B25. Management and medical treatment of patients with urinary stones

From greek.doctor

Kidney stone disease, also called nephrolithiasis or urolithiasis, refers to the presence of symptomatic kidney stones in the urinary tract. When stones are present in the ureter it may be called ureterolithiasis, while stones in the bladder are usually simply called bladder stones or bladder calculi. It's a relatively common condition, with a lifetime prevalence of 10 - 20 percent.

Many have asymptomatic kidney stones (which is not considered kidney stone disease), but in some cases stones can cause urinary obstruction (obstructive uropathy) and resulting damage to the kidney, as well as episodes of severe pain called renal colic. The vast majority of kidney stones pass without intervention within a few days or weeks, but there are options for treatment, including using radiowaves to crush them (ESWL) and removing them surgically.

Management

Asymptomatic stones need no management or follow-up. Uncomplicated small (< 5 mm) stones need only symptomatic treatment and follow-up imaging after 4 - 6 weeks to see if the stone has passed. These cases can be treated out-patient.

Consider hospital admission and treatment to remove or crush the stones in:

  • Complicated stones (causing obstruction, acute kidney injury, infection)
  • Larger stones (> 5 mm)
  • Stones which haven't passed after 4 - 6 weeks

For stones in the distal ureter, an alpha blocker like tamsulosin may be considered as it may fascilitate passage of the stone.

Symptomatic treatment for renal colic

An NSAID like ketorolac or diklofenac is the best first choice for renal colic. In addition to relieving pain they also decrease ureteral smooth muscle tone. Hydration, preferably intravenous, is important. A spamsolytic like butylscopolamine may be used as well.