CHP. 19. Stone Disease 129.
What are the symptoms of a urinary stone?
The symptoms of urinary stone may vary with size, shape, and location
of the urinary stone. Common symptoms of urinary stone are:
130. Save Your Kidneys
- Abdominal pain.
- No symptoms. Accidental detection of urinary stone on routine health
checkups or during the workup for unrelated conditions. Stones
that do not cause any symptoms and are detected accidentally on
radiological examinations are known as “silent stones.”
- Frequency of urination and persistent urge to urinate is found in
patients with a urinary bladder stone.
- Nausea or vomiting.
- Passage of blood in urine (hematuria).
- Pain and/or burning while passing urine.
- If the bladder stone gets stuck at the entrance to the urethra, the
flow of urine suddenly stops during urination.
- Passage of stones in urine.
- In a few cases urinary stones can cause complications such as
recurrent urinary tract infection and obstruction of the urinary tract,
causing temporary or permanent damage to the kidney.
Characteristics of abdominal pain due to urinary stone
- The severity and the location of the pain can vary from person to
person depending upon the type, the size and the position of the
stone within the urinary tract. Remember, the size of the stone does
not correlate with the severity of pain. Smaller-sized rough stones
usually cause more severe pain than bigger-sized smooth stones.
- Stone pain can vary from a vague flank pain to the sudden onset of
severe unbearable pain. Pain is aggravated by change of posture
and vehicular jerks. The pain may last for minutes to hours followed
by relief. Waxing and waning of pain is characteristic of a stone
passing down the ureter.
- The abdominal pain occurs on the side where the stone is lodged.
Classical pain of kidney and ureteric stone is the pain from loin to
groin and is usually accompanied by nausea and vomiting.
- A bladder stone may also cause lower abdominal pain and pain
during urination, which is often felt at the tip of the penis in males.
- Many people who experience sudden severe abdominal pain from
stone in the urinary tract rush to seek immediate medical attention.
Abdominal pain and blood in urine strongly
indicate the presence of urinary stones.
Can kidney stones damage the kidney?
Yes. Stones in the kidney or ureter can block or obstruct the flow of
urine within the urinary tract. Such obstruction can cause dilatation of
the urinary pelvis and calyces in the kidney. Persistent severe dilatation
due to blockage can cause kidney damage in the long term in a few
patients.
Diagnosis of urinary stones
Investigations are performed not only to establish diagnosis of urinary
stones and to detect complications but also to identify factors which
promote stone formation.
Radiological investigations
KUB Ultrasound:
The KUB ultrasound is an easily available, less
expensive and simple test that is used most commonly for the diagnosis
of urinary stones and to detect the presence of obstruction.
KUB X-ray :
Size, shape and position of the urinary stones can be
seen on the X-ray of the kidney-ureter-bladder (KUB). A KUB X-
ray is the most useful method to monitor presence and size of stone
before and after treatment of calcium containing stones.It cannot be
used to identify radiolucent stones such as those containing uric acid.
CT scan:
CT scan of the urinary system is an extremely accurate and
themost preferred diagnostic method to identify stones of all sizes and
to determine the presence of obstruction.
Intravenous urography (IVU):
Less frequently used, IVU is very
reliable in detecting stones and obstruction. The major benefit of IVU
is that it provides information about the function of the kidney. Structure
of the kidney and details about ureteric dilatation is better judged by
this test. It is not useful and should not be used when the serum creatinine
is elevated.
Laboratory investigations
Urine tests:
Urine tests to detect infection and to measure pH of the
urine; 24 hour urine collection to measure total daily urine volume,
calcium, phosphorous, uric acid, magnesium, oxalate, citrate, sodium
and creatinine.
Blood tests:
Basic tests such as complete blood count, serum creatinine,
electrolytes and blood sugar; and special tests to identify certain
chemicals which promote stone formation such as calcium, phosphorus,
uric acid and level of parathyroid hormone.
Stone analysis:
Stones that pass out or are removed by different
treatment modalities should be collected for analysis. Chemical analysis
of stones can establish their composition, which helps in treatment
planning.
Beware of “Silent Stones” which cause no pain,
but are most likely to cause kidney damage.