Test and Diagnosis
Blood tests may reveal too much calcium or uric acid in your blood. Blood test results help monitor the health of your kidneys and may lead your doctor to check for other medical conditions.
Ultrasound is a noninvasive test that can be used to diagnose kidney stones. This test involves the use of sound waves, and does not require exposure to radiation or to contrast dye. Ureteral stones usually cannot be seen using ultrasound, unless the stone is located at the junction of the ureter and the bladder. In most cases, the effects of the stone (e.g., dilation of the collecting system) are indicated by ultrasound. Movement of the urine from the ureters into the bladder can also be seen using ultrasound. Normally, there are two sprays, or "jets," of urine—one from each ureter. If one spray is missing, there may be an obstructing stone in the ureter. Ultrasound can be used in women who are or may be pregnant and in patients who are allergic to contrast dye. It can also provide useful information about other conditions that cause abdominal pain, such as gallbladder disease, appendicitis, and gynecological cancers in women.
Abdominal x-rays may be used to diagnose kidney stones. Approximately 80 percent of kidney/ureteral stones are calcified and can be seen on x-ray. An x-ray of the abdomen (known as a KUB—kidney, ureter, bladder) may show a small stone overlying one or both of the renal shadows or a stone in one of the ureters. Other types of stones (e.g., phleboliths, which form in the venous structures of the pelvis) also may be visible on abdominal x-ray. In a diagnostic test called an Intravenous Pyelogram (IVP) a dye is injected intravenously. This dye, which is relatively dense, is excreted by the kidneys and can be detected by x-rays. Normally, the dye is excreted quickly by both kidneys, appears in the collecting systems, and then moves into the ureters. If there is a blockage, it takes longer for the dye to be excreted. If obstruction is very high grade, it may take hours to see the dye in the obstructed ureter. IVP is a reliable test for kidney/ureteral stones, but it has a few drawbacks (e.g., exposure to radiation, intravenous dye may cause an adverse reaction). Intravenous pyelogram often is not able to diagnose other conditions that can cause one-sided abdominal pain.
When a more direct test is needed, CT KUB may be performed. Conventional CT scan (computed tomography) creates one image, slides the patient in a bit, and makes another image. Spiral CT does essentially the same thing, but continuously, and high-speed spiral CT creates images continuously and very fast. In CT KUB, numerous, consecutive images of the abdomen and pelvis are obtained. To diagnose kidney/ureteral stones, the radiologist focuses on a given structure (e.g., the ureter) and follows it along, image by image, in rapid sequence. This test provides images of the liver, pancreas, gallbladder, and other upper abdominal organs. The radiologist can evaluate the appendix for inflammation, detect diverticulitis, and look for bowel obstruction. In the urinary tract, the kidneys and ureters can be studied in detail, looking for stones, tumors, or other signs of obstruction. he type of imaging test used to diagnose kidney stones depends on a number of factors, such as the clinical circumstances, the age and sex of the patient, and the availability of the test in a given radiology department. Some departments, for example, may rely more heavily on IVP if spiral CT and ultrasound are not as available.
Treatment of Urinary stones.
Treatment of urinary stone to great extent is influenced by the site and size of the stone
Small stones with minimal symptoms
Most kidney stones won't require invasive treatment. You may be able to pass a small stone by:
When to Contact Your Doctor
c) If you are having difficulty with bladder control as a result of increasing your fluid intake
Large stones and those that cause symptoms
Any stone large tha 7-8 mm may produce symptoms if in ureter. Or any stone large than 8 mm in urinary tract require active intervention. Lithotripsy is the safe and non surgical procedure for treatment of stone upto 20 mm. To large success of lithotripsy depends on type of lithotripter and treating doctors expertise.
Kidney stones that can't be treated with conservative measures - either because they're too large to pass on their own or because they cause bleeding, kidney damage or ongoing urinary tract infections - may require more extensive treatment. Procedures may include: Majority of renal calculus upto 20 mm can be safely treated with lithotripsy. In some of instance were physician expects that broken fragments would not pass out because of anatomy most commonly Lower pole calculus with long and acute angle, calculus with in narrow infundibular calyx. Might serve as expectation to the lithotripsy.
As a patient it your basic right to know the type of machine used for lithotripsy. As there are many lithotripter with different method shockwave generation available in the market. Electromagnetic lithotripters are the best lithotripter for patients, however most common lithotripters in market are Electrohydraulic lithotripters. As its question of your kidney it is always better to subject yourself to lithotripter with high safety standards. Machines with US FDA and European CE approved have high safety standards. Studies have shown that if ultrasound is used as imaging guide during lithotripsy the results of lithotripsy are superior when compared to flouroscpy. Flouroscopy is the machine which emits low dose X ray to localize the stone. There is tendency of stone to get shifted during lithotripsy, hence repeated X ray exposure is required. Some studies have demonstrated with there is 2% chances of cancer in the future generation of patients who are exposed to X rays during lithotripsy. Hence ultrasound is safe radiation free imaging method during lithotripsy. Always insist on US FDA and European CE approved electromagnetic lithotripter with ultrasound as imaging modality for treatment.
For kidney stones larger than 20 mm endoscopic procedures are recommended based on site and size of stone.