (Kessler and Hesse, 2000, Br J Nutr). In 34 patients with recurrent stones it raised urinary pH to a level suitable for prevention and increased both citrate and magnesium; calcium oxalate supersaturation, however, fell with both waters tested thanks to the larger volume (Karagülle et al., 2007, World J Urol).
- Magnesium. In a randomised trial with 51 patients with calcium oxalate stones, bicarbonate water increased urine volume, magnesium, pH and citrate over 12 weeks compared with plain water; oxalate excretion did not change (Lu et al., 2022, Int Urol Nephrol).
Drinking a suitable mineral water therefore measurably changes the composition of urine, and that is precisely the aim of the drinking cure in patients with stones.
Why the Physician Decides Which Spring You Drink
Alkalising the urine helps with calcium oxalate and uric acid stones. With calcium phosphate stones or infection stones it can, on the contrary, be a disadvantage; in the study by Karagülle et al., the risk of phosphate stones increased while drinking bicarbonate water. This is why the drinking cure is prescribed only after the stone and urine have been analysed, and why several springs with different compositions are combined in Mariánské Lázně.
Springs Used in Urology
- Rudolph Spring (Rudolfův pramen) — water with a higher content of calcium and bicarbonates; traditionally the basic spring for patients with urinary stones and inflammations.
- Caroline Spring (Karolinin pramen) — water with a higher proportion of magnesium; physicians often prescribe it in combination with the Rudolph Spring at a different time of day.
- Forest Spring (Lesní pramen) — a more mildly mineralised water, suitable for topping up the daily fluid volume; it rises in the Ensana Centrální Lázně building.
The detailed composition and location of all the springs can be found in the springs overview.
Inflammations of the Urinary Tract and Kidneys
Recurrent bladder infections and chronic inflammation of the renal pelvis are treated at the spa during quiet periods of the disease, never during an acute infection. The aim of the drinking cure is to increase urine flow and thereby dilute and flush out bacteria; baths and wraps are intended to ease muscle tension and improve blood flow to the kidney region. Antibiotic treatment and its timing are decided by the urologist.
In a controlled study of 95 patients with chronic pyelonephritis, antibiotic treatment supplemented with bicarbonate mineral water resulted in roughly a quarter fewer recurrences over the following two years than antibiotics alone (Neimark et al., 2004, Vopr Kurortol).
Conditions after Surgery and after Stone Fragmentation
After kidney and urinary tract surgery, after prostatectomy and after shock wave lithotripsy, the stay serves as after-treatment: the drinking cure supports the flushing out of remaining fragments, guided exercise and physiotherapy restore fitness, and the spa physician checks the urine regularly. The review by Mennuni et al. lists the drinking cure precisely as a tool for clearing residual fragments after lithotripsy (Mennuni et al., 2015, Clin Ter).
Chronic Prostatitis
Chronic prostatitis is listed as contributory care (VIII/4). The spa programme combines warm treatments applied to the pelvic region, the drinking cure and guided exercise. A regular exercise programme is one of the non-pharmacological approaches whose benefit in chronic prostatitis is documented by a Cochrane review (Franco et al., 2019, BJU Int). The stay complements the treatment led by the urologist.
Other Treatments
The drinking cure forms the foundation; depending on your condition, the spa physician adds:
- Carbonic mineral baths — 20 minutes in water at 33–34 °C saturated with natural carbon dioxide; used for general relaxation and to improve blood flow in the skin and subcutaneous tissue.
- Peat wraps on the lower back and lower abdomen — the warmth eases muscle tension and relieves pain.
- Diathermy and magnetotherapy — deep warming and a pulsed magnetic field as a complement in chronic inflammation and pain.
- Remedial exercise and terrain cure — walks through the spa park and exercises for the pelvic floor and lower back.
What Is Being Researched in Mariánské Lázně
The drinking cure complements the long-term prevention led by a urologist or nephrologist, and the spa stay is an opportunity to adopt the right drinking regimen. The long-term results of spa treatment in urological patients are now being followed in a clinical trial launched in 2026 by the Institute of Spa Medicine and Balneology together with Léčebné lázně Mariánské Lázně. It follows more than one hundred patients with urological and nephrological diagnoses before and after spa treatment; the study's medical guarantor is Dr Ladislav Špišák, CSc. The trial is registered as NCT07435844. Results are not yet available; once they are published, we will update this article.
How Long the Stay Lasts and What a Day Looks Like
The length of a covered stay is set by the indication list for the specific diagnosis, usually 21 days; a repeat stay in contributory care is 21 or 14 days. Self-paying guests choose the length in consultation with the spa physician. Shorter stays are regenerative rather than therapeutic in character.
An example of a urological patient's day (the actual schedule is drawn up by the physician):
- 6:30–7:30 — morning dose of the drinking cure at the spring, a slow walk along the colonnade
- 8:00 — breakfast
- 9:00–11:00 — treatments (mineral bath, peat wrap or diathermy)
- 11:30 — second dose of the drinking cure
- 12:30 — lunch
- 15:00 — third dose of the drinking cure, a walk in the park
- 18:00 — dinner, evening walk
The daily volume of mineral water is usually around 1.5–2 litres and is adjusted during the stay according to check-up urine tests.
Spa Referral and Insurance
For guests insured in the Czech Republic, the referral for spa care is issued by the treating urologist, nephrologist or general practitioner and approved by the insurer's reviewing physician; in comprehensive care the insurer covers treatment, standard accommodation and meals, in contributory care only the treatment. The step-by-step procedure is described in the spa treatment insurance guide. Those who are not eligible can take the stay as a self-paying guest; the Ensana spa hotels offer urological treatment programmes with an initial examination, the drinking cure and treatments.
Why Mariánské Lázně
The combination of several springs with different ratios of bicarbonates, calcium and magnesium allows physicians to compose a drinking regimen according to the type of stone or inflammation. Add to that two hundred years of experience with urological patients, a spa park for the terrain cure and, since 2026, the spa's own clinical research. Spa treatment here is no substitute for urology; it is an environment where the advice "drink more and keep an eye on your urine" becomes a habit you take home with you.
