Symptoms and Complications of Urinary Stones

Pain is the commonest complaint. The pain can be excruciating and very often liken to labour pains; the sufferer becomes restless and unable to find relief. Kidney stones can cause pain in the flanks, while pain from the loin to the groin indicates stones caught in the process of coming down the drainage tube of the kidney (ureter). The pain usually occurs suddenly late at night or during the early hours of the morning. There is often accompanying nausea and vomiting. Blood in the urine is rarely seen, but can be detected with dipsticks.

Painful, frequent and urgent need to pass urine can be due to stones in the ureter near the bladder or in the bladder itself.

The most important complications of urinary stones are obstruction to the kidneys and infection. If an obstructing stone is not removed, it can lead to permanent kidney damage. This can happen within weeks if there is complete blockage. When both kidneys are blocked, no urine can pass down into the bladder. This will cause acute renal failure. This is a dangerous situation. The other emergency situation is when an obstructed kidney has become infected. This is usually manifested by high fever, chills and rigors and pain in the small of the back of the affected side. In both these conditions, emergency drainage of the kidneys is required. This will involve puncturing a small hole in your loin and inserting a small tube into the affected kidney.

When pain due to urinary stone occurs in pregnancy, it is a challenging problem. It is important to exclude pregnancy-related problems. Ultrasound of the kidney is the investigation of choice in order to avoid radiation to the baby. A dilated kidney would suggest a ureteric stone if there is typical ureteric colic; however since ureteric stone is difficult to visualise by ultrasound, we can never be completely sure that it is not due to compression by the pregnant uterus. If it is important to confirm a stone, a limited IVU can be done.

Fortunately, the rate of spontaneous passage of stone is high in pregnancy due to the natural dilatation of the ureter by the hormones of pregnancy. Hence, most cases can be managed by liberal fluid intake and pain-killers while waiting for the stone to pass. If surgery is needed, cystoscopy and insertion of a ureteric stent is the best option since this can be done under local anasthesia with the least complications for baby and mother. This will relief the ureteric obstruction and, hence the pain. Otherwise, ureteroscopic fragmentation of the stone and retrieval (preferably with the flexible ureteroscope) has been successfully performed.