Skip to main content
SpringerLink
Log in

Diagnosis of Urinary Tract Stones: An Overview

  • Chapter
  • First Online:
Urolithiasis

  • 345 Accesses

Abstract

Diagnosis of urinary tract stones starts with careful history taking. In case of presence of recurrent attacks of renal colic and stone disease, the recommended diagnostic approach is to start with plain radiography and ultrasonography. Non-contrast computed tomography is currently the diagnostic image modality of choice and has replaced intravenous pyelography especially in case of atypical presentation or when history of stone disease is absent. Contrast-enhanced computed tomography or intravenous pyelography should be done if further intervention is planned. T2-weighted magnetic resonance imaging (MRI) is useful particularly in pregnant women. Each patient with urolithiasis (no difference between high- or low-risk groups) should undergo basic biochemical workup.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Travaglini F, Bartoletti R, Gacci M, Rizzo M. Pathophysiology of reno-ureteral colic. Urol Int. 2004;72(1):20–3.

    Article  PubMed  Google Scholar 

  2. Teichman JM. Clinical practice. Acute renal colic from ureteral calculus. N Engl J Med. 2004;350(7):684–93.

    Article  PubMed  CAS  Google Scholar 

  3. Shokeir AA. Renal colic: pathophysiology, diagnosis and treatment. Eur Urol. 2001;39(3):241–9.

    Article  PubMed  CAS  Google Scholar 

  4. Rucker CM, Menias CO, Bhalla S. Mimics of renal colic: alternative diagnoses at unenhanced helical CT. Radiographics. 2004;24 Suppl 1:S11–28.

    Article  PubMed  Google Scholar 

  5. Clark AJ, Norman RW. “Mirror pain” as an unusual presentation of renal colic. Urology. 1998;51(1):116–8.

    Article  PubMed  CAS  Google Scholar 

  6. Eskelinen M, Ikonen J, Lipponen P. Usefulness of history-taking, physical examination and diagnostic scoring in acute renal colic. Eur Urol. 1998;34(6):467–73.

    Article  PubMed  CAS  Google Scholar 

  7. Shokeir AA. Renal colic: new concepts related to pathophysiology, diagnosis and treatment. Curr Opin Urol. 2002;12(4):263–9.

    Article  PubMed  Google Scholar 

  8. Serinken M, Karcioglu O, Turkcuer I, Ozkan HI, Keysan MK, Bukiran A. Analysis of clinical and demographic characteristics of patients presenting with renal colic in the emergency department. BMC Res Notes. 2008;1:79.

    Article  PubMed  Google Scholar 

  9. Bove P, Kaplan D, Dalrymple N, Rosenfield AT, Verga M, Anderson K, et al. Reexamining the value of hematuria testing in patients with acute flank pain. J Urol. 1999;162(3 Pt 1):685–7.

    Article  PubMed  CAS  Google Scholar 

  10. Wagner CA, Mohebbi N. Urinary pH and stone formation. J Nephrol. 2010;23 Suppl 16:S165–9.

    PubMed  Google Scholar 

  11. Pietrow PK, Preminger GM. Evaluation and management of urinary lithiasis. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell–Walsh urology, vol. II. 9th ed. Philadelphia: Saunders Elsevier; 2007. p. 1393–431. Chap 43.

    Google Scholar 

  12. Lalli AF. Symposium on renal lithiasis. Roentgen aspects of renal calculous disease. Urol Clin North Am. 1974;1:213–27.

    PubMed  CAS  Google Scholar 

  13. Roth R, Finlayson B. Observations on the radiopacity of stone substances with special reference to cystine. Invest Urol. 1973;11:186–9.

    PubMed  CAS  Google Scholar 

  14. Heidenreich A, Desgrandschamps F, Terrier F. Modern approach of diagnosis and management of acute flank pain: review of all imaging modalities. Eur Urol. 2002;41(4):351–62.

    Article  PubMed  Google Scholar 

  15. Kennish SJ, Bhatnagar P, Wah TM, Bush S, Irving HC. Is the KUB radiograph redundant for investigating acute ureteric colic in the non-contrast enhanced computed tomography era? Clin Radiol. 2008;63(10):1131–5.

