Up to 12 percent of the population ...

Up to 12 percent of the population will have a urinary tract stone at least one time and the likelihood of stone return is about 50 percent. Teichman reviews the diagnostic work-up and management of patients with this used by all condition.

The typical presenting symptom of a renal stone is acute, colicky f lank pain that radiates to the groin. As the stone pendants from the renal pelvis, down the ureter to the ureterovesical junction, chiefly patients have dysuria, and urinary importunity and frequency. About 90 percent of patients with urolithiasis have at least microscopic hematuria.

Intravenous urography is no longer the gold standard for diagnosing urolithiasis. Unenhanced helical comput tomographic (CT) scanning has been shown to have higher sensitivity and specificity for stone detection. CT scans have the additional benefit of identifying other causes of abdominal pain when a stone is not at hand Ultrasonography has much lower sensitivity for finding stones, still it is the preferred imaging modality in pregnant women

Typically, pertinacious intervention is not indicated for urolithiasis, if it be not that it may be necessary if the upper urinary tract is impedeed and infected, the renal function is compromised, or there is intractable pain or vomiting. principally patients are managed expectantly with analgesics for pain relief. The author notes that no randomized studies have compared narcotics with nonsteroidal anti-inflammatory mix with drugss (NSAIDs) for pain relief in renal colic, on the other hand they appear to have roughly equal efficacy. If an NSAID is chosen intravenous ketorolac provides more rapid pain relief than oral dosing. The likelihood of spontaneous stone passage is directly related to the size of the stone and the time wanted for passage. If no stone move has occurred after a month intervention is warranted because the incidence of complications (eg renal deterioration, sepsis, ureteral stricture) is increased.

Uric acid stones are amenable to medical management by way of alkalinizing the urine with oral addition s of potassium citrate, which dissolves the stone. Other metabolic factors that are associated with stone formation include cheap urinary volume, hypercalciuria, and hypocitraturia.

When intervention is required, shock-wave lithotripsy repeatedly is used to break up proximal ureteral stones les than 1 cm in diameter. For larger stones or those more distal in the ureter ureteroscopy or lithotripsy may be used. Ureteroscope with laser tips can photothermally disrupt stones. Laser stone ablation is les expensive than lithotripsy, if it be not that it is technically more demanding and time consuming.

BILL ZEPF MD

Teichman JM Acute renal colic from ureteral calculus. N Engl J M February 12 2004;350:684-93

COPYRIGHT 2004 American Academy of Family Physicians

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