What are the common symptoms of kidney stones?
The most common symptom is pain. The pain usually appears suddenly and is sharp and piercing around the waist, under the rib cage. The pain is generally referred to as colic pain and occurs when the stone blocks the passage of urine from the kidney.

The ureter is a long thin tube which transmits the urine from the kidney to the bladder. When the stone is in the ureter it blocks the passage of urine and it is more likely the pains will be stronger. If the stone advances towards the bladder, the pain could move to the lower abdomen and groin areas. A feeling of nausea and/or vomiting is common with significant pain and there is often a need for frequent urination.  

The severity of pain is not necessarily connected to the size of the stone. While small stones can cause excruciating pain, larger stones may not cause any pain at all, particularly those located in the kidney itself. Stones like these may often be detected after finding blood in regular urine samples. Although these stones do not cause pain, it is important to detect them as early as possible because they are liable to grow to a size that will not allow for spontaneous passage through the ureter and out of the body. If there is a suspicion of infection in the urine together with stones in the urinary tract, the patient could suffer from a high temperature and shivering. This can be life-threatening and it is crucial to contact a doctor as soon as possible.

How is a kidney stone diagnosed?
The diagnosis begins with a physical examination and an assessment of the patient’s medical history. The urologist will gather data on the current symptoms, on the period before the emergence of the stones, on past illnesses, current medical state, what drugs the patient is taking, dietary habits and family history. The physical examination is designed to identify common kidney stone symptoms, such as pains in the side (waist), lower abdomen or groin.

The patient is asked to provide a urine sample, so the doctors can look for signs of blood, infection or crystals. It is common to find microscopic blood spots in the urine when there is a stone in the kidney, particularly when it is moving down the ureter. In such a case, the blood sample is sent for analysis and we can check for kidney functioning and/or infection.

The full diagnosis for kidney stones is conducted through an X-Ray. A simple screening of the empty stomach could be enough for an initial diagnosis, since most stones in the urinary system are visible. Despite this, stones consisting of uric acid may be more difficult to identify. Therefore, we also perform a CT scan to receive all the information.

Another test is an IVP, which involves injecting a contrast liquid into a vein on the hand, and then following its progress – via X-Ray – through the kidney, ureter and bladder. However, this test is being conducted less and less these days. In most cases, a CT scan without contrast material is the best diagnostic test, because almost all the different types of stones can be located. Moreover, the test allows for precise imagery of the kidneys, the ureter and the bladder and all organs in that area, such as the intestines.

In many cases, CT scans conducted to check other medical situations reveal stones in the urinary tract.
By identifying the exact location of the stone, its size and knowing if there is more than one, we are able to better adapt the treatment approach to the patient’s individual needs. 

How do we treat kidney stones?
At Shaare Zedek we take the two-step approach to treating kidney stones. The first step is removing the stones and the second is preventing the development of new ones.

Most of the smaller kidney stones (less than 5mm diameter) will come out automatically in the urine with no need for treatment. By drinking more liquids, the patient can enhance the passage of the stones. It is beneficial to filter the urine so that the stone can be sent for analysis.

By determining the composition of the stone, we can receive important data for the prevention stage and treatment planning. There are a number of possibilities that may demand intervention, even for small stones. For example, intervention will be needed if the patient only has one kidney, kidney failure, complete urine blockage or infection. While waiting for the spontaneous exit of the stone, we can provide conservative treatment such as painkillers, liquids and rest.

In addition, recent studies suggest a group of drugs known as Alpha blockers, which can increase the likelihood of stones in the lower part of the ureter coming out by themselves. Alpha blockers are a group of drugs usually prescribed for treating enlarged prostates in men, and include drugs such as Cadex, Xatral, Hytrin or Omnic.

Surgical intervention will only be needed if the stone has still not come out after four to six weeks. Other factors involved in determining the treatment are the number of stones, their size, location and composition.