Can A Kidney Stone Get Stuck
Ureteral stones almost always originate in the kidney or, more precisely, in the renal pelvis or the renal calices. For a detailed description of the different types of urinary stones, please refer to the chapter on “Kidney stones”. If a kidney stone detaches from the renal pelvic calices, it can enter the ureter. The ureter itself is a muscular tube just about 1mm in diameter. Depending on the size of the urinary stones, which can range from a few tenths of a millimeter to several centimeters, they either pass through and cause more or less pain, or become trapped on their way to the urinary bladder. This occurs primarily at physiological constrictions, such as the renal pelvic outlet, a vascular crossing or the passage of the ureter through the bladder wall muscles. This can cause severe, colicky flank pain, nausea and vomiting, and a high degree of internal agitation. Fortunately, we now have intravenous medications that can usually control this pain within a few minutes. At the beginning of every further therapy, we carry out a detailed diagnosis, which can tell us a great deal about the stone and the best way to proceed. If the x-ray shows the stone to be sufficiently small (< 3mm), the pain can be controlled with medication, the kidney is draining sufficiently, and there are no signs of a Hanrwegian infection (such as increased infection levels in the blood, chills, or fever), a wait-and-see approach can be chosen. In this case, the patient is given medications that have both analgesic and decongestant and muscle relaxant effects. In addition, it is possible to administer fluids as well as diuretic drugs. In addition, the patient should perform so-called "stone gymnastics" (you can find a corresponding instruction as a pdf file in our download center). Treated in this way, in many cases the ureteral stone is eliminated naturally with the urine (spontaneous stone discharge). The stone should be collected and sent to a laboratory for analysis to determine its composition and future metaphylaxis. (Ureterorenoscopy URS Ureteral stone, laser, dormia basket) Ureterorenoscopy (URS) involves the use of a rigid or flexible instrument to perform a ureteroscopy or renoscopy. The instruments are equipped with a light source and a camera so that the entire urinary tract can be examined from the inside. In this way, stones in the ureter or kidney can be located and removed. Extremely small instruments such as forceps or baskets are available for this purpose. Since the instrument is inserted into the urethra as the natural entrance to the urinary tract, no external scars remain. The advantage of the procedure is rapid and low-risk stone removal. Depending on the size and location of the stone, the procedure takes between half an hour and an hour. In the case of very large stones in the kidney, the procedure may take longer. n almost all cases, the stone can be completely removed with a single treatment. A URS is always performed under general anesthesia to ensure complete freedom from pain. In most cases, a ureteral stent (double J catheter; pigtail catheter) is inserted into the ureter after stone removal to ensure the flow of urine from the kidney to the bladder. This can usually be removed one week later by the resident urologist. The risks of URS are very low. The most common is a short-term blood spotting in the urine, but this passes on its own. In addition, fever may occur in rare cases, which makes short-term antibiotic therapy necessary. Serious injuries to the ureter or kidney are extremely rare with the new, thin instruments. If a stone is too large to be completely removed, it can first be crushed in situ with a holmium laser during a ureteroscopy (URS) until the debris is small enough to be safely pulled through the natural urinary tract. The debris is then removed with forceps or a basket (Dormia basket). State-of-the-art and very fine instruments are available at the Clinic for Urology Bochum. Serious injuries of the ureter have thus become very rare. We use a holmium laser of the latest generation. The revolutionary feature of the Holmium Laser is that it reliably crushes urinary calculi of any kind, but the human tissue (ureter and kidney) remains completely unaffected. In some cases, such as when the ureter is too narrow for the endoscopic instrument or there is an infected urinary stasis kidney, it may be necessary to first treat the ureter with a ureteral splint. This is a flexible, hollow silicone tube that ensures proper drainage of urine from the renal pelvic caliceal system. This immediately alleviates the symptoms of discomfort and provides time for further therapy planning. Usually, after a few days and, if necessary, after antibiotic therapy, the ureteral stone can be retrieved in a second session. Very large stones that get stuck in the ureter near the kidney are usually pushed back into the renal pelvis with the help of a probe or an endoscope (stone push). In this case, there is either the option of removing the stone under further anesthesia or of bombarding it with shock waves by means of so-called extracorporeal shock wave lithotripsy (ESWL). In this procedure, shock waves/pressure waves are directed at the body from the outside, which strike the stone through the tissue and cause it to disintegrate. The debris must then be excreted by itself via the natural urinary tract. If the risk of colic is too great, a ureteral splint may have to be inserted temporarily. A skin incision is not necessary for ESWL, nor for the insertion of a ureteral splint. Our clinic for urology in Bochum has the most modern lithotrypsy unit in the world at the moment. It allows the location of ureteral or kidney stones with ultrasound or digital X-ray. Extracorporeal shock wave lithotripsy (ESWL) is a minimally invasive therapeutic procedure for the treatment of kidney and ureteral stones. The procedure is based on the disintegration of the stones by pressure waves (so-called shock wave). It was invented in Germany in the 1980s and was groundbreaking. The shock waves are generated in an energy source outside the body and are adjusted to the stone by means of X-ray or ultrasound control (targeting device). The shock wave generates tensile and shear forces due to the sudden pressure fluctuation in the stone, this causes the stone to shatter. The surrounding tissue usually remains undamaged due to its elasticity. The fragments can then be excreted naturally in the urine.