    Article  PubMed  CAS  Google Scholar 

  16. Portis AJ, Sundaram CP. Diagnosis and initial management of kidney stones. Am Fam Physician. 2001;63(7):1329–38.

    PubMed  CAS  Google Scholar 

  17. Moş C, Holt G, Iuhasz S, Moş D, Teodor I, Hălbac M. The sensitivity of transabdominal ultrasound in the diagnosis of ureterolithiasis. Med Ultrason. 2010;12(3):188–97.

    PubMed  Google Scholar 

  18. Patlas M, Farkas A, Fisher D, Zaghal I, Hadas-Halpern I. Ultrasound vs CT for the detection of ureteric stones in patients with renal colic. Br J Radiol. 2001;74(886):901–4.

    PubMed  CAS  Google Scholar 

  19. Varma G, Nair N, Salim A, Marickar YM. Investigations for recognizing urinary stone. Urol Res. 2009;37(6):349–52.

    Article  PubMed  Google Scholar 

  20. Middleton WD, Dodds WJ, Lawson TL, Foley WD. Renal calculi: sensitivity for detection with US. Radiology. 1988;167(1):239–44.

    PubMed  CAS  Google Scholar 

  21. Holmes 3rd DR, Robb R. Trans-urethral ultrasound (TUUS) imaging for visualization and analysis of the prostate and associated tissues. Stud Health Technol Inform. 2000;70:126–32.

    PubMed  Google Scholar 

  22. Serafini G, Gandolfo N, Gandolfo N, Gazzo P, Martinoli C, Derchi LE. Transvaginal ultrasonography of nongynecologic pelvic lesions. Abdom Imaging. 2001;26(5):540–9.

    Article  PubMed  CAS  Google Scholar 

  23. Cantoro D, Galosi AB, Conti A, Muzzonigro G. Distal ureter studied with endocavitary end-fire probe: application in adult urology ultrasonographic clinic. Arch Ital Urol Androl. 2010;82(4):211–4.

    PubMed  Google Scholar 

  24. Dalla Palma L, Pozzi-Mucelli R, Stacul F. Present-day imaging of patients with renal colic. Eur Radiol. 2001;11(1):4–17.

    Article  PubMed  CAS  Google Scholar 

  25. Shokeir AA, El-Diasty T, Eassa W, Mosbah A, El-Ghar MA, Mansour O, Dawaba M, El-Kappany H. Diagnosis of ureteral obstruction in patients with compromised renal function: the role of noninvasive imaging modalities. J Urol. 2004;171(6 Pt 1):2303–6.

    Article  PubMed  Google Scholar 

  26. Shokeir AA, Abdulmaaboud M. Resistive index in renal colic: a prospective study. BJU Int. 1999;83(4):378–82.

    Article  PubMed  CAS  Google Scholar 

  27. Shokeir AA, Mahran MR, Abdulmaaboud M. Renal colic in pregnant women: role of renal resistive index. Urology. 2000;55(3):344–7.

    Article  PubMed  CAS  Google Scholar 

  28. Shokeir AA, Abdulmaaboud M. Prospective comparison of nonenhanced helical computerized tomography and Doppler ultrasonography for the diagnosis of renalcolic. J Urol. 2001;165(4):1082–4.

    Article  PubMed  CAS  Google Scholar 

  29. Shokeir AA, Abdulmaaboud M, Farage Y, Mutabagani H. Resistive index in renal colic: the effect of nonsteroidal anti-inflammatory drugs. BJU Int. 1999;84(3):249–51.

    Article  PubMed  CAS  Google Scholar 

  30. Elton TJ, Roth CS, Berquist TH, Silverstein MD. A clinical prediction rule for the diagnosis of ureteral calculi in emergency departments. J Gen Intern Med. 1993;8:57–62.

    Article  PubMed  CAS  Google Scholar 

  31. Morcos SK, Thomsen HS, Webb JA, Contrast Media Safety Committee of the European Society of Urogenital Radiolology. Prevention of generalized reactions to contrast media: a consensus report and guidelines. Eur Radiol. 2001;11(9):1720–8.

    Article  PubMed  CAS  Google Scholar 

  32. Thomsen HS, Morcos SK. Contrast media and the kidney: European Society of Urogenital Radiology (ESUR) guidelines. Br J Radiol. 2003;76(908):513–8.

