Urolithiasis

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    Last updated: December 2020

     

    Urolithiasis is the formation and passage of calculi (stones) in the urinary tract.

    Clinical features

    • Many calculi do not cause symptoms; they may be found incidentally through radiology exams.
    • Symptoms arise when calculi cause partial or complete obstruction and/or infection:
      • Intermittent, acute flank to pelvic pain (renal colic). Pain can be severe and typically causes nausea and vomiting. Abdomen/flank may be tender to palpation. Patients are typically restless, finding no comfortable position.
      • Haematuria and/or gravel (calculi) passed in urine.
      • Fever and signs of pyelonephritis if secondary infection develops (see Acute pyelonephritis, Chapter 9).

     

    Note: if available, ultrasound may demonstrate calculi and hydronephrosis.

    Treatment

    • Encourage the patient to drink fluids.
    • Administer analgesics according to the intensity of pain (see Pain, Chapter 1).
    • In case of secondary infection: antibiotic treatment as for pyelonephritis. The effectiveness will depend on the passage of calculi.

     

    Note: the majority of calculi pass spontaneously. If there are signs of significant renal dysfunction or secondary infection that does not improve with antibiotic treatment, consider surgical referral.