Follow-up radiology will often not be required as it is likely that the stone will pass without the need for surgery, however, the location of the stone will also influence this. The patient should be monitored for signs of infection and advised to contact the practice once they have passed the urinary stone. Untreated obstruction of the ureter can lead to a permanent loss of renal function and it can be expected that urological follow up will be advised if the patient has not passed a stone after two to three weeks.
A practical tip for patients with smaller stones is to ask the patient to sieve their urine, e. Patients with a stone larger than 4 mm on CT urogram, with a stone in the kidney or multiple urinary stones should be discussed with an Urologist who will generally arrange for follow-up radiology. Stones greater than 6 mm in diameter have a low likelihood of spontaneous passage and these patients should be immediately discussed with an Urologist to ensure the patient is prioritised appropriately.
The size of the urinary stone, its position and the general health of the patient will determine which technique is the most appropriate for the removal of stones that require surgery.
Uretero pyeloscopic laser lithotripsy uses laser pulses to break up ureteric and smaller renal stones. This has high stone-clearance rates but may cause: 2. Urinary tract infection is the only specific contraindication for this technique, and patients are able to continue to take antithrombotic medicines. Shock wave lithotripsy is the least invasive but also least effective method for removing urinary stones. It is not commonly used to treat urinary stones in the ureter, but may occasionally be used to treat those in the upper ureter.
The technique is generally indicated for renal stones in patients who are not troubled by pain or for patients with stones that are inaccessible via retrograde or percutaneous routes.
This technique is contraindicated in patients who: are pregnant, have an active UTI, are taking antithrombotic medicines, have an aortic aneurysm or with drainage abnormalities of the kidney. Percutaneous nephrolithotripsy is generally performed on renal stones larger than 20 mm and particularly staghorn calculi. Open surgery is performed rarely for patients with urinary stones that have not passed and requires an extended period in hospital and an approximate six week convalescence.
Patients can take several steps to reduce the likelihood of future urinary stone formation including: 2. An analysis of stone content can guide dietary and medical interventions for urinary stone prevention. This may be useful for patients with a history of recurrent urinary stones. Patients with stones containing calcium oxalate can be advised to reduce their salt and oxalate intake. Potassium citrate is subsidised under Special Authority for patients who have had recurrent calcium oxalate urinary stones and who have had more than two episodes of urinary stones in the previous two years.
For patients with urate stones, reducing dietary purines by eating less purine-rich meat e. Allopurinol is indicated for the prophylaxis and treatment of patients with either urate or calcium oxalate renal stones. If a patient is suspected of having a renal tract abnormality that may predispose them to stone formation or if a patient passes a urinary stone that when analysed has an unusual composition, e.
Some general features of the patient encounter that increase the suspicion of drug-seeking behaviour include: Clinicians who suspect that a patient is seeking an opioid for reasons other than legitimate pain relief should document the discussion and diagnosis. During the history and examination and before any treatment is prescribed consider:.
Patients who are fabricating their condition will be highly attuned to clinical indecisiveness and a firm and evidence-based clinical opinion is the best way to discourage drug-seekers. When there is a strong suspicion that a patient is a drug-seeker other practice members should be alerted in case the patient displays threatening behaviour. Drug seekers will often use more than one doctor or be known by local Pharmacists and phone calls to colleagues once the patient has left the practice may confirm that a patient has a history of drug-seeking behaviour.
Follow us on facebook. Decision support for health professionals ». South Island general practice support ». Practice acquisition and careers in health ». Click here to register ». Forgot your login? Login to my bpac. Remember me. Genitourinary system male Gynaecology and urinary tract disorders female Nephrology Pain management. Managing patients with renal colic in primary care: Know when to hold them Approximately one in ten people will be affected by renal colic at some stage in their life.
In this article Assessing renal colic Management of renal colic in primary care References In this article. Assessing renal colic Renal colic is generally caused by stones in the upper urinary tract urolithiasis obstructing the flow of urine; a more clinically accurate term for the condition is therefore ureteric colic.
Which patients are most likely to develop urinary stones? Diagnosing renal colic Patients with renal colic classically present with sudden and severe loin pain that occurs in waves of intensity and may be accompanied by nausea and vomiting.
Examining the patient Patients with renal colic typically appear restless and unable to find a comfortable position. Diagnostic uncertainty is an indication for referral to hospital as renal colic can be difficult to differentiate from a number of other conditions, including: 3, 5 Biliary colic and cholecystitis Aortic and iliac aneurysms — particularly in older patients with left-side pain, hypertension or atherosclerosis Appendicitis, diverticulitis and peritonitis. These patients are less likely to appear restless and generally prefer to lie still.
