Urinary tract stones: Difference between revisions
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====Bladder stones==== | ====Bladder stones==== | ||
The main symptoms are: '''pain''' in the [[suprapubic]] area, [[perineum]] and the tip of the [[penis]]/[[labium majorum]] exacerbated by an upright postue, jolting movements and the end of [[micturition]]; '''[[urgency]]''' and '''[[frequency]]''' usually during the day with sensation of incomplete micturition; '''strangury''', the feeling of painful, frequent, small-volume micturition with severe urgency and feeling of incomplete emptying; '''haematuria''' at the end of micturition; and [[urinary obstruction]]. | The main symptoms are: '''pain''' in the [[suprapubic]] area, [[perineum]] and the tip of the [[penis]]/[[labium majorum]] exacerbated by an upright postue, jolting movements and the end of [[micturition]]; '''[[urgency]]''' and '''[[frequency]]''' usually during the day with sensation of incomplete micturition; '''strangury''', the feeling of painful, frequent, small-volume micturition with severe urgency and feeling of incomplete emptying; '''haematuria''' at the end of micturition; and [[urinary obstruction]]. | ||
Men may also have '''prostatic enlargement''' whilst women may have a '''palpable stone''' on bimanual examination. | |||
===Investigations=== | ===Investigations=== | ||
===Management=== | ===Management=== | ||
===Prognosis=== | ===Prognosis=== |
Revision as of 17:13, 4 November 2009
Definition
Stone in the urinary tract. Anywhere. Even the willy.
Epidemiology
Has a prevalence of 3% in the UK but a staggering, a shocking, a mind-blowing like you just found your Mum is a real life Jack Bauer, 12% in the USA. I'm probably labouring the point a bit. M:F, 2.5:1 and has a bi-modal peak distribution with peaks at mid-20s and mid-50s though the later peak is mostly due to infections in women. 40% pass spontaneously though incidence of upper tract stones is increasing. Upper tract is more common in the developed world. 80% are unilateral.
Awesome.
Pathophysiology
Stones can be made out of lots of stuff. They are created when there's a high amount of said stuff in the urine. So if the stone is made of calcium, that is more likely in somebody who has a large amount of calcium in the urine. It's called supersaturation. However, sometimes stones just form and nobody's sure why.
Calcium (80%), phosphate (10%) and uric acid (5-10%) are the most common constituents of stone.
Risk Factors
There three category of risk factor with specific ones within each category:
- Excess normal constituents in urine
- increased serum calcium in hypoparathyroidism
- increased uric acid
- decreased urinary volume in hot climates
- impaired drainage
- abnormal constituents
- infection (causes epithelial sloughs which form stones)
- foreign bodies (e.g. catheter)
Clinical Features
The clincal features depend very much on whereabouts the stone is. It's worth remembering that about 80% of stones are asymptomatic. Stones can present in any number of extremes from an incidental finding on an X-ray to bilateral hydronephosis and renal failure.
Kidney stones
The primary symptoms are: flank pain which spreads round the abdomen as the stone moves down; haematuria which is common and can be both microscopic and macroscopic; and infection which will cause loin tenderness, pyrexia and sepsis.
Ureteric stones
Generally, colic (from flank through to scrotum/labia minorum), haematuria and infection. Tenderness along the renal angle or along the line of the ureter.
Bladder stones
The main symptoms are: pain in the suprapubic area, perineum and the tip of the penis/labium majorum exacerbated by an upright postue, jolting movements and the end of micturition; urgency and frequency usually during the day with sensation of incomplete micturition; strangury, the feeling of painful, frequent, small-volume micturition with severe urgency and feeling of incomplete emptying; haematuria at the end of micturition; and urinary obstruction.
Men may also have prostatic enlargement whilst women may have a palpable stone on bimanual examination.