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Preface and Contents

Stone Disease

Symptoms and Diagnosis of Stone Disease

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.