OT - Passing a kidney stone

Submitted by Zarniwoop on May 18th, 2017 at 11:25 AM

I'm going to be passing a 5mm stone that's currently stuck in my ureter within the next few days. Looking for veterans that can tell me what to expect.

Is it worst in the ureter or the urethra?

Outside of the pain meds, is there anything I can do to make it more bearable?

Any other suggestions. I ended up in the ER last night because of the excruciating pain of having it taversing my ureter. Not looking forward to more of this.

Yes, I know this isn't a medical board. But, I'm utterly miserable with pain and this is my online "home" so to speak. There's something comforting about seeing the layout when you're in agony.

Comments

Blue4U

May 18th, 2017 at 11:47 AM ^

Drink ALOOOT of water and hold your pee as long as you can.  Hopefully the buildup of pressure will help flush it out.  I went to the hospital and they sent me home with pain meds along with some other med to open the canal further (I think).   The problem was I was sooo sick I kept vomitting and all the fluids I was taking in was coming out just as fast.   I went to the hospital after 2 days and they removed it surgically.  Good luck, it hurts like hell as I'm sure you already know.

Roy G. Biv

May 18th, 2017 at 11:49 AM ^

I hope yours passes. Mine did not. It had to be removed. A stent was put in to help my inflamed parts. Felt like someone poking me in the sack with a needle . . . from the inside. Stent removal? You don't want to know.

Zarniwoop

May 18th, 2017 at 11:56 AM ^

I've had a stent removal.

It was so much worse than having the stone that I can't even describe it. I would rather have been shot than experienced stent removal (from the uretor).

When that giant telescope passes your prostate, its like nothing else on earth. I couldn't call it pain. But, the discomfort is a 12 on a scale of 10. I was literally only touching the table with my heels and the back of my head.

He told me to breathe and I gasped that I couldn't. It was so uncomfrotable I started laughing uncontrollably in shock.

jabberwock

May 18th, 2017 at 12:34 PM ^

I wish.

Try having a Hydroselectomy, getting a liter of fluid drained out of your scrotum, stitching up the internal parts, having a 6' drain tube installed and then having your testical surgically sewed to your scrotum to reduce torsion.

That is a bucket-load of agony that takes months to ease.

A needle, hmph!

treetown

May 18th, 2017 at 12:03 PM ^

1. Stones are not round - you might told the diameter of the stone as x millimeters but remember that is one dimension and the stones are usually not perfectly round - think of them more like aggregates or concretions like bits of roundish coral. Because of this, they can have edgs and points that can catch and nick the lining.

2. Smaller stones are more likely to pass. A general rule of thumb is 5 mm stones have a 90% chance of passage. This is very general - rounder smoother stones that are bigger can pass, but usually if it gets bigger than 5-6 mm, it becomes less and less likely.

3. There are traditionally 3 points where stones can get "caught" (a) where the renal pelvis meets the ureter (the tube that connects the kidney to the bladder), (b) where the ureter passes over the iliac vessels (the big trunk arteries and veins heading to the pelvis and legs) and (c) where the ureter enters the bladder.

4. Once the stone is inside the bladder, it is a lot easier to pass due to the relative size. The typical adult male urethra is about a size 20-26 Fr (scale used to size urethral catheters) whereas the typical adult male ureter is about 5-8 Fr, maybe 10-12 Fr with some dilation.

5. Drink a lot of water and void - you want to keep the urine moving along. Holding in the bladder may help you expel a stone there but not help you pass stones in the kidney or bladder.

6. Sometimes a medication called tamsulosin is used. Not giving medical advice but noting that in the literature smooth muscle relaxants have been used to help dilate the ureter. Talk with a urologist! It is controversial. Studies in Europe and US suggest different degrees of help - that is using it in general for all stones may not make a difference in passage but some stones (e.g. almost into the bladder) may benefit.

6. See a urologist! If the stone gets stuck and dilation starts occuring (means urine is having a harder time passing down around the stone - bad for the kidney), you might need to get a ureteral stent - a soft silicon tube passed around the stone to vent the urine. Further procedures with a ureteroscope (a long flexible tube passed up the ureter) and laser lithotripsy might be needed (I hope note).

7. Once the stone is done - do a work up to find out what factors may make you vulnerable. Stone analysis, some basic blood tests and a 24 hour urine collection. See a urologist. You want to prevent future stones. Statistically once you have a stone, if you do nothing, your odds of having another stone in the next 3-5 years is about 50% so see a urologist.

8. See a urologist. Good luck!

ScruffyTheJanitor

May 18th, 2017 at 12:29 PM ^


3. There are traditionally 3 points where stones can get "caught" (a) where the renal pelvis meets the ureter (the tube that connects the kidney to the bladder), (b) where the ureter passes over the iliac vessels (the big trunk arteries and veins heading to the pelvis and legs) and (c) where the ureter enters the bladder.

