Kidney and Ureteral Stones

The kidneys, ureters and bladder are part of your urinary tract. The urinary tract makes, moves, and stores urine in the body.

The kidneys make urine from water and your body’s waste. The urine then travels down the ureters into the bladder, where it is stored. Urine leaves your body through your urethra. Kidney stones form in the kidney. If a stone leaves the kidney and gets stuck in the ureter, it is called a ureteral stone.

Common symptoms of kidney stones include a sharp, cramping pain in the back and side. This feeling often moves to the lower abdomen or groin. The pain often starts suddenly and comes in waves. It can come and go as the body tries to get rid of the stone. Other signs of kidney stones are:

  • A feeling of intense need to pass urine.
  • Passing urine more often or a burning feeling when you pass urine.
  • Urine that is dark or red due to blood. (Sometimes urine has only small amounts of red blood cells that can’t be seen with the naked eye.)
  • Nausea and vomiting.
  • A feeling of pain at the tip of the penis in men.
  • Low urine volume: Constantly having a low urine volume is a major risk factor for kidney stones. Low urine volume may come from dehydration (loss of body fluids) from hard exercise, working or living in a hot place, or not drinking enough fluids. When your urine volume is low, urine is concentrated and dark in color. Concentrated urine means there is less fluid to keep salts dissolved.
  • High levels of calcium in the urine: Reducing salt in the diet lowers urine calcium. This will make it less likely for you to form stones. Because oxalate is a component of the most common type of kidney stone (calcium oxalate), eating foods rich in oxalate can raise your risk of forming these stones.
  • A diet high in animal protein, such as beef, fish, chicken and pork, can raise the acid levels in the body and in the urine. High acid levels make it easier for calcium oxalate and uric acid stones to form. The breakdown of meat into uric acid also raises the chance of forming a kidney stone.
  • Bowel conditions: Certain bowel conditions that cause diarrhea (such as Crohn’s Disease or ulcerative colitis) or surgeries on the intestines (such as gastric bypass surgery) can raise the risk of forming calcium oxalate kidney stones. Diarrhea may result in loss of large amounts of fluid from the body, lowering urine volume. Your body may also absorb excessive oxalate from the intestine, resulting in 6 more oxalate in your urine. Both low urine volume and high levels of urine oxalate can help to cause calcium oxalate kidney stone formation.
  • Obesity is a risk factor for stones. Obesity may change the acid levels in the urine, leading to stones.

How is it diagnosed?

  • “Silent” kidney stones, those that cause no symptoms, are often found with an X-ray.
  • Other people have their stones diagnosed when sudden pain occurs while the stone is passing and they may need medical help.
  • When a person has blood in their urine (hematuria) or sudden abdominal or side pain, tests may be ordered.
  • An ultrasound or a CT scan can clearly diagnose a stone.
  • A urinalysis is also done to learn whether or not you have a kidney infection.
  • If you are at high risk for getting stones in the future, a 24-hour urine collection can be done. This test will reveal the levels of different stone-forming matter in your urine.
  • The results of this test can help your doctor help you prevent future stones through proper diet and medication.

How is it treated?

  • The type of stone you have.
  • Location of the stone.
  • Length of time you have had symptoms.
  • Medication: Certain medications have been shown to help stones pass. The most common medicine prescribed is tamsulosin. Tamsulosin relaxes the ureter, making it easier for the stone to pass.
  • Surgery may be needed to remove a stone from the ureter or kidney if:

Today, surgery often involves small or no incisions (cuts), minor pain and minimal time off work.

Shock Wave Lithotripsy (SWL) is used to treat stones in the kidney and ureter. Shock waves are focused on the stone using X-rays or ultrasound to pinpoint the stone. Repeated firing of shock waves on the stone usually causes the stone to break into small pieces. These smaller pieces of stones pass out in the urine over a few weeks. Because there will likely be pain caused by the shock waves, and the need to control breathing during the procedure, some form of anesthesia is often needed.

Ureteroscopy (URS) is used to treat stones in the kidney and ureter. URS involves passing a very small telescope, called an ureteroscope, into the bladder, up the ureter and into the kidney. Rigid telescopes are used for stones in the lower part of the ureter near the bladder. Flexible telescopes are used to treat stones in the upper ureter and kidney. The ureteroscope lets the urologist see the stone without making an incision (cut). General anesthesia keeps you at ease during the URS procedure. Once the urologist sees the stone with the ureteroscope, a small, basket-like device grabs smaller stones and removes them. If a stone is too large to remove in one piece, it can be broken into smaller pieces with a laser or other stone-breaking tools. Once the stone has been removed in whole or in pieces, your health care provider may place a temporary stent in the ureter. A stent is a tiny, rigid plastic tube that helps hold the ureter open so urine can drain from the kidney into the bladder. Unlike a bladder catheter or kidney drainage tube, this tube is within the body and does not need a bag to collect urine. You may go home the same day as the URS and can begin normal activities in 2 to 3 days. If your urologist places a stent, he or she will remove it 4 to 10 days later.

Percutaneous Nephrolithotomy (PCNL) is the best treatment for large stones in the kidney. General anesthesia is needed to do a PCNL. PCNL involves making a half-inch incision (cut) in the back or side, just large enough to allow a rigid telescope (nephroscope) to be passed into the hollow center part of the kidney where the stone is located. An instrument passed through the nephroscope breaks up the stone and suctions out the pieces. The ability to suction pieces makes PCNL the best treatment choice for large stones. After the PCNL, a tube may be left in the kidney to drain urine into a bag outside of the body. This will allow for drainage of urine and stop any bleeding. The tube is left in overnight or for a few days. You may have to stay in the hospital overnight after this surgery. Also, a temporary stent may be left in place to manage recovery. Your urologist may choose to do X-rays while you are still in the hospital to see if any stone pieces remain. If there are any, your urologist may want to remove them. You can begin normal activities after about one to two weeks.

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