Advantages of ESWL
The advantage of the procedure is the non-contact, low-complication stone disintegration, which usually does not require general anesthesia. Immediately before the start of the treatment, the patient is administered a painkiller and a sedative so that the treatment is experienced as little discomfort as possible. Alternatively, treatment under general anesthesia is also possible. The treatment time is approximately one hour, depending on the size and location of the stone. The risks of ESWL are very low. In addition to a bruise (hematoma) in the skin and blood admixture in the urine, in very rare cases a bruise (hematoma) around the kidney may occur. Furthermore, stone fragments can get stuck in the ureter and cause colic there. For this reason, in the case of larger stones, it may be necessary to insert a so-called ureteral splint (double J catheter; pigtail catheter) to ensure the outflow of urine from the kidney into the bladder. Not every stone is suitable for ESWL therapy. Certain types of stones are too hard to be crushed by ESWL. In addition, if the stone mass is large, multiple ESWL treatments are needed to achieve complete stone clearance. As a rule, ureteral stones are less suitable for ESWL treatment than kidney stones. Hard, stone-like masses can form in the urinary tract (calculi), causing pain, bleeding, as well as infection and obstructing urinary flow.
- Small stones do not cause symptoms, but larger stones can result in severe pain in the back (area between the ribs and the hip).
- Stones are usually diagnosed by imaging and urinalysis.
- Sometimes the formation of stones can be prevented by changing the diet and increasing fluid intake.
Stones in the urinary tract form in a kidney and can enlarge in a ureter or bladder. Depending on where a stone is located, it is called a kidney stone, ureter stone or bladder stone. The process of stone formation is called urolithiasis or nephrolithiasis (kidney stone disease).
The urinary tract
Annually, 0.1 percent of adults in the United States are hospitalized for stones in the urinary tract. The stones are more common in middle-aged and older people. The stones can be so small that you can’t see them, or they can be up to 2.5 centimeters or more in diameter. A large so-called deer antler stone (due to its frequently observed resemblance to a deer antler), can fill almost the entire renal pelvis (the central collecting basin of the kidney) and the inflowing ducts (calices).
