Kidney Stones: Frequently Asked Questions
A KUB may not identify calcium stones that are smaller than 3mm and/or very faint. The KUB will miss the less common uric acid and cystine stones. Only a CAT scan will pick up these smaller stones.
If your pain is quite severe, or you cannot hold down fluids from the associated nausea, you might contact us to discuss measures to remove the stone. If you develop a fever or an associated urinary infection, you should contact us about treatment for the infection and stone intervention.
Elderly patients may not have the typical severe flank or abdominal pain when a stone tries to pass. Confusion and vague abdominal pain may be the only symptoms. Unfortunately, confusion may also be a sign of an active urine infection, possibly one that has gotten into the blood system. This patient should go to the ER and may need urgent treatment.
Both have high success rates. SWL is less invasive, but it may not completely clear the stone as well as ureteroscopy. If you choose SWL and the stone or its fragments does not pass, you would need a ureteroscopy as a backup procedure.Large stones in the kidney may not be suitable for ESWL. You would have to discuss your individual case with your urologist.
Ideally, we would want to remove all of the stones, then work on stone prevention by conducting a metabolic evaluation (see glossary). The newest flexible endoscopes make this much more feasible, although it can sometimes require several procedures to get you “stone free.” This is the preferred goal for younger people with generally good health.
In a very sick or elderly patient, it’s all about risk assessment and likelihood of successful treatment. It’s not always wise to do procedures for non-obstructing stones because of their medical risks and/or their medications (e.g., blood thinners that increase bleeding). Smaller stones that do not cause obstruction may be observed. Larger stones require discussion and shared decision-making whether to treat. Although less common, infection stones, or struvite stones, are best removed to prevent serious urine and blood borne infections.