 

treetown

May 18th, 2017 at 12:09 PM ^

1. Stones are not round - you might be told the diameter of the stone as x millimeters but remember that is one dimension and the stones are usually not perfectly round - think of them more like aggregates or concretions like bits of roundish coral. Because of this, they can have edgs and points that can catch and nick the lining.

2. Smaller stones are more likely to pass. A general rule of thumb is 5 mm stones have a 90% chance of passage. This is very general - rounder smoother stones that are bigger can pass, but usually if it gets bigger than 5-6 mm, it becomes less and less likely.

3. There are traditionally 3 points where stones can get "caught" (a) where the renal pelvis meets the ureter (the tube that connects the kidney to the bladder), (b) where the ureter passes over the iliac vessels (the big trunk arteries and veins heading to the pelvis and legs) and (c) where the ureter enters the bladder.

4. Once the stone is inside the bladder, it is a lot easier to pass due to the relative size. The typical adult male urethra is about a size 20-26 Fr (scale used to size urethral catheters) whereas the typical adult male ureter is about 5-8 Fr, maybe 10-12 Fr with some dilation. This is an old legacy scale from wire scales - 9 Fr = 3 mm diameter. In Europe, the term is Ch or Charriere after the inventor.

5. Drink a lot of water and void - you want to keep the urine moving along. Holding one's urine does not help you pass stones in the kidney or ureter.

6. Sometimes a medication called tamsulosin (aka Flowmax) is used. Not giving medical advice but noting that in the literature smooth muscle relaxants have been used to help dilate the ureter. Talk with a urologist! It is controversial. Studies in Europe and US suggest different degrees of help - that is using it in general for all stones may not make a difference in passage but some stones (e.g. in the ureter and almost into the bladder) may benefit.

6. See a urologist! If the stone gets stuck and dilation starts occuring (means urine is having a harder time passing down around the stone - bad for the kidney), you might need to get a ureteral stent - a soft silicon tube passed around the stone to vent the urine. Further procedures with a ureteroscope (a long flexible tube passed up the ureter) and laser lithotripsy might be needed (I hope note).

7. Once the stone is done - do a work up to find out what factors may make you vulnerable.  Try to catch and save the stone if you pass it so it can be analyzed. Stone analysis, some basic blood tests and a 24 hour urine collection will be needed. See a urologist. You want to prevent future stones. Statistically once you have a stone, if you do nothing, your odds of having another stone in the next 3-5 years is about 50% so see a urologist.

8. See a urologist. Good luck!

Rabbit21

May 18th, 2017 at 1:23 PM ^

From what I have been given to understand a lot of it is dependent on one's physical make-up(i.e. you're either pre-disposed to them or you aren't) so it seems to boil down to:

1. Drink craploads of water

2.  Pray

 

MLG2908

May 18th, 2017 at 12:13 PM ^

I have had many kidney stones over the years.  My last stone was 13 mm and had to be broken up and removed via laser lithotripsy.  Because my left kidney has atrophied due to an earlier blockage, I know a stone may not only be painful but could cause permanent damage if not passed promptly.  

A 5 mm stone will pass in most cases, but is large enough that in some cases it may not pass without intervention. If the pain continues too long you may want to explore ureteroscopy with a urologist.  Also, you may want to monitor your blood pressure.  My systolic pressure has reached 200 due to kidney stone pain. 

http://www.webmd.com/kidney-stones/ureteroscopy-16859

The advice you received to drink plenty of fluids and use a heating pad is helpful.  Are you taking Flomax or the generic version Tamsulosin?  This medication may help facilitate passing your kidney stone.

http://www.livestrong.com/article/87968-flomax-work-kidney-stones/

Good luck.

bluesalt

May 18th, 2017 at 12:17 PM ^

I'm not one to recommend narcotics, but if they've given them to you, take them when you start to feel pretty much the slightest discomfort. I've dealt with them multiple times. The first time I was in so much pain I literally fell off the examining table at the doctor, for writhing around so much. Another time a roommate drove me to the hospital, and I had to open the car door on the way there and vomit from the pain. I especially recommend the pain meds before falling asleep, as the stones tend to have a way of moving through your system while sleeping.

But give it a day or three, and you'll be fine.

MLG2908

May 18th, 2017 at 12:40 PM ^

I also have been told it is important to take the pain medication before the pain is too bad or it will be less effective in controlling the pain.

I have been prescribed hydrocodone, oxycodone and other opiates for kidney stone pain.  While opiates may alleviate the kidney stone pain, the constipation that comes later from the opiate use may also be quite painful.

For me, Toradol (Ketorolac) given to me in the hospital for kidney stone pain was more effective than opiates in controlling the pain and had fewer unpleasant side effects

https://en.wikipedia.org/wiki/Ketorolac

Michiganfootball13

May 18th, 2017 at 12:20 PM ^

My dad is built like a lumberjack and I've never seen him so close to crying in my life, even at his sisters funeral. He said for him he has never had something so painful in his life. However I am not sure how big his was. Good luck man, I pray I never get them.

