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Kidney and Ureteral Stones

Kidney stones are rock like masses within the urinary tract formed by the crystallization of various elements excreted in the urine. Common types of kidney stones are composed of calcium oxalate, calcium phosphate, uric acid or magnesium ammonium phosphate.

Kidney stones form within the collecting duct of the kidneys, where urine is first formed. Kidney stones cause pain when the stones block the flow of urine causing a back-up. When kidney stones travel to the ureters (tubes that connect the kidneys to the bladder) they become ureteral stones. Ureteral stones are more likely to cause pain and discomfort than kidney stones. Typically, once stones reach the bladder they can be easily passed with normal urination, but older men with enlarged prostates may have some difficulty passing stones from the bladder.

Symptoms of kidney or ureteral stones include pain in the upper back, upper abdomen or high on the side of the abdomen, visible blood in the urine or microscopic (non-visible) blood in the urine. Nausea and vomiting can also accompany stone pain. High fever may be a sign of an associated infection and should be treated as a serious condition.

Once an individual has formed a kidney stone, they have about a 50 percent chance of forming another stone within five years. The best prevention against kidney stones involves high fluid consumption to produce two liters, or one gallon, of urine a day. Medication can also be used to help prevent stone formation. A diet low in oxalate may help prevent the formation of calcium oxalate stones.

Tests:

Kidney stones may be diagnosed through X-rays, including a KUB (Kidney–Ureter-Bladder) X-Ray, CT scans, ultrasounds or through an intravenous pyelogram (IVP). With an IVP, a patient undergoes a series of X-rays before being given intravenous contast that is filtered and excreted by the kidneys. As the contrast is excreted by the kidneys, the urinary system can be clearly visualized through additional X-rays.

Treatments:

Kidney and ureteral stones are treated with a variety of procedures. Patients with small stones who have few symptoms may be observed to see if they can pass the stones on their own.

Ureteroscopy with stone extraction of laser lithotripsy.

• In this outpatient surgical procedure, surgeons reach the stone with various scopes and extract it using a special type of basket or break it with a laser beam. The tiny pieces of the stone that remain in the ureters or kidney are then spontaneously passed. This form of treatment is best for stones located in the lower part of the ureters.

Extracorporeal Shock Wave Lithotripsy (ESWL)

• In this outpatient surgical procedure, shock waves are transmitted through the body to break up kidney stones and the remaining fragments are able to drain through the urinary system on their own. This treatment is best for stones located in the kidneys or upper ureters.

• ESWL may not be the right form of treatment for patients who are obese as it can limit the surgeon's ability to adequately see the stones for treatment. In addition, stones that cannot be seen with a KUB X-ray may be difficult to treat with ESWL.

Percutaneous Nephrolithotomy

• Patients requiring this procedure are placed in the hospital. It begins with the placement of a small tube or wire through the back and into the kidney. The tube is enlarged in the operating room and the stones or stone are broken up by an ultrasound or laser surgery. Following the procedure, the tube is removed within two days and the patient is sent home with a uretal stent in place. This form of treatment is usually best for kidney stones larger than 2 cm in size.

Medical Therapy

• Because 10 percent of kidney stones are composed of uric acid, they can be dissolved by decreasing the acidity of urine with appropriate medications.

Open surgery

• This surgical procedure is rarely performed any longer to treat kidney and ureteral stones. Here, stones are removed from the urinary system after an incision is made through the skin to open the muscles and tissues leading to the stones.

Ureteral stents

• In this procedure, tubes are placed in the ureters from the kidney to the bladder, allowing urine to drain and relieve obstruction. The stents are often inserted following kidney stone surgery to prevent potential swelling following a ureteroscopy or blockage from kidney stone fragments following ESWL. Once swelling has decreased and stone fragments have been removed, the stents are removed from the patient in an office procedure.

Click here for more information on the identification and treatment of kidney stones.