Usually present with severe pain as the stones formed in the kidney moves down the ureter which is the tube connecting the kidneys to the bladder.
Urinary Stone Disease
Urinary stone disease can be a very painful condition. The symptoms of stones in the urinary tract depend on the site of the stones. The stones are generally formed in the kidney and they could move down the ureter into the bladder and finally it is passed through the urethra. On the way down these stones can cause obstruction to the ureters and cause severe pain which is called renal colic or ureteric colic. Patients presenting with ureteric colic have excruciating pain on the side of the body and the flanks moving down to the groin. The pain can come at intermittent episodes of increased severity. If the obstruction is associated with infection they could present with severe fever and feeling unwell and at times with features of sepsis. Stones in the bladder can cause pain just after passing urine. Stones in the urethra can cause severe pain of stinging and burning in the urethra.
How common is stone formation?
Stone disease affects 1-5% of the population with a lifetime risk of 10-20% in Caucasian men and is about 5-10% for women. For those who form stones the risk of making another stone within five years of the first stone is about 50%.
What are the types of stones?
The composition of the stones varies. The most common type of stone contains calcium and oxalate occurring alone or in combination with other salts. This accounts for 80% of all types of stones. The remaining 20% of stones are composed of salts which do not contain calcium.
What are the risk factors for stone formation?
The highest incidence of stones occurs in the age group of 20 – 50 and male populations are more likely to develop stones.
There is a heredity tendency in making stones
The stones are more likely to occur in the parts of the world populated by Caucasians and Asians.
Certain hereditary disorders can promote the development of stones
What other factors are considered in the treatment of stones?
The treatment of stones depends on the size of the stones and where they are located and also the presence of other factors like obstruction and presence of infection. Kidney stones are treated if they are causing symptoms. Some stones can grow rapidly in the kidney and become large (called staghorn stones). Such stones are more likely to cause infection at a later stage and therefore these stones will be treated. Stones larger than 2cm in size in the kidney are more likely to be treated by keyhole surgery called percutaneous nephrolithotomy. Stones smaller then 2cm may be amenable to a treatment by shockwave treatment, called extracorporeal shockwave lithotripsy. Stones located in the lower part of the kidney, if they are more than 1cm in size are more likely to be treated keyhole surgery called percutaneous nephrolithotomy.
Patients presenting with ureteric stones present as an emergency with severe pain or with obstruction or with infection. If they present with obstruction and infection the immediate treatment would be to decompress the kidney by means of passing a needle from the back and drain the kidney or to place a plastic tube between the kidney and the bladder though an endoscopy (the plastic tube is called stent). Once the kidney is decompressed then the stone, if it is small in size (less than 6mm) may pass spontaneously. If not these stones maybe treated by endoscopy fragmentation (breaking) by using laser or other energy sources and these stones can be retrived.
Bladder stones are treated by breaking them through and endoscope and removing them.
What should I do if I think I have stones?
If you have severe pain on the side you present to your local Accident and Emergency Unit. Sometimes other serious conditions in the abdomen, like rupture of aortic aneurism or other problems with the bowel can be confused as kidney or ureteric stones. Therefore if you have severe pain in your abdomen, you should visit the nearest Accident and Emergency Unit or seek help from your general practitioner if that is possible. If you have intermittent variable pain on your side, this could be due to your kidney stones and you should seek advice from your general practitioner.
What tests will I have, if I am suspected to have stones?
Your general practitioner may organise for an ultrasound scan and a plain x-ray which may show the presence of any blockage to the kidney or it may show the stones. A more accurate test for looking for the stones would be a CT scan which is done without any contrast material. This CT scan can pick up stones as small as 2mm in size.
If I have already had a stone and was treated, what can I do to prevent further stone formation?
If you have formed stones on more than one occasions or if you have multiple stones at the time of initial presentation, you urologist may check for any underlying causes for this stone formation. This may include increased calcium or oxalate salts in the urine or uric acid in the urine. This is done by checking for these salts in the blood and to check the salts levels in the urine. To more reliably check the salts in the urine they would require a collection of urine passed over a 24 hour period.
What at the side effects of stents, which are put in during the initial presentation of the stone pain?
The stents are place to decompress the kidney and bypass the blockage. Unfortunately the stents can irritate the bladder and you may find yourself having irritation and pain in the bladder area or in the urethra. You may also have the necessity to go to the toilet more frequently. Sometimes the body can react to aggressively against this foreign material stent and it could cause soreness or inflammation of the bladder lining which may result in presence of blood in the urine.
How successful is stone treatment?
The outcome of the stone treatment will depend on the size of the stones. The larger the stone, the treatment can be harder and you may require more than one sitting of treatment (either by shockwave lithotripsy or by keyhole surgery). Small ureteric stones or kidney stones could be removed by the endoscopy and this also may require more than one sitting.
What can I do to prevent stone formation?
If there is an underlying cause for your stones, this may be treated with a specific treatment. Otherwise the only proven preventative measure is to increase your fluid intake and to make sure you pass at least 2 litres of urine per day. To achieve that you would have to drink at least 3 litres of fluids per day.
These are the stones which have moved down the tube from the kidneys. Depending on the site of the stone within the ureter the distribution of the pain can vary from the upper back on the side of the kidney to down to the flanks and to the groin and all the way up to the genitals.
The stones less than 5 mm in size have a 95% chance of moving down from the ureter and entering the bladder. However the passage of the stone through the ureter can be extremely painful which may need to visit the hospital for control of pain. If there is during the passage of the stone it can also cause acute blockage to the kidney which could also cause kidney pain. If there is associated with infection then it could be a really significant emergency. Uretic stones are treated on an emergency setting by control of the pain. If there is any significant obstruction of the kidneys or compromise to the overall kidney function for example stone in a single kidney then the kidneys need to be immediately unblocked by passing a small plastic tube called a stent which is passed from the bladder up in to the kidney or by draining the kidney from the side of the abdomen by a tube called nephrostomy. It may be possible to break the stone and remove the stone during the urgent (acute presentation). However it may not be possible majority of the times due to the impact to the stone causing inflammation and weakening of that part of the wall of the ureter which carries increased risk of rupture of the ureter. Therefor the usual practice would be to put a stent and drain the kidney and go back in a few weeks afterwards to treat the stone by removing it without breaking depending on the size. The stones less than 5mm in size which are not causing significant pain or if the pain is controlled by painkillers can be expected to pass themselves spontaneously in this situation patients could be prescribed with a medication to relax the tubes called Tamsulosin and also simple painkillers. This is called medical ?? treatment. Of course if that passing of the stone is proving to be difficult and if it continues to cause pain or causing blockage or infection then those stones need to be treated accurately. Bladder stones are usually due to the obstruction to the ?? of the bladder at the level of the prostate these stones tends to be larger in size which would need to be surgically removed. Soft flaky stones can also form around the urinary catheters causing frequent blockage of the catheter or bladder spasms and dry passage and leakage of urine around the catheter. Therefore the bladder ?? would need to be treated surgically. Rarely the stones from the kidney or the bladder can get stuck in the ureter and cause blockage to the urine or significant pain which will also need to be treated surgically unless the stone passes spontaneously.