Education And Debate

ABC of Urology: URINARY STONE DISEASE

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7040.1219 (Published 11 May 1996) Cite this as: BMJ 1996;312:1219
  1. Chris Dawson,
  2. Hugh Whitfield

    Investigation

    Most patients with urinary stones have microscopic haematuria detected by routine urine analysis. An absence of red cells in the urine suggests an alternative diagnosis.

    Presenting features of urinary stone disease

    • Renal pain is usually felt in the loin, sometimes spreading to the umbilicus and testis. Pain from irritation of the intercostal nerves is not colicky and may be provoked by pressure on a trigger spot

    • Obstruction of the mid-ureter may mimic appendicitis on the right and diverticulitis on the left

    • Obstruction of the lower ureter may lead to bladder irritability or pain in the scrotum, penile tip, or labia majora

    • A recurrent painful desire to micturate, with only a little urine passed each time (strangury)

    An x ray film of the kidneys, ureters, and bladder shows the position and size of the kidneys as well as the presence of any calculi, which usually obstruct at the pelviureteric junction, the point where the ureter crosses the iliac arteries at the pelvic brim, or the vesicoureteric junction. All patients suspected of having a urinary stone should then have intravenous urography, although renal ultrasonography is acceptable in patients who are either allergic to contrast medium or pregnant. Obstruction may be detected by the delayed appearance or persistence of the nephrogram phase on the intravenous urogram or by the finding of caliceal dilatation in an ultrasound scan.

    Differential diagnosis of renal colic

    • Acute appendicitis

    • Diverticulitis

    • Salpingitis

    • Ruptured aortic aneurysm

    • Pyelonephritis

    Renography after injection of technetium-99m mercapto acetyltriglycine is not routinely used and …

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