Know the stone:
A stone is a hard, solid mass that can form in the gallbladder, bladder, and kidneys. These types of stones have different causes and are treated in different ways.
This information includes kidney and ureteral stones. Stone develops in the kidney and either stay there or move to the ureter (Fig. 1).
Generally, Kidney stones form when minerals or acid salts in urine crystalize. Most stones leave body while urinate. However, sometimes stones get stuck in the ureter, block the normal flow of urine, and cause symptoms. Stones can also be too big to leave the kidney. In both cases you may need treatment to remove the stone.
Medical terms for stones:
- Calculi → stones
- Ureteral calculi → stones in your ureter
- Renal calculi → stones in your kidney
- Urolithiasis → stone disease
Causes of stones
Some people are more likely to form stones than others. You are at higher risk if you have:
- A family history of stone disease
- A stone which contains brushite, uric acid, or urate
- Stones caused by an infection in your urinary system
- A genetic condition which makes you prone to forming stones
- A narrowing of your ureters
- An obstruction at the junction where your ureter meets your kidney
- Certain urological conditions may increase the risk of stone disease:
- Medullary sponge kidney (a birth defect)
- A cyst or a condition called calyceal diverticulum
- Vesicoureteric reflux (an abnormal movement of urine into the ureters or kidneys)
- Horseshoe kidney (a birth defect)
- Swelling in one of your ureters, called ureterocele
- Nephrocalcinosis (too much calcium in the kidneys)
- Some other conditions are also associated with stone disease. These include:
- Hyperparathyroidism (excessive production of the parathyroid hormone by the parathyroid glands)
- Gastrointestinal diseases (jejuno-ileal bypass, intestinal resection, Crohn’s disease, malabsorptive conditions, and urinary diversion)
- Sarcoidosis (inflammation that causes tiny lumps of cells in various organs in your body)
People often associate kidney and ureteral stones with pain. However, symptoms can vary from severe pain to no pain at all, depending on stone characteristics – such as the size, shape, and location of the stone in the urinary tract (Fig. 1).
Severe pain (renal colic)
If the stone blocks the normal urine flow through the ureter you will experience severe pain, known as renal colic. This is a sharp pain in the loin and the flank (the side of your body, from the ribs to the hip). If the stone is not in your kidney but in your ureter, you may feel pain in the groin or thigh. Men can also have pain in their testicles (Fig. 2).
Other symptoms that may accompany renal colic are:
- Blood in the urine (urine appears pink)
- Painful urination
Renal colic is an emergency situation and you should contact your family doctor or nearest hospital to relieve the pain. In case of high fever you must seek medical help immediately.
Fig. 2: Area of possible renal colic pain.
No pain or no symptoms at all…/Asymptomatic stone…
Stones can also cause a recurrent, dull pain in the flank. This kind of pain may be a symptom of other diseases as well, so you will need to take medical tests to find out if you have kidney or ureteral stones.
Some stones do not cause any discomfort. These are called asymptomatic stones and are usually small. They do not block the flow of urine because they are located in the lower part of the kidney or attached to the ureteral wall. In general asymptomatic stones are found during x-ray or similar imaging procedures for other conditions.
Treatment of Kidney and Ureteral Stones:
There are different treatment options.
Factors that influence the decision include:
- Stone characteristics
- Medical history of patient
- The kind of treatment available at hospital and the expertise of your doctor
- Patient personal preferences and values
Not all stones require treatment. You need treatment if your stone causes discomfort and does not pass naturally with urine. Doctor may also advise treatment if you have pre-existing medical conditions.
If you have a kidney or ureteral stone which does not cause discomfort, you will generally not receive treatment. Your doctor will give you a time schedule for regular control visits to make sure your condition does not get worse.
Conservative stone treatment
If your stone is likely to pass with urine, your doctor can prescribe drugs to ease this process. This is called conservative treatment.
If your stone continues to grow or causes frequent and severe pain, you will get active treatment.
There are 4 common ways to remove stones:
- ESWL – shock-wave lithotripsy
- URS – Ureteroscopy
- PCNL – Percutaneous nephrolithotomy
- RIRS – Retrograde intrarenal surgery – THE LATEST LASER METHOD