Gynaecological causes, e. Red flags that over-ride requests for testing and require immediate referral of the patient to the emergency department include: 3, 5 Fever or other features, e. Management of renal colic in primary care In a patient suspected of having renal colic initial management will generally include: Acute pain control with either a non-steroidal anti-inflammatory drug NSAIDs or morphine see below Laboratory testing, e.
Additional pain management options Paracetamol and a weak opioid, e. This page has been produced in consultation with and approved by:. Bedwetting is a problem for many children and punishing them for it will only add to their distress. Your bladder is a hollow organ that stores urine from the kidneys. Bladder cancer affects twice as many men as women. Bladder prolapse is when the bladder bulges into the vagina.
Cystitis is the most common urinary tract infection in women. Content on this website is provided for information purposes only. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional.
The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances.
The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website. Skip to main content. Kidney and bladder. Home Kidney and bladder. Kidney stones. Actions for this page Listen Print. Summary Read the full fact sheet. On this page. What are kidney stones? Symptoms of kidney stones Causes of kidney stones Diagnosis of kidney stones Complications of kidney stones Avoiding recurrence of kidney stones Where to get help.
Types of kidney stones There are four major types of kidney stones, including: stones formed from calcium not used by the bones and muscles, combined with oxalate or phosphate — these are the most common kidney stones stones containing magnesium and the waste product ammonia — these are called struvite stones and form after urine infections uric acid stones — these are often caused by eating very large amounts of protein foods cystine stones — these are rare and hereditary.
Symptoms of kidney stones Many people with kidney stones have no symptoms. The pain may be severe enough to cause nausea and vomiting blood in the urine cloudy or bad smelling urine shivers, sweating and fever — if the urine becomes infected small stones, like gravel, passing out in the urine, often caused by uric acid stones an urgent feeling of needing to urinate, due to a stone at the bladder outlet.
Treatment for kidney stones Most kidney stones can be treated without surgery. Treatments include: extracorporeal shock-wave lithotripsy ESWL — ultrasound waves are used to break the kidney stone into smaller pieces, which can pass out with the urine. ESWL is used for stones less than 2 cm in size percutaneous nephrolithotomy — for stones larger than 2cm.
A small cut is made in your back, then a special instrument is used to remove the kidney stone endoscope removal — an instrument called an endoscope is inserted into the urethra, passed into the bladder and then to where the stone is located.
It allows the doctor to remove the stone or break it up so you can pass it more easily surgery — if none of these methods is suitable, the stone may need to be removed using traditional surgery. This will require a cut in your back to access your kidney and ureter to remove the stone.
Medication for kidney stones For most people with recurrent calcium stones, a combination of drinking enough fluids, avoiding urinary infections, and specific treatment with medications will significantly reduce or stop new stone formation. Causes of kidney stones A kidney stone can form when substances such as calcium, oxalate, cystine or uric acid are at high levels in the urine, although stones can form even if these chemicals are at normal levels.
Diagnosis of kidney stones Many kidney stones are discovered by chance during examinations for other conditions. Further tests may include: ultrasound CT scans x-rays, including an intravenous pyelogram IVP , where dye is injected into the bloodstream before the x-rays are taken. Analysis of kidney stones If you pass a stone, collect it and take it to your doctor for analysis.
Complications of kidney stones Kidney stones can range in size from a grain of sand to that of a pearl or even larger. When these stones grow big enough, they can become very painful. Small stones may not cause any symptoms. Larger stones can cause renal colic, especially if they block a ureter. This is the tube urine travels through on its way from your kidney to your bladder. Renal colic pain often comes in waves. These waves can last from 20 to 60 minutes.
Renal colic happens when a stone gets lodged in your urinary tract, often in a ureter. The stone stretches and widens the area, causing intense pain. About 12 percent of men and 6 percent of women will get one or more urinary stones in their lifetime. The rate of renal colic is increasing due to changes in our diet and lifestyle habits. See your doctor if you have symptoms of renal colic or urinary stones.
Your doctor can do tests to look for increased levels of substances that form stones in your blood or urine.
A CT scan can look for stones in your kidneys and other urinary organs. If you have a large stone, your doctor can do one of these procedures to remove it and relieve renal colic:.
In the short term, your doctor will give you medicines to relieve the pain of renal colic. Options include:.
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