- Aditya Manjunath, ST4 trainee in urology 1,
- Richard Skinner, GP partner 2,
- John Probert, consultant urological surgeon 1
- 1Urology Department, Weston General Hospital, Urology, Weston-Super-Mare BS23 4TQ, UK
- 2West Street Health Centre, Bargoed, Mid Glamorgan, UK
- Correspondence to: A Manjunath
- Accepted 8 January 2013
A 34 year old man visits his general practitioner with a short history of intermittent severe pain radiating from his right loin to right groin. He is unable to get comfortable and is also complaining of urinary frequency and occasional urgency. His temperature is normal. A urine dipstick test shows only non-visible haematuria. The initial diagnosis is suspected renal/ureteric colic secondary to a stone.
What you should cover
Important features to explore in the history include:
Onset of pain—might be acute or insidious.
Duration of pain—longer duration indicates a stone in the kidney or could indicate another cause.
Location—predominantly loin, groin, or both (“loin to groin” pain).
Severity of pain—classically “worst pain ever,” patients are unable to get comfortable (unlike peritonism), but this is not always the case.
Urinary symptoms—distal ureteric stones often cause frequency, dysuria, and urgency and occasionally there is visible haematuria.
Associated symptoms—nausea and vomiting, fever/rigors, which indicate possible sepsis.
History of renal stones—lifetime risk of 50% for forming subsequent stones after first presentation.
Patient’s demographics—peak incidence of stone formation is in those aged 20-50, with a 3:1 male to female preponderance.
Family history of stone formation—stone formation is more common in white people and Asians, with about 20% having a positive family history.
Associated medical conditions—in general practice commonly seen conditions associated with increased risk of stone formation include recurrent urinary tract infections, gout, inflammatory bowel disease, hypercalcaemic disorders such as primary hyperparathyroidism, and anatomical abnormalities of the urinary tract such as polycystic kidney disease.
Environmental factors—“western” lifestyle, warmer temperature, and …