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Ureteral Stones

Mike Weinstock, MD and Adrienne Carmack, MD
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What are typical symptoms of ureteral stone and how do we distinguish from pyelo?

Which tests can be helpful for dx? Does flomax help w stone passage? How do we interpret urine dip?

What are the complications and referral indications in patients with ureteral/renal colic? Mike sits down with Adrienne Carmack to discuss these questions and more.

 

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Angelina M. -

How soon should the patients being sent home f/u with their pcp or urology?

Also, if you incidentally find out their stone is obstructive and causing hydronephrosis does this change your management? ie do you get labs to eval their kidney function or try to get them in with urology sooner? I typically get a KUB to confirm my suspicion of stone (makes me feel better, and also I think the patient likes having some sort of imaging done). However, the other day I had a healthy female come in with sxs consistent with uretal colic, my KUB was negative, I ended up getting a CT and it showed a 4mm obstructive stone causing hydronephrosis. I was wondering if I should do any further testing with this finding but it also made me stop and think because I dont when I seen a stone on the KUB (even though I know very well their could be some hydronephrosis with a uretal stone). She was in her 30s, healthy, no co-morbidities, and responded well to toradol.

Mike W., MD -

Hi Angelina, thx for the question. I can see your points, but I would be reluctant to place credence in a KUB when you need to rule out other serious diagnoses such as AAA, malignancy, SBO etc. An uncomplicated obstructive stone does not require lab testing except an UA looking for infection. So many great questions - perhaps we need another segment on this!!

Angelina M. -

Yes! I agree - definitely not to rule out other more serious diagnoses - but I am just talking about a young healthy pt with what seems like uncomplicated ureteral colic. Does the finding of hydronephrosis prompt kidney function testing or sooner urology referral? The KUB has also been useful in the past for evaluating stone size. I have had a patient with a 16mm stone that urology wanted to see right away. I'm not sure if stone size should dictate f/u time but it does not seem like that would pass on its own? and without the KUB, I would have likely told the patient this should pass on its own over the next month. Also, I am curious of how you determine who to give MET (flomax) to if you dont know the stone size (I know you probably just dont give it) - but it seems the debate that goes back and forth keeps agreeing on use of MET for stones >5mm but we would not know this without imaging. Thanks for the help! So many useful segments and it does seem like I am still needing an additional one!

Mike W., MD -

Hi Angelina, thx for the follow up. And yes, you are right, I typically don't give the flomax if I don't know the stone size, but I get your point about the KUB. I would caution that it should not be used for diagnosis, esp if there is some question about whether the patient's symptoms are from ureteral colic or something else, though if you have already confirmed a ureteral stone (or more importantly excluded a more serious diagnosis), then a KUB does seem reasonable w a radio opaque stone. And thx for the comments - yes, SO many interesting topics to discuss!!

Mike W., MD -

Hi Angelina, thx for the follow up. And yes, you are right, I typically don't give the flomax if I don't know the stone size, but I get your point about the KUB. I would caution that it should not be used for diagnosis, esp if there is some question about whether the patient's symptoms are from ureteral colic or something else, though if you have already confirmed a ureteral stone (or more importantly excluded a more serious diagnosis), then a KUB does seem reasonable w a radio opaque stone. And thx for the comments - yes, SO many interesting topics to discuss!!

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