Urinary stones, are more common in adults, but in our practice are seen frequently in children and teens.
Why do stones form?
Urinary stones form when a chemical in the urine crystallizes and grows to form a stone. They may occur anywhere in the urinary system (kidneys, ureters or bladder). Urinary stones in children can result from recurrent urinary tract infections, inflammatory bowel disease or certain genetic disorders. There is also a hereditary disposition to stone formation. The vast majority, however, occur sporadically.
What are stones made of?
The most common stones are composed of calcium (calcium oxylate). Stones may also be composed of uric acid, cystine or struvite. Other, more rare types of stones also exist.
What are the symptoms of stones?
The most common presenting symptom of kidney stones is pain in the flank. Typically this is more toward the back just beneath the ribs. The pain may be quite severe and is often associated with nausea and vomiting. Other symptoms include hematuria (blood in the urine), abdominal pain, and discomfort or burning with voiding.
Children as young as age 5 are now being diagnosed with urinary tract stones, which are typically found in adults between the ages of 35 and 60. The warm southern climate coupled with a high-sodium diet and a lack of exercise could be putting Georgia’s children at an increased risk of developing urinary tract stones.
How are urinary stones diagnosed?
A computed tomography (CT) scan is generally the most accurate test for diagnosing kidney stones. This is a non-invasive X-ray that takes only a few minutes and does not require an injection of dye. However, a CT scan does involve exposure to radiation, so your child’s doctor may choose to perform a plain abdominal X-ray and an ultrasound instead.
How are urinary stones treated?
Many small urinary stones, even in children, will pass on their own. During this time your child may be given pain medicines to help make passage easier. If the pain is severe or persistent or if your child cannot drink, he or she may need to be admitted to the hospital until the stone passes or until it is removed surgically. In certain situations your doctor will need to place a tube or stent in the ureter. The stent acts to bypass the urine and also gently stretches the ureter over time to allow for stone passage or for easier retrieval later with a scope (ureteroscope).
Types of Surgery
There are three principal ways urinary stones can be surgically removed. The best way to remove a stone depends on several factors including the number, type, location and size of the stone/s. Extracorporeal shock wave lithotripsy (ESWL) is the most straight-forward and least invasive. During this procedure the stone is targeted by X-ray while your child is asleep. Once the stone is targeted, sound waves (no incision) are concentrated on the stone to disintegrate the stone into multiple small fragments. This is typically done as an outpatient procedure under general anesthesia. This treatment option typically requires that stone be seen on standard X-ray. It may not be a practical option for multiple or large stones or stones in certain locations. In other instances the pediatric urologist might find it necessary to perform ureteroscopy. During this procedure a small scope is passed through the urethra, into the bladder, and up the ureter. The stone can then be removed with special instruments or broken up with a laser. If the kidney stone is very large percutaneous nephrolithotripsy (PCNL) may be required. During this procedure a scope is passed directly into the kidney through a small incision in the back. The stone is then broken up or removed. In some cases this procedure requires more than one operation to completely remove all the stones.
How are stones prevented?
Your doctor will likely run a series of tests to determine why your child formed stones. This information will be used to give specific instruction on how to best prevent stones from recurring. In many cases, however, the principal way to prevent stones from forming and recurring is to drink plenty of water and keeping your child well hydrated.
When should you call your doctor?
Once your child has been determined to have a stone, reasons to seek immediate medical attention include:
- Severe, persistent pain
- Nausea and vomiting that causes your child to skip more than onemeal
- Fever higher than 101.5