    Article  PubMed  CAS  Google Scholar 

  33. Tiselius HG, Alken P, Buk C, Gallucci M, Knoll T, Sarica K, et al. EAU guidelines on urolithiasis. Diagnostic procedures. The edition presented at EAU annual congress. Guidelines Office, Arnhem, The Netherlands. 2008. p. 9–19.

    Google Scholar 

  34. Wu DS, Stoller ML. Indinavir urolithiasis. Curr Opin Urol. 2000;10(6):557–61.

    Article  PubMed  CAS  Google Scholar 

  35. Smith RC, Rosenfield AT, Choe KA, Essenmacher KR, Verga M, Glickman MG, Lange RC. Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography. Radiology. 1995;194(3):789–94.

    PubMed  CAS  Google Scholar 

  36. Nakada SY, Hoff DG, Attai S, Heisey D, Blankenbaker D, Pozniak M. Determination of stone composition by noncontrast spiral computed tomography in the clinical setting. Urology. 2000;55(6):816–9.

    Article  PubMed  CAS  Google Scholar 

  37. Zarse CA, McAteer JA, Sommer AJ, Kim SC, Hatt EK, Lingeman JE, et al. Nondestructive analysis of urinary calculi using micro computed tomography. BMC Urol. 2004;4(1):15.

    Article  PubMed  Google Scholar 

  38. Boll DT, Patil NA, Paulson EK, Merkle EM, Simmons WN, Pierre SA, et al. Renal stone assessment with dual-energy multidetector CT and advanced postprocessing techniques: improved characterization of renal stone composition – pilot study. Radiology. 2009;250(3):813–20.

    Article  PubMed  Google Scholar 

  39. Ferrandino MN, Pierre SA, Simmons WN, Paulson EK, Albala DM, Preminger GM. Dual-energy computed tomography with advanced postimage acquisition data processing: improved determination of urinary stone composition. J Endourol. 2010;24(3):347–54.

    Article  PubMed  Google Scholar 

  40. El-Ghar ME, Shokeir AA, El-Diasty TA, Refaie HF, Gad HM, El-Dein AB. Contrast enhanced spiral computerized tomography in patients with chronic obstructive uropathy and normal serum creatinine: a single session for anatomical and functional assessment. J Urol. 2004;172(3):985–8.

    Article  PubMed  Google Scholar 

  41. Thomson JM, Glocer J, Abbott C, Maling TM, Mark S. Computed tomography versus intravenous urography in diagnosis of acute flank pain from urolithiasis: a randomized study comparing imaging costs and radiation dose. Australas Radiol. 2001;45(3):291–7.

    Article  PubMed  CAS  Google Scholar 

  42. Kluner C, Hein PA, Gralla O, Hein E, Hamm B, Romano V, et al. Does ultra-low-dose CT with a radiation dose equivalent to that of KUB suffice to detect renal and ureteral calculi? J Comput Assist Tomogr. 2006;30(1):44–50.

    Article  PubMed  Google Scholar 

  43. Van Der Molen AJ, Cowan NC, Mueller-Lisse UG, Nolte-Ernsting CC, Takahashi S, Cohan RH, CT Urography Working Group of the European Society of Urogenital Radiology (ESUR). CT urography: definition, indications and techniques. A guideline for clinical practice. Eur Radiol. 2008;18(1):4–17.

    Article  Google Scholar 

  44. Jellison FC, Smith JC, Heldt JP, Spengler NM, Nicolay LI, Ruckle HC, et al. Effect of low dose radiation computerized tomography protocols on distal ureteral calculus detection. J Urol. 2009;182(6):2762–7.

    Article  PubMed  Google Scholar 

  45. Poletti PA, Platon A, Rutschmann OT, Schmidlin FR, Iselin CE, Becker CD. Low-dose versus standard-dose CT protocol in patients with clinically suspected renal colic. AJR Am J Roentgenol. 2007;188(4):927–33.

    Article  PubMed  Google Scholar 

  46. Niemann T, Kollmann T, Bongartz G. Diagnostic performance of low-dose CT for the detection of urolithiasis: a meta-analysis. AJR Am J Roentgenol. 2008;191(2):396–401.

