Spa treatment by condition
Spa treatment for kidney stones
Kidney stones are one of the oldest reasons for treatment in Marienbad: the town’s bicarbonate-rich mineral springs have been used for the drinking cure since the 19th century. The Czech indication list lists nephrolithiasis without urinary obstruction as its own position, alongside aftercare following procedures on the kidneys and urinary tract.
What is treated here
- Kidney stones (nephrolithiasis) without current urinary obstruction, especially calcium oxalate stones
- Nephrocalcinosis
- Aftercare following stone fragmentation (ESWL) or other procedures on the kidneys and urinary tract
- Prevention of new stone formation through medically guided increases in fluid intake
How the cure works
Initial examination on arrival day
The spa physician reviews imaging, stone analysis (if available) and kidney function, and sets an individual drinking plan. Bring recent ultrasound or CT reports, and the stone’s composition if known.
Drinking cure on a fixed schedule
Mineral water from the assigned springs is drunk at set times of day in gradually increasing amounts. The goal is sufficient urine volume over the day, not a fixed amount to drink — the spa physician adjusts the amount individually.
Supplementary movement
Walks on the spa paths and measured exercise support general metabolism and fluid distribution through the day.
Weekly check-up and final report
The spa physician checks urine values and adjusts the drinking plan. At the end you receive a report for your urologist and a drinking plan for home.
Treatments used
- Spring selection according to stone composition
- The town’s springs differ considerably in their chemistry, so the choice depends on the type of stone: the Caroline Spring for stones of unknown composition and for oxalate stones, the Forest Spring, with its high bicarbonate content, for uric acid stones, and the Ambrose Spring for calcium phosphate stones. The Rudolph Spring is not suitable for phosphate stones.
- Drinking cure at the mineral springs
- Bicarbonate-rich mineral water increases urine volume, urinary pH and citrate excretion, lowering the supersaturation from which calcium oxalate stones form.
- Individual adjustment of drinking amount
- The spa physician sets the amount and timing according to the type of stone, kidney function and other conditions.
- Nutrition counselling
- On salt, protein and oxalate intake, as part of preventing recurrence alongside the drinking cure.
- Exercise therapy
- Walks and measured exercise as a general part of the spa programme, without direct evidence of their own for stone formation.
- Regular urine checks
- pH and other urine values are checked repeatedly during the stay to adjust the drinking plan.
- Aftercare following lithotripsy
- The drinking cure supports flushing out stone fragments after extracorporeal shock wave lithotripsy (ESWL).
How long, and when
For nephrolithiasis without urinary obstruction (position VIII/2), stays covered by Czech public health insurance run to 21 days of comprehensive or contributory spa care, with repeat stays of 21 or 14 days of contributory care; following procedures on the kidneys and urinary tract, including aftercare after lithotripsy (VIII/3), it is likewise 21 days. Self-paying guests usually choose two to three weeks. The drinking cure can be done all year round; there is no medically preferred season.
What the research on the drinking cure for kidney stones shows
The mechanism is well studied: in a crossover study in healthy men, water containing 1,715 mg of bicarbonate per litre raised urinary pH and citrate excretion and lowered oxalate and the supersaturation for calcium oxalate and uric acid, comparable to potassium citrate (Kessler T, Hesse A, 2000, Br J Nutr; healthy volunteers, not patients). A double-blind crossover study of 34 patients with recurrent calcium oxalate stones found, under 1.5 l of water with 2,673 mg of bicarbonate per litre, a urinary pH of 6.73, higher citrate and magnesium levels and lower calcium oxalate supersaturation, alongside a higher risk of phosphate stones; even ordinary water lowered supersaturation, purely through the amount drunk (Karagülle O et al., 2007, World J Urol; only 3 days, small sample). A 12-week RCT of 51 patients found higher urine volume, magnesium, pH and citrate under bicarbonate-rich water compared with normal water, while oxalate and the Tiselius index did not differ (Lu Y et al., 2022, Int Urol Nephrol; open-label study). The European guideline on preventing recurrence names adequate fluid intake, alongside managing calcium and salt intake, as the basis of prevention (Skolarikos A et al., 2024, Eur Urol). A review describes the drinking cure with low-mineral waters, aiming for at least 2.5 l of urine daily, as a component of prevention in predisposed patients and for flushing out fragments after lithotripsy (Mennuni G et al., 2015, Clin Ter; narrative). In Marienbad itself, a clinical study on the objective effects of spa treatment for urological and nephrological diagnoses has been running since 2026 — the first in 30 years — following more than 100 patients; results are not yet available (Institute of Spa Treatment and Balneology & Léčebné lázně Mariánské Lázně, 2026, ClinicalTrials.gov NCT07435844). None of these studies shows that the drinking cure dissolves existing stones or replaces a necessary stone fragmentation procedure; its documented effect concerns urine composition and the prevention of new stones.