Inside the kidney
The stones are made of crystallized minerals of the urine. Sometimes these crystals grow and stones form. About 85 percent of stones are calcium; the rest are substances such as uric acid, cystine, and struvite. Struvite stones, a mixture of magnesium, ammonium and phosphate, are also called infection stones because they form only in infected urine. They can form because the urine is too saturated with salts that can form stones, or because it lacks the normal inhibitors against stone formation. Citrate is one such inhibitor because it usually combines with calcium, which is often involved in stone formation. Stones are more common in people with certain conditions (e.g., hyperparathyroidism Hyperparathyroidism In hypercalcemia, the level of calcium in the blood is too high. High calcium levels can be caused by a problem with the parathyroid glands or by diet, cancer, or diseases involving bones…. Learn More , Dehydration Dehydration is a lack of water in the body. Vomiting, diarrhea, excessive sweating, burns, renal insufficiency, and use of diuretics can cause dehydration. One… Learn more and renal tubular acidosis Renal tubular acidosis (RTA) In renal tubular acidosis, the malfunction of the renal tubules causes excessive acid concentration in the blood. When taking certain medications or with certain other… Learn More ) as well as in people whose diets contain a lot of animal proteins or vitamin C, or who take in too little calcium or drink too little water. People with a corresponding family history are more prone to the formation of calcium stones, or to form calcium stones more frequently. People who have undergone weight loss surgery (bariatric surgery) are also at increased risk of developing stones. In rare cases, medications (e.g. indinavir) and additives in the diet (e.g. melanin) can also cause stones. Stones, especially the small ones, may remain asymptomatic. Stones in the bladder can cause pain in the lower abdomen. Those that block the ureter, renal pelvis, or a ureter can cause back pain and severe colicky pain. Renal colic is characterized by very severe, cramping pain, usually in the area between the ribs and hips on one side, often spreading across the abdomen to the reproductive organs. The pain occurs in waves and intensifies until it reaches a maximum; it decreases over the next 20 to 60 minutes. The pain may radiate toward the abdomen, groin, or testicles or vulva. There may be other symptoms such as nausea and vomiting, restlessness, sweating, and blood or a stone (or part of a stone) in the urine. The affected person feels a frequent urge to urinate, especially if the stone passes through the ureter. Sometimes there are chills, fever, burning or pain during urination, cloudy and foul-smelling urine, and swelling of the abdomen.
- Computed tomography (CT) scan.
Doctors often suspect stones in patients with renal colic. In some cases, stones are suspected as the cause in people who experience tenderness in the back and groin or pain in the genital area for no apparent reason. While not all stones cause blood in the urine, it does strengthen the diagnosis. In some cases, symptoms and examination findings are so characteristic that no further tests need to be performed, especially in people who have had stones in the urinary tract in the past. However, most people experience such severe pain, and the symptoms and examination findings allow for other causes of the pain, so further testing must be done. Stones need to be differentiated from other possible causes of severe abdominal pain, including If stones have already been diagnosed, tests are often performed to determine their type. Stones that are passed in the urine should be collected if possible. This can be done by sieving the urine through a paper or mesh filter. These stones can now be analyzed. Depending on the type of stone, urine or blood tests may be necessary to measure the concentration of calcium, uric acid, hormones and other substances that increase the risk of stone formation. In people who have excreted a calcium stone for the first time in their lives, the risk of new stone formation is 15 percent within the first year, 40 percent within 5 years and 80 percent within 10 years. The measures that can be taken to prevent the formation of new stones depend on their composition. An ample fluid intake, 8 to 10 glasses (300 ml each) per day, is recommended to prevent the formation of new stones. Affected individuals should drink enough fluids to form more than about two liters of urine per day. Other preventive measures depend to some extent on the type of stone. Thiazide diuretics such as chlorthalidone or indapamide can also reduce urinary calcium concentrations in affected individuals. If urinary citrate levels are low, potassium citrate (a substance that inhibits the formation of calcium stones) can be administered to increase these levels. Reducing animal proteins can also decrease urinary calcium concentrations, and the associated risk of calcium stone formation. Excessive urinary oxalate concentration, another risk factor for calcium stone formation, can occur from excessive consumption of foods such as rhubarb, spinach, cocoa, nuts, pepper, and tea, or in certain intestinal conditions (including various weight loss surgical procedures). Calcium citrate, cholestyramine, and a diet low in fat and oxalate may help lower urinary oxalate concentrations. Pyridoxine (vitamin B6) reduces the amount of oxalate produced by the body. Uric acid stones are almost always caused by too much acid in the urine. When uric acid stones are present, potassium citrate should be given to reduce acidity (urine is alkalinized as a result); this neutralizes the high acidity that leads to the uric acid stones. Occasionally, a low animal protein diet or allopurinol is also used to lower the acidity in the urine. Attention should also be paid to adequate fluid intake. If cystine stones have formed, cystine concentrations must be kept low by copious fluid intake and sometimes with the aid of alpha-mercaptopropionylglycine (tiopronin) or penicillamine.
