Kidney, ureteral and bladder stones
Which are the symptoms?
The main symptom of calculosis is colic, a sharp and very intense pain associated with nausea, vomiting and general malaise. This pain has different characteristics depending on the localization of the stone: at renal level (renal colic) there will be a dull and constant pain in the lumbar region that radiates to the side and anteriorly; at ureteral level (ureteral colic) the pain will often be intermittent and variable depending on the location along the course of the ureter, starting from the side until the groin, the testicle in men and the labia majora in women and the inner thigh. With regard to bladder stones, blood in the urine, difficulty and pain when urinating, widespread pain in the lower abdomen, increased number of nocturnal trips to the bathroom to urinate are the most common symptoms.
- renal colic
- ureteral colic
- presence of blood in the urine
- pain or difficulty in passing urine
- widespread pain in the lower abdomen
- increased nocturnal urination
How is it diagnosed?
Urological examination: during the examination, personal and family clinical information is collected. X-ray of the abdomen: highlights the radiopaque stones, so defined because they do not allow themselves to be crossed by x-rays. Ultrasonography of the urinary apparatus: it shows the state of dilatation of the renoureteral cavities and also radiolucent calculi, so defined because they allow themselves to be crossed by X-rays. CT scan of the abdomen: In order to have a precise indication of the presence of stones, their location, size and consequences caused to the excretory tract, it is necessary to perform a CT scan of the abdomen or an X-ray investigation with or without contrast medium, depending on the case. Hematochemical and urine tests: detect metabolic or functional alterations of the excretory system and possible traces of blood in the urine or crystal aggregates.
How is it treated?
RENAL STONES. Extracorporeal shock wave lithotripsy (ESWL): stone fragmentation from outside with shock waves. This treatment is applicable in the presence of kidney stones that are not particularly hard, less than 2 cm in size and in normal weight patients. Percutaneous nephrolithotomy (PNL): a minimally invasive technique that involves accessing the renal cavities via percutaneous access and performing lithotripsy with ballistic and/or ultrasonic energy. This technique is used for large calculosis (> 2cm). Endoscopic lithotripsy with retrograde access (ureterorenoscopy or URS): minimally invasive technique that consists of going up inside the kidney by retracing the urinary system (urethra, bladder and ureter) to reach the stones and their fragmenting with laser energy.
URETERAL STONES. Extracorporeal shock wave lithotripsy (ESWL): fragmentation of the stone from the outside with shock waves. It applies only in selected cases (stones < 1cm and well visible at ultrasound/fluoroscopic targeting in normal weight patients). Endoscopic lithotripsy with retrograde access (ureterorenoscopy or URS): passing through the urethra and bladder (retrograde access) with endoscopic instruments, it goes back inside the ureter where the stones are fragmented with laser energy.
BLADDER STONES. Endoscopic lithotripsy by transurethral route: passing through the urethra, the bladder is reached, where the stones are fragmented with laser energy.
POSSIBLE COMPLICATIONS. Extracorporeal shock wave lithotripsy (ESWL) and endoscopic lithotripsy (URS) are less invasive treatments than percutaneous nephrolithotomy, which exposes you to higher risk of bleeding. In extracorporeal shock wave lithotripsy, the presence of blood in the urine after treatment is frequently observed, generally of low entity, and renal hematomas or kidney ruptures may occur, although in very low percentages. In endoscopic lithotripsy with retrograde access, ureteral lesions may occur such that corrective surgery is exceptionally required, or ureteral strictures after some time.