Urinary Tract Stones


General

Stones can occur in any part of the urinary tract, from the kidneys down to the urethra.


Signs and Symptoms

  • Stones that obstruct the flow of urine in the upper urinary tract (i.e. kidneys or ureters) can cause severe flank, back, or abdominal pain, nausea and vomiting, and blood in the urine. Any associated infection can cause fever, chills, white count elevation, and an inflammatory response.
  • Stones that are blocking the flow of urine in the lower urinary tract (i.e. bladder or urethra) can cause urine retention with associated pain in the urethra, bladder, or suprapubic region. If obstruction is significant enough, it can lead to upper urinary tract obstruction with associated pain, nausea and vomiting. Stones of the lower urinary tract can also lead to lower urinary tract symptoms (i.e. frequency of urination, urgent need to urinate, night time urination, burning with urination, weak stream, etc.). Any associated infection can cause fever, chills, white count elevation, and an inflammatory response.
  • Stones that are not blocking the flow of urine in the urinary tract may be totally asymptomatic.

Risk Factors

Prior history of urinary tract stone disease, family history of urinary tract stone disease, some types of bone disease, some types of gastrointestinal disease, history of gout, history of chronic urinary tract infections, obesity, type 2 diabetes mellitus, decreased fluid intake, decreased urine output, fluid loss, taking stone provoking medications (i.e. types of diuretics, gout medications, vitamin C, etc.), high or low Calcium intake, high oxalate diet (i.e. nuts, spinach, chocolate, tea, potatoes, vitamin C supplements, etc.), high salt intake, high animal protein diet, low citrus fruit intake.


Evaluation

  • Serum laboratory tests: to evaluate kidney function, and to evaluate for potential contributors to stone formation.
  • Urine tests: urinalysis and urine culture and sensitivity if indicated, 24-hour urine sample as a stone risk analysis and potentially performed on various diets.
  • Imaging: plain film x-rays of the urinary tract, CT scan, ultrasound, or other type depending on various indications).
  • Any stone specimen that is required either by the patient or the physician is typically sent to the lab for stone analysis.

Treatment Options

  • Kidney Stones:

    • Observation if stones are very small or not blocking the urinary tract.
    • Ureteroscopy: performed throught the natural tracts of the urinary tract with access obtained through the lower urinary tract. Treatment of the stone is typically via lasers and devices used to extract stones.
    • Extracorporeal shockwave lithotripsy (ESWL): Performed using a non-invasive high intensity focused acoustic pulse which is directed using x-rays or ultrasound.
    • Percutaneous nephrostolithotomy (PCNL): Performed through a tract which traverses the back into the kidney. Treatment of the stone is typically using lasers or ultrasonic devices that break up stone fragments.
    • Open/Laparoscopic/Robotic incisional removal: Only performed in rare circumstances in which ureteroscopy, ESWL, or PCNL are not possible.
    • Ureteral stents (i.e. internal kidney drainage tubes) or percutaneous nephrostomy tubes (i.e. external kidney drainage tubes that drain the kidney through the back) may be required for a period of time following any of the types of surgical management.
  • Ureteral Stones:

    • Observation if stones are very small or not blocking the urinary tract.
    • Ureteroscopy: performed through the natural tracts of the urinary tract with access obtained through the lower urinary tract. Treatment of the stone is typically via lasers and devices used to extract stones.
    • Extracorporeal shockwave lithotripsy (ESWL): Performed using a non-invasive high intensity focused acoustic pulse which is directed using x-rays or ultrasound
    • Percutaneous nephrostolithotomy (PCNL): Performed through a tract which traverses the back into the kidney. Treatment of the stone is typically using lasers or ultrasonic devices that break up stone fragments.
    • Open/Laparoscopic/Robotic incisional removal: Only performed in rare circumstances in which ureteroscopy, ESWL, or PCNL are not possible.
    • Ureteral stents (i.e. internal kidney drainage tubes) or percutaneous nephrostomy tubes (i.e. external kidney drainage tubes that drain the kidney through the back) may be required for a period of time following any of the types of surgical management
  • Bladder Stones:

    • Cystoscopy: Use of special bladder scopes which can visualize stones and allow for treatment of the stones using lasers, ultrasonic devices, or mechanical crushing devices. (**Also may require treatment of an enlarged prostate at the same time, if the enlarged prostate is thought to be the cause of the bladder stone.)
    • Open/Laparoscopic/Robotic incisional removal: Only performed when stone burden in the bladder is excessive and difficult to completely extract using scopes.
  • Urethral Stones:

    • Urethroscopy: Use of special scopes which can visualize stones and allow for treatment of the stones using lasers, ultrasonic devices, or mechanical crushing devices.
    • Open incisional removal: Only performed when stone burden is such that scopes are incapable of treating stone burden to completion.


Follow-up

Depending on risk factors, patients can undergo a metabolic analysis (i.e. evaluation of serum and urine on various diets) to evaluate a potential cause for stone formation and to determine if there are any potential measures that can be performed by the patient to prevent future stone development.

If a stone is being observed, follow-up imaging may be required.

Huge kidney stone (30 mm)

(example of a kidney stone)