- Non-steroidal anti-inflammatory drugs (NSAIDs) or opioids to relieve severe pain if needed
- Sometimes removal of the stones
Small stones that do not cause symptoms or obstruction Urinary tract obstruction Urinary tract obstruction prevents urine from passing through the normal pathway (the urinary tract), which includes the kidneys, ureter, bladder, and urethra. The obstruction… Learn More or cause infections, usually do not need to be treated and are often eliminated on their own. Larger stones (over 5 mm) and those located closer to the kidneys are less likely to be excreted on their own. The likelihood of spontaneous excretion of stones may also be increased by certain medications (tamsulosin or calcium channel blockers). The pain of renal colic can be relieved with NSAIDs. Extremely severe pain may require the use of opioids. Drinking plenty of fluids or a large volume of intravenous fluids has previously been recommended to facilitate stone excretion, but it is unclear whether these measures provide the desired assistance. Alpha blockers (such as tamsulosin) may also aid in excretion. Once the stone has been eliminated, no further acute treatment is required. In some cases, if the obstruction is very massive, a tube (stent) is temporarily inserted into the ureters to bypass the obstruction. The doctor inserts a telescopic instrument with an optical system (cystoscope, a type of endoscope) into the bladder and slides the stent through it into the ureter opening. The stent is pushed up, past the blocking stone. The stent remains in the urinary tract until the stone can be removed (e.g., by surgery). Alternatively, the blocked region can be drained via a drainage catheter inserted into the kidney through the back (nephrostomy catheter). Often, a shock wave lithotripsy can be used to break up stones less than one centimeter in diameter in the renal pelvis or the upper part of the ureter. This involves the use of sound waves that are directed into the body and break up the stone. The stone sand then goes away with the urine. Sometimes a stone is removed after a small incision in the skin with the help of an endoscope and forceps, or the stone is crushed by lithotripsy, the probe-assisted generation of shock waves, so that the individual fragments can later be excreted in the urine. Sometimes the stone is broken up with the help of a laser. This procedure is called holmium laser lithotripsy. A ureteroscope (a small telescope, kind of like an endoscope) may be inserted into the urethra, over the bladder, and up the ureter to remove small stones in the lower part of the ureter that need treatment. Sometimes the ureteroscope is used in conjunction with a device that shatters stones; these fragments can then be removed endoscopically or flushed out with urine (intracorporeal lithotripsy). Holmium laser lithotripsy is the most commonly used. In this procedure, a laser is used to break up the stone. Somewhat larger kidney stones can be removed with percutaneous nephrolithotomy can be removed. In this procedure, the physician makes a small incision on the back and inserts a telescopic instrument with an optical system (called a nephroscope, a type of endoscope) into the kidney. A probe is inserted through the nephroscope, which breaks the stones into smaller pieces and then removes them (nephrolithotripsy). By alkalizing the urine (e.g., with potassium citrate to be taken orally for 4 to 6 months), uric acid stones can sometimes be dissolved. However, other stones cannot be dissolved in this way. In the case of larger stones that block the urinary tract, sometimes a surgical removal necessary. Struvite stones usually must be removed by endoscopic surgery removed. Until the stones are removed, antibiotics are useless in the treatment of urinary tract infections (UTIs). The Stent implantation in the ureters refers to the placement of a soft, hollow tube that helps urine drain into the bladder. After a procedure to remove a stone, a stent in the ureter may be needed for one to two weeks. Irritation from the stone or from removal can cause inflammation of the ureter. The stent helps this inflammation subside.
Kidney stone disintegration with sound waves
Some kidney stones can be disintegrated by sound waves generated by a lithotripter. This procedure is called extracorporeal shock wave lithotripsy (SWL). After the stone is located on ultrasound or by fluoroscope, the lithotripter is pressed against the back and the shock waves are focused on the stone, shattering it. Now the patient must drink a lot to flush the fragments of the stone out of the kidney and help their excretion with the urine. Sometimes there is blood in the urine or the abdomen is swollen after the procedure, but serious problems are rare. Can A Kidney Stone Get Stuck.
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