Acute Stone Management

PRESENTATION

The patient with stone typically presents with unilateral renal colic and hematuria. Renal colic refers to an intermittent flank pain arising in the kidney or ureter and may radiate to the ipsilateral groin or testis. Patients generally toss about and cannot find a comfortable position. Guarding with nausea and vomiting is occasionally noted. Low-grade fever and mild elevation of the white count may be present. Evidence of serious infection (e.g., high-grade fever, white count, and pyuria) demands immediate intervention, especially in diabetics.

DIAGNOSIS

Urinalysis will almost always show red blood cells, and 90% of stones can be demonstrated on a kidney, ureter, and bladder (KUB) film of the abdomen. A stone protocol (i.e., non-contrast) computed tomography (CT) scan of the abdomen and pelvis has become the standard initial workup of patients with suspected stone. The modern high-speed helical (spiral) CT scanners with sagittal and coronal reconstructed images can be performed in minutes and reliably make the diagnosis of urolithiasis.

Workup

▪ Laboratory Tests

A urinalysis should always be obtained. Hematuria will be present in most cases. Pyuria would suggest an associated infection that will need immediate attention. A urine culture should be sent if the urinalysis indicates pyuria or significant bacteriuria. A serum creatinine should be obtained to evaluate renal function. A complete blood count may be indicated to screen for evidence of serious infection.

▪ Imaging Studies

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