Kidney Stones


Substances in the urine (calcium, oxalate, phosphate, and uric acid, in particular) can crystallize within the kidney and form rock-like particles (calculi) called stones. The medical term for this condition is nephrolithiasis or renal stone disease. Kidney stones may be as small as a grain of sand or larger than a golf ball. They may be smooth, round, jagged, spiky, or asymmetrical depending on their composition. Most stones are yellowish to brownish-black in color, but variations in chemical composition can produce stones that are tan, gold, or black.

The four most common types of stones are made of various combinations of calcium, phosphorus, oxalate, magnesium, ammonia, uric acid, and cystine.

There are four common types of Kidney Stones.

Signs & Symptoms

Kidney stone symptoms can vary from person to person. Most people complain of a sharp and severe pain in their back localized to one side or the other. It may slowly evolve over a few days or it may come on quickly. The pain may radiate down into the abdomen and groin or even cause nausea and vomiting. Some patients will note blood in their urine or very dark urine

"the pain from a stone is typically sudden in onset and quite severe"

As most people are aware, the pain from a stone is typically sudden in onset and quite severe. Although the pain is usually located in the flank region, some patients will experience pain in the abdominal region, which may be mistaken for other conditions. Associated symptoms may include nausea and vomiting as well as fever and chills if any infection is present. At times the patient may notice urinary frequency and a sense of bladder irritation as the stone nears the bladder. Although gross urinary tract bleeding is sometimes seen, microscopic bleeding is more common.

  • Extreme pain in your side and back, below your ribs
  • Pain that spreads to your lower abdomen and groin area
  • Pain that comes and goes and changes in intensity
  • Nausea, vomiting, fever or chills
  • Pink, red or brown urine
  • Cloudy or bad smelling urine
  • Persistent urge to urinate or urinating more than usual

Diagnosis & Treatment

If a stone is found, there are many kidney stone treatment options available. Small stones will usually pass on their own, however it is impossible to predict when this will occur. If the stone is blocking the kidney, creating infection or causing severe symptoms, there may be a need to intervene before the stone passes.

An x-ray in our office may show an obvious stone, however, if no stone is seen and the symptoms are consistent with a kidney stone, a CT scan or IVP may be needed. These special x-rays help find a stone that is too small to be seen or is invisible to plain x-rays. A urine check at our Columbia, Missouri office is necessary to make sure there is no infection. Blood is not always present in the urine.

"Blood is not always present in the urine."

Small Stones

If your stone is small, your doctor may recommend you try to pass it out in your urine. To do this, you need to drink a lot of water so that your urine is almost clear. Normally, your doctor will prescribe a pain medication to help with the discomfort and a medication help your ureters (the tubes that carry urine) relax to allow the stone to pass.



A small stone in the ureter (thin tube connecting the kidney to the bladder) can be treated with a procedure called ureteroscopy if it does not pass on its own. In this procedure, your urologist passes a flexible tube with a camera through your urethra. A wisk-like basket on the end of the scope snares the stone and removes it. If the stone is too large, the urologist can use a laser inserted through the scope to break the stone apart. After a ureteroscopy, the urologist places a stent in the ureter to hold it open until the swelling subsides. The stent is removed a day later.

Shockwave Lithotripsy

Larger stones in the kidneys can usually be treated with a procedure called lithotripsy. This is a way to break up the stone in the kidney without making any incisions or utilizing any scopes. In an outpatient surgery center, your urologist uses a machine called a lithotriper to direct ultrasonic shock waves to hit the stone repeatedly until it crumbles into small particles that you an pass in your urine. This is the most frequently used procedure for eliminating kidney stones.


Large or Complicated Stones

If your stone is too large to pass, blocking the flow of urine or causing other complications, your doctor may recommend one of these treatments.

Percutaneous Nephrolithotomy/Stone Extraction

For large stones that can’t be effectively treated with lithotripsy or ureteroscopy, your urologist can perform a minimally-invasive surgery through a 1 centimeter incision in your back. Using a scope and special tools, the urologist can break apart the stone and suction it out. Typically requires hospitalization at least overnight.

Most people with kidney stones never find out why they are making stones and never undergo a metabolic workup. An metabolic evaluation is an important component of your overall management of kidney stone disease. Once all kidney stones have passed or been surgically removed, a patient can undergo evaluation.

Metabolic Evaluation and Management of Stone Disease

Patients with recurrent kidney stone disease or stone formers at increased risk of recurrence deserve a thorough metabolic workup. Once all kidney stones have passed or been surgically removed, patients will undergo a metabolic workup, an important component of your overall management of kidney stone disease.

What is a Metabolic Evaluation?

Metabolic evaluations are a vital component of a well-designed kidney stone prevention and to help decrease incident for reoccurrence. A series of diagnostic tests help your physician determine the causes of your stone disease. The metabolic workup includes several key components:

  1. Urine tests- This shows the levels of stone-related chemicals in your urine. You collect all your urine for 24 hours in a special container.
  2. Blood work-This measures your levels of stone-related chemicals, such as calcium. They may also find possible causes, such as gout or hyperparathyroidism.
  3. Crystal analysis (when a stone or fragment of the stone is available)- This test shows what your stone is made of, if the stone is retrieved. This may suggest the cause of your stone.

Results from the metabolic workup often yield a diagnosis such as dehydration, low urinary citrate or elevated levels of urinary sodium or protein. Understanding the factors that caused your body to produce kidney stones ultimately helps your physician map out a comprehensive treatment and prevention plan to help ensure you stay stone free.

What is Metabolic Management?

Urology Associates kidney stone disease specialists are committed to keeping you stone free for the long term. This means that our specialists won’t just see you when you have a stone and need treatment, but will follow you at regular intervals after the removal of a stone to help you follow a comprehensive treatment and stone disease prevention plan that is designed to minimize the recurrence of stones.

Once you have undergone a thorough metabolic evaluation to determine exactly why your body is producing kidney stones, your physician will be able to develop a treatment plan that will manage your stone disease for the long-term. Managing your stone disease involves regular testing and evaluation, annual exams as well as changes to diet that can help prevent stones from forming in the future.

Frequently Asked Questions

Can Women Get Kidney Stones?

While middle-aged men are the most likely group to develop kidney stones, women can also be affected by the hardened mineral buildups. Over the past 30 years, research has shown an increase in kidney stone development among women. Learn more here.