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Urolithiasis: Symptoms, Evaluation and Diagnosis, Treatment

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Urolithiasis is the technical term for stones in the urinary tract. The urinary tract extends from kidneys, ureters, urinary bladder and ends in the urethra. Calculi or stones can be found anywhere in these organs.

However, a majority of the urinary tract stones are produced in the kidney and travel along the track to reach these organs. 

What are the symptoms of stones in the urinary tract?

Pain is the most common symptom. However, the character and type of pain depend upon the location of the stone. It is as follows:

Kidney stone: The person may have a dull aching pain in the back on either side of the midline. The pain may be localized or it could radiate to the groin. The pain can be mild or moderate but usually not very severe. It could be very misleading in the sense that it may occur once or twice and may disappear and not appear for the next few days or even weeks. This may give a false sense that the stone has passed off.

Surprisingly the pain could present as ‘gastritis’ which can mislead the doctor and the patient into treating it with antacids. This is quite a common presentation!

The patient may also have nausea and vomiting which again could be misconstrued as gastritis.

Ureteric stone: Pain is a predominant symptom in people with stone in the ureter. The pain is very severe in intensity and described as colicky in type. It is described as gripping or squeezing in type and radiates typically to the groin and even to the upper thigh. It may not reduce despite multiple analgesics and even injection painkillers may not work well at times. Most often it is accompanied by vomiting. The patient will not be able to lie still and will be wriggling and constantly moving on the bed.

Urinary bladder stone: These stones may be dropped down stones from the kidney through the ureter or they could be produced in the urinary bladder itself. They are formed in the bladder in children due to nutritional deficiencies and in the elderly due to prostatic enlargement. The person may have burning urination, painful urination, blood in the urine, urgency in urination or lower abdominal pain. Sometimes it can result in complete urine blockage necessitating emergency treatment.

A bladder stone may migrate further down into the urethra leading to complete blockage of urine with severe pain.

Evaluation and diagnosis of urinary tract stones:

The mainstay in the diagnosis is the ultrasound scan. It is easily available and diagnoses all renal stones and many ureteric stones. There are some ureteric stones that are not seen on ultrasound due to interference by bowel gases. In such cases, a CT scan will help in the accurate diagnosis albeit at a higher cost. X rays are not commonly done now as they fail to detect small stones and radiolucent stones.

Treatment of kidney stones:

The treatment of urolithiasis depends upon many factors. They are:

  • Location of the stones
  • Size of the stones
  • The hardness of the stones
  • Patient’s symptoms
  • The degree of obstruction caused by the stone

Usually, kidney stones which are about 3-4 mm are not treated because they do not cause symptoms. Larger stones are treated because there is a chance that they may migrate into the ureter and cause a blockage. The treatment of such stones is either by ESWL or endoscopy.ESWL is the breaking of the stones by using shock waves. It is a non-invasive, method causing little pain. Anesthesia is not needed and the patient is not hospitalized. Endoscopy is done using a flexible endoscope and the stone is fragmented using a laser. This procedure is done under anesthesia and the hospitalization is for 1-2 days. After the procedure, a stent is kept to facilitate the passage of stone fragments. This stent is removed after 3-4 weeks.

If the stone is in the ureter, it is treated by many methods. If the stone is small,i.e less than 5-6 mm, it is treated by medicines. However medical management is not always successful. In such cases, endoscopy or ESWL are chosen to treat the stone. The choice depends upon many factors. Hard, a large stone is better treated endoscopically as ESWL fails in such stones. The choice also depends upon the desires of the patient as some want only noninvasive methods of treatment and some want more effective treatment.

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