a patient with a calculus in the ureter would most likely experience:

A patient with a calculus in the ureter would most likely experience

A patient with a calculus in the ureter would most likely experience

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A patient with a calculus in the ureter would most likely experience

Stones impacted within the ureter cause abrupt, severe, colicky pain in the flank and ipsilateral lower abdomen with radiation to the testicles or the vulvar area. Intense nausea, with or without vomiting, usually is present. Pain from upper ureteral stones tends to radiate to the flank and lumbar areas.

 

A patient with a calculus in the ureter would most likely experience
A patient with a calculus in the ureter would most likely experience

 

Signs of Kidney and Ureteral Stones

What is a ureteral stone?

A ureteral (pronounced “yer-ree-ter-uhl”) stone is an irregularly shaped solid mass or crystal that’s become stuck in one of your ureters (pronounced “yer-it-ters”). Your ureters are two tubes of muscle that carry urine (pee) from your kidneys to your bladder. You have one ureter per kidney.

Ureteral stones can appear in your left ureter or your right ureter. In most adults, your ureters are between 10 inches and 12 inches long. Stones may be near the proximal end (near the point of origin) or the distal end (away from the point of origin) of your ureter.

The proximal end of your ureter connects to your renal pelvis. There’s a renal pelvis in the center of each of your kidneys, and it collects pee. The distal end of your ureter connects to your bladder.

Ureteral stones are often tiny. Some are too small to see with the naked eye. They pass through your pee and don’t cause any problems.

If a ureteral stone is large enough, it can block the flow of pee from your kidneys to your bladder. This blockage can cause severe pain. Ureteral stones form when minerals and salts build up in your pee. The minerals form crystals that grow into stones.

Just having kidney stones may not cause any symptoms, but when they begin to move or pass into your ureter (ureteral stones), you will likely experience symptoms.

Signs and symptoms of kidney and ureteral stones may include:

  • Pain in the back and side, often just below the ribs
  • Pain that changes, for example:
    • It spreads to the lower abdomen and possibly the groin
    • It comes in waves
    • It changes in intensity
    • It shifts locations
  • Pain with urination
  • Nausea and/or vomiting
  • More frequent urination
  • Urine that is cloudy or has a strong, foul smell
  • Blood in the urine

You may also have a fever and/or chills if you have an infection along with your stones.

When to call your doctor

If you have any of the above signs or symptoms of kidney or ureteral stones , you should call your doctor to make an appointment.

Seek immediate medical attention if you have the following symptoms:

  • Pain that is accompanied by nausea and vomiting, fever or chills
  • Severe pain that makes finding a comfortable position difficult
  • Blood in your urine
  • Difficulty urinating

Nephrolithiasis Clinical Presentation

Patients with urinary calculi may report pain, infection, or hematuria. Small nonobstructing stones in the kidneys only occasionally cause symptoms. If present, symptoms are usually moderate and easily controlled. The passage of stones into the ureter with subsequent acute obstruction, proximal urinary tract dilation, and spasm is associated with classic renal colic.

Acute onset of severe flank pain radiating to the groin, gross or microscopic hematuria, nausea, and vomiting not associated with an acute abdomen are symptoms that most likely indicate renal colic caused by an acute ureteral or renal pelvic obstruction from a calculus.

 

A patient with a calculus in the ureter would most likely experience
A patient with a calculus in the ureter would most likely experience

 

What is nocturia?

Nocturia is a condition that causes you to wake up during the night to urinate. This can be thought of as nocturnal urinary frequency — having to urinate more often at night. This condition becomes more common as people age and occurs in both men and women, sometimes for different reasons.

It can be common for most people to wake up once during the night to urinate, but urinating more frequently may be a sign of something else going on. Nocturia can be associated with daytime urinary frequency or occur by itself. It’s important to distinguish nocturia (urinating too frequently) from polyuria (urinating too much volume).

What are the causes of nocturia?

There are many possible causes of nocturia, depending on the type. The types of nocturia include:

  • Polyuria.
  • Nocturnal polyuria.
  • Nocturnal urinary frequency.

Polyuria

People with polyuria urinate >3,000mL in 24 hours. This is usually caused by there being too much water filtered by the kidneys. It can also happen if something is in the urine, pulling the extra water out, such as sugar (glucose).