When a spa cure is not an option
- Acute urinary obstruction, colic or blockage of the urinary tract — this needs acute urological treatment, not a spa cure
- An active urinary tract infection with fever
- Unexplained bleeding from the urinary tract
- General contraindications: uncontrolled heart failure, active cancer, pregnancy
Whether and to what extent a spa cure is right for you is decided by the spa physician at the initial examination, based on your imaging and kidney function. This page provides information and does not replace urological advice.
Frequently asked questions
Which spring should you drink for which kidney stone?
The assignment is made by the spa physician and depends on the composition of the stone. For stones of unknown composition and for oxalate stones, the Caroline Spring is prescribed. For uric acid stones, the Forest Spring: it contains a great deal of bicarbonate and alkalinises the urine, and uric acid stones can be dissolved by alkalinisation. For calcium phosphate stones, the Ambrose Spring. The Rudolph Spring, otherwise the best known in the town, is explicitly not suitable for phosphate stones. So never drink a different spring, or a different amount, than prescribed.
Which spa cure helps with kidney stones?
Marienbad lists nephrolithiasis without urinary obstruction as an official indication (position VIII/2) and uses a structured drinking cure from the bicarbonate-rich mineral springs for it. Controlled studies show that such water raises urinary pH and citrate excretion and lowers supersaturation for calcium oxalate.
Does a spa cure in Marienbad help with kidney stones?
The general effect of bicarbonate-rich mineral water on urine composition is supported by several controlled studies. Specifically for Marienbad, a dedicated clinical study on urological and nephrological diagnoses has been running since 2026, the first in 30 years; its results are not yet available.
How much mineral water do you drink during a drinking cure?
There is no fixed litre amount for every guest: the spa physician sets the drinking amount individually, aiming for sufficient urine volume over the day. A review on kidney stone prevention names at least 2.5 l of urine daily as a benchmark.
Can I go for a spa cure with kidney stones and no symptoms?
Yes, that is the typical case for position VIII/2: nephrolithiasis without current urinary obstruction. If there is acute colic, a urinary tract blockage or a feverish infection, acute urological treatment is needed first, not a spa cure.
Does the drinking cure replace stone fragmentation (ESWL)?
No. The drinking cure supplements urological treatment, for example as aftercare following lithotripsy and to flush out fragments, but does not replace a necessary procedure for larger or obstructing stones.
Sources
Studies and official documents this article relies on. Our content does not replace medical advice.
- Léčebné lázně Mariánské Lázně — treatment of urological conditions — The operator’s page: assignment of the springs to stone type — Caroline Spring for unknown composition and oxalate stones, Forest Spring for uric acid stones, Ambrose Spring for calcium phosphate stones. Czech text.
- Czech indication list for spa treatment (Decree No. 2/2015 Coll.), Group VIII — diseases of the urinary system — Positions VIII/2 (nephrolithiasis without urinary obstruction, nephrocalcinosis) and VIII/3 (conditions after operations on the kidneys and urinary tract), with type of care and length.
- Kessler T, Hesse A 2000, Br J Nutr — crossover study, healthy men — Bicarbonate-rich water raised urinary pH and citrate, lowered oxalate and supersaturation for calcium oxalate and uric acid. Healthy volunteers, not patients.
- Karagülle O et al. 2007, World J Urol — double-blind crossover study, 34 patients — Higher citrate and magnesium levels, lower calcium oxalate supersaturation, higher phosphate stone risk. Only 3 days, small sample.
- Lu Y et al. 2022, Int Urol Nephrol — RCT, 51 patients with calcium oxalate stones — 12 weeks: higher urine volume, magnesium, pH and citrate compared with normal water. Open-label study.
- Skolarikos A et al. 2024, Eur Urol — EAU guideline update — Adequate fluid intake and calcium intake, less salt and protein, as the basis of preventing recurrence.
- Mennuni G et al. 2015, Clin Ter — review on the drinking cure for nephrolithiasis — Drinking cure with low-mineral waters, aiming for ≥2.5 l of urine daily, as prevention and for aftercare following lithotripsy. Narrative.
- Institute of Spa Treatment and Balneology & Léčebné lázně Mariánské Lázně 2026, ClinicalTrials.gov (NCT07435844) — Ongoing clinical study on spa treatment for urological and nephrological diagnoses in Marienbad, over 100 patients. Results not yet available.
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