JimboLanian

May 18th, 2017 at 12:22 PM ^

I had a 5mm stone that caused PAIN when it traversed the ureter. Had the pain for a few hours and then nothing. 3 Weeks later I pissed it out without any pain whatsoever.

Boner Stabone

May 18th, 2017 at 12:27 PM ^

I have had 2 in my life.  Worse pain ever.!!!!    My doctor told me to drink lots of beer to get it moving.  Passing it was no problem.  My grandma also had them, she said kidney stones were worse than giving birth to her 3 kids.  

StephenRKass

May 18th, 2017 at 12:30 PM ^

What in the world causes kidney stones? Diet? Age? Lack of exercise? Bad luck?

I'm either lucky or live right and eat right, 'cause I've never had one. And I definitely never want to get one. Criminy, that doesn't sound like fun.

MLG2908

May 18th, 2017 at 12:58 PM ^

I am a patient at the U of M Nephrology Clinic.  Dr. Patel there is an expert on kidney stone formation.  He is working with me to reduce the occurence of my kidney stones.

There are different chemical compositions for kidney stones and different factors that contribute to stone formation.  

My stones are calcium oxalate.  Too much oxalate in the urine that may contribute to stone formation can come from the individual body chemistry and/or diet.  In my case, the meical advice boils down to: (1) limiting oxalate in diet (from sources including spinach, strawberries, nuts and certain beers), (2) keeping well hydrated to dilute the materials that may form stones, (3) taking certain medications to modify the composition of my urine, and (4) increasing the acidity in my urine to help keep stone forming materials dissolved in the urine.  

Some people have uric acid based kidney stones that have a very different causation and treatment.

Age is another factor.  I had kidney stones that showed on x-rays for a decade before these passed and became a painful problem.  

So keep hydrated and watch your diet and hopefully you will never experience kidney stones.

Goggles Paisano

May 18th, 2017 at 12:43 PM ^

The wealth of knowledge and experience on this board is amazing.  I think there are experts on here for any topic this life can throw at us.  I knew very little or really nothing about kidney stones before reading this thread.  One thing I would like to know that has not been addressed yet is how do you get them?  It is poor diet, not drinking enough water, genetic, just bad luck, etc?  

CarlosSpicyweiner21

May 18th, 2017 at 12:52 PM ^

Good luck. I chugged Cranberry Juice as it seems to help push it along due to the acidity of the juice. Had a few pass ok, but had to have one blasted into smaller pieces. Place heating pad on the area helps with the pain some.

Wazoo

May 18th, 2017 at 1:05 PM ^

My urologist told me that just about anyone could have kidney stones if they don't hydrate properly. Nothing quite like having razor wire draging its way across your insides.  I've had one and hopefully never have another.  Everyone on this board, drink lots of water on a regular basis.  A good way to practice your chugging.

MTbluewolverine

May 18th, 2017 at 1:09 PM ^

I had one half the size of yours a few weeks ago.  I ended up in the ER as well and it was the worst pain I've ever experienced.  The Flomax helped me pass the stone, and also the Hydrocodone helped with the pain.  Highly recommend a heating pad for your back as well.  Good luck and I do not envy you.  

blue4ever

May 18th, 2017 at 1:22 PM ^

It was my largest to date at a little over 5mm. It may sound weird but you'll want cranberry juice. The real stuff. It is supposed to open up the plumbing and allow for easier passage.

As for the pain, it's a bear( capital B lower case itch). I passed my first when I was 40 which is also when I found out that I was born with only 1 kidney. The bad news is when it's blocked it's blocked. The good news is when it's blocked I am at the ER no questions asked and 10 minutes later I can't feel a thing.

Good luck.

Danwillhor

May 18th, 2017 at 1:27 PM ^

Family history and a bad combo of: tons of milk, too much pop/soda and not enough water in my diet. I went from zero warning to the worst pain I've ever felt (to this day) in a split second. I was sitting in a chair and when I stood up - BAM! 0-100 in less than a second. I had no car, only younger brother home. Within 15 mins I was vomiting. He called my mother from work and I went to the hospital for more puking and demorol shots. Spent the night, lithotripsy (sp) 2 days later but I had to return for demorol shots each day until and a few after. The pain after the litho was worse, even with the mountain of vicodin I was given. Threw up for days in horrible pain. To this day I have light bruising on my lower spine from the litho blasting the stone into dust. I live in constant fear of another sneak attack lol. I've been a gallon a day water drinker since and I cut the soda down to very rarely. I've passed two small ones since but nothing too bad. One was a damn razorblade! It looked like a tiny snowflake - mostly flat - but it was sharp on the edges. The body is fd up. Good luck, man.