    Article  PubMed  Google Scholar 

  47. Kalb B, Sharma P, Salman K, Ogan K, Pattaras JG, Martin DR. Acute abdominal pain: is there a potential role for MRI in the setting of the emergency department in a patient with renal calculi? J Magn Reson Imaging. 2010;32(5):1012–23.

    Article  PubMed  Google Scholar 

  48. Abou El-Ghar ME, Shokeir AA, Refaie HF, El-Diasty TA. MRI in patients with chronic obstructive uropathy and compromised renal function: a sole method for morphological and functional assessment. Br J Radiol. 2008;81(968):624–9.

    Article  PubMed  CAS  Google Scholar 

  49. Türk C, Knoll T, Petrik A, Sarica K, Straub M, Seitz C. Guidelines on urolithiasis. Arnhem: European Association of Urology; 2011. Chapter 11, Section 1.

    Google Scholar 

  50. Shekarriz B, Stoller ML. Uric acid nephrolithiasis: current concepts and controversies. J Urol. 2002;168(4 Pt 1):1307–14.

    PubMed  CAS  Google Scholar 

  51. Tiselius HG. Aetiological factors in stone formation. In: Davison AM, Cameron JS, Grunfeld J-P, Kerr DN, Ritz E, Winearls CG, editors. Oxford textbook of clinical nephrology. 3rd ed. Oxford: Oxford University Press; 2005. p. 1201–23.

    Google Scholar 

  52. Coe FL, Evan A, Worcester E. Kidney stone disease. J Clin Invest. 2005;115(10):2598–608.

    Article  PubMed  CAS  Google Scholar 

  53. Welch BJ, Graybeal D, Moe OW, Maalouf NM, Sakhaee K. Biochemical and stone-risk profiles with topiramate treatment. Am J Kidney Dis. 2006;48(4):555–63.

    Article  PubMed  CAS  Google Scholar 

  54. Wilcox WR, Khalaf A, Weinberger A, Kippen I, Klinenberg JR. Solubility of uric acid and monosodium urate. Med Biol Eng. 1972;10(4):522–31.

    Article  PubMed  CAS  Google Scholar 

  55. Pak CY, Waters O, Arnold L, Holt K, Cox C, Barilla D. Mechanism for calcium urolithiasis among patients with hyperuricosuria: supersaturation of urine with respect to monosodium urate. J Clin Invest. 1977;59(3):426–31.

    Article  PubMed  CAS  Google Scholar 

  56. Mattle D, Hess B. Preventive treatment of nephrolithiasis with alkali citrate – a critical review. Urol Res. 2005;33(2):73–9.

    Article  PubMed  CAS  Google Scholar 

  57. Rodgers AL, Allie-Hamdulay S, Jackson GE. JESS: what can it teach us? In: Evan AP, Lingeman JE, Williams Jr JC, editors. Proceedings of renal stone disease 1st annual international urolithiasis research symposium, 203 November 2006, Indianapolis, Indiana. Melville/New York: American Institute of Physics; 2007. p. 183–91. ISBN 878-0-7354-0406-9.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt

    Ahmed S. El-Hefnawy M.D. & Ahmed A. Shokeir M.D., Ph.D., FEBU

Authors
  1. Ahmed S. El-Hefnawy M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmed A. Shokeir M.D., Ph.D., FEBU
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ahmed A. Shokeir M.D., Ph.D., FEBU .

Editor information

Editors and Affiliations

  1. Department of Surgery Section of Urology, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan

    Jamsheer J. Talati

  2. Karolinska Institutet, Solnavägen 1, Solna, Stockholm, 171 77, Sweden

    Hans-Goran Tiselius

  3. , Syracuse University, Crouse Hospital, 1226 East Water Street, New York, 13210, New York, USA

    David M. Albala

  4. , Department of Urology, Tongji Hospital, 1095 Jiefang Avenue, Wuhan, 430030, China, People's Republic

    ZHANGQUN YE

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag London

About this chapter

Cite this chapter

El-Hefnawy, A.S., Shokeir, A.A. (2012). Diagnosis of Urinary Tract Stones: An Overview. In: Talati, J., Tiselius, HG., Albala, D., YE, Z. (eds) Urolithiasis. Springer, London. https://doi.org/10.1007/978-1-4471-4387-1_30

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-4387-1_30

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4383-3

  • Online ISBN: 978-1-4471-4387-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation