Kidney stones occur when excess minerals and salts accumulate as hard deposits in the kidneys. Their size can vary from that of a grain of sand to a golf ball. While a lot is discussed regarding their causes, symptoms, and treatments, the location of the stone is one key issue that is often overlooked. The location of the stone in the urinary tract significantly affects the type of symptoms the patient has, how the condition is diagnosed, and what treatment is most suitable.
We focus on the impact of the location of the kidney stone on its treatment while outlining why this detail makes all the difference in determining the course of treatment in this blog.
The Urinary Tract: A Quick Overview
Knowing the reason of how matter stone location affects the mentioned challenges can be simplified by understanding basic the structure of urinary tract. These include:
– Kidneys: The two bean-shaped organs that act as filters of blood to produce urine.
– Ureters: Tubes through which urine would flow from the kidneys to the bladder.
– Bladder: The accepted terminology for the area that stores urine until prompted for expulsion.
– Urethra: The exits pipe for urine.
All parts of the kidneys and bladder are connected by tubes, and every part has its corresponding challenges.
1. Stones in the Kidney
These types of stones are fewer, tend to be small and pass unobserved, and if non-obstructive, stones can form in different areas of the kidney.
Urinary bladder: the small cavities that receives urine from the kidney.
Kidney basin: the major part of the kidney that gathers urine prior to it passing through the urine tube.
Symptoms:
- Mild discomfort around the flank area
- Blood presence in urine (hematuria)
- No symptoms (if small stone and non obstructive)
Diagnosis:
- Detected via ultrasound or CT scan
- X-ray for stones consisting of calcium.
Treatment:
Less than 5 mm: small stones generally pass by themselves.
Large stones: require methods like RIRS, extracorporeal shockwave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL)/ureteroscopy.
2. Stones in the Ureter
The shift of a stone from the kidney to the ureter causes intense symptoms due to narrowing of ureter. The stones can become lodged in these three common places:
Ureteropelvic junction (UPJ): Kidney to ureter transition.
Mid-ureter: Towards the pelvic brim relgion where the ureter crosses over.
Ureterovesical junction (UVJ): The meeting of the ureter and bladder.
Symptoms:
- Excruciating, sharp pain that progresses from the side towards lower abdomen and groins (renal colic).
- Nausea and vomiting.
- Painful urination or the uncontrollable need to urinate.
- Hematuria.
Diagnosis:
- Non-contrast CT scan is the patron.
- Ultrasound in quick evaluation.
Treatment:
Less than 5 mm: small stones require hydration and pain management to pass.
Large stones require RIRS, ureteroscopy with laser lithotripsy or stent insertion.
Important Note: They can imitate the symptoms of a urinary tract infection or bladder issues, hindering the diagnosis.
3. Stones in the Bladder
Bladder stones are less common and are usually formed secondary to the incomplete evacuation of the bladder because of prostatic enlargement, neurogenic bladder, or bladder diverticula.
Symptoms:
- Dysuria
- Terminal dribbling
- Urge incontinence
- Suprapubic discomfort
- Hematuria
Diagnosis:
– Ultrasound or cystoscopy
Treatment:
Smaller stones: Increased fluid consumption may lead to spontaneous passage.
Larger stones: Usually removed by cystolitholapaxy (endo- broke stone).
4. Stones in the Urethra
It is very rare for stones to become lodged in the urethra, but in such cases the pain is instantaneous and extremely acute. Usually, these are the last stages of a migrating stone.
Symptoms:
- Severe pain around the glans penis or urethra
- Stoppage of urination
- Inflammation or redness around the urinary opening
- Incomplete emptying of the bladder
Diagnosis:
– Clinical evaluation and scanning
Treatment:
– Excision with high precision endoscopes or physical dislodgment.
Why Placement is Important for Treatment Choices
- Understanding Pain: A ureteral stone will usually hurt worse than a kidney stone.
- Selection of Procedure: A stone located in the renal pelvis can be treated by ESWL. However, a mid-ureteric stone may require ureteroscopy.
- Risk of Complications: Kidney stones can lead to obstruction, infection, or hydronephrosis (swelling of the kidney due to urine backup), making urgent treatment necessary.
- Overlapping Symptoms: Different stone placements can imitate different problems. For instance, a UVJ stone may mimic a bladder infection.
How Stone Size and Location Work Together
Location is of great importance, but size also matters. A 3 mm stone in the kidney may go unnoticed, but the same stone in the ureter can obstruct the flow of urine and result in severe pain. Typically:
– Stones < 5 mm have a good chance of passing on their own
– Stones > 7 mm often require assistance
– Stones > 10 mm almost always need some type of procedure
Diagnosis: Gaining the Entire View
To accurately diagnose the location of a kidney stone, the following methods tend to work best.
- Non-contrast CT scan: Most precise method
- Ultrasound: Uses less radiation; safe for the kidneys and bladder
- X-ray: Only for certain types of stones, e.g. calcium oxalate
- Intravenous pyelogram (IVP): Not commonly used presently, but does give a detailed view of the urinary tract
Prevention strategies are the Same
No matter where the stone is located, the suggested prevention measures are mostly identical:
– Increase intake of fluids
– Decrease intake of sodium and animal proteins
– Keep track of calcium and oxalate-rich foods
Treat conditions behind such as hyperparathyroidism or urinary tract infections
Closing Thoughts
Kidney stones can form at any point in the urinary tract and tend to have a notable effect on your symptoms, treatment, and removal methods used.
The pain of a kidney stone isn’t simply related to the kidney; its passage through the urinary system predicts the level of discomfort as well as the treatment plan.
Schedule an appointment with Dr. Deepanshu Gupta, a skilled urologist renowned for his diagnostics. If you notice symptoms of a stone or are worried about future stones forming, he is the right doctor to discuss with. With the right physician, you can easily manage your kidney stone treatment seamlessly.