The causes of polyuria can include:

  • High fluid intake.
  • Untreated diabetes (Type 1 and Type 2).
  • Diabetes insipidus, gestational diabetes (occurs during pregnancy).

Nocturnal polyuria

Those with nocturnal polyuria experience a high urine volume only at night. Their urine volume during the day is normal or reduced. This is usually due to fluid retention during the day that often accumulated in the feet or legs. Once you lie down to sleep, gravity no longer holds the fluid in your legs. It can re-enter your veins and be filtered by your kidneys, producing urine.

The causes of nocturnal polyuria can include:
  • Congestive heart failure.
  • Edema of lower extremities (swelling of the legs).
  • Sleeping disorders, such as obstructive sleep apnea (breathing is interrupted or stops many times during sleep).
  • Certain drugs, including diuretics (water pills), cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, and excessive vitamin D.
  • Drinking too much fluid before bedtime, especially coffee, caffeinated beverages or alcohol.
  • Having a diet that’s high in sodium.

Nocturnal urinary frequency

If you have nocturnal urinary frequency, you may urinate in small amounts or urinate more frequently. The total amount of urine produced is not elevated. This is usually due to an inability of the bladder to fully empty (this is why it fills up faster) or the inability of the bladder to fill completely before developing the urge to urinate (low bladder volume).

This can also occur due to difficulty sleeping — you may wake up for one reason, but then go to the bathroom while you’re awake, which will make you think that you woke up because you had to urinate.

The causes of an inability to fully empty your bladder can include:

  • Bladder obstruction.
  • Benign prostatic hyperplasia (men), a non-cancerous overgrowth of the prostate that obstructs the flow of urine.

The causes of an inability of the bladder to fully fill can include:

  • Bladder overactivity (bladder spasms).
  • Bladder infection or recurrent urinary tract infection.
  • Bladder inflammation (swelling).
  • Interstitial cystitis (pain in the bladder).
  • Bladder malignancy.
  • Obstructive sleep apnea.

What are the symptoms of nocturia?

Normally, you should be able to sleep six to eight hours during the night without having to get up to go to the bathroom. People who have nocturia wake up more than once a night to urinate. This can cause disruptions in a normal sleep cycle.

Symptoms of nocturia can include:

  • Waking up more than once a night to urinate.
  • Urinating more volume (if polyuria is present).
  • Fatigue, sleepiness — even after waking up. This occurs because the frequent urinations can interrupt your sleep cycle.

 

A patient with a calculus in the ureter would most likely experience
A patient with a calculus in the ureter would most likely experience

 

How is nocturia diagnosed?

To help your healthcare provider diagnose nocturia, you can keep a fluid and voiding diary. This is a two-day record of how much you drink, how often you have to go the bathroom and how much you urinated (volume in mL’s).

You should also record any medications you are taking, any urinary tract infections and any related symptoms. Your healthcare provider will review the diary in order to determine the possible cause(s) of and treatment for the nocturia.

Your provider may ask you the following questions:

  • When did this condition start?
  • How many times do you need to urinate each night?
  • Is there a large or small volume of urine when you void at night?
  • Has there been a change in urination output (increase or decrease)?
  • How much caffeine do you drink each day, if any?
  • Does frequent urination during the night keep you from getting enough sleep?
  • Do you drink alcoholic beverages? If so, how much each day?
  • Has your diet changed recently?

In addition to reviewing your voiding diary, your doctor may order a urinalysis to examine your urine for infection.

Is nocturia treatable?

If you think you might have nocturia, see your healthcare provider. He or she may refer you to a urologist to treat the condition.

Treatment usually is targeted toward the underlying cause. If sleep apnea is considered, you may be referred to a sleep specialist or pulmonologist. If prostate enlargement is the cause, medications or surgery may be needed.

Treatment options for nocturia, regardless of cause, may include:

Interventions:

  • Restrict fluids in the evening (especially coffee, caffeinated beverages, and alcohol).
  • Time intake of diuretics (take them mid- to late afternoon, six hours before bedtime).
  • Take afternoon naps.
  • Elevate the legs (this helps prevent fluid accumulation).
  • Wear compression stockings (this also helps prevent fluid accumulation).

 

 

 

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