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View Full Version : Kidneystones: in the bladder


dougie_monty
02-09-2009, 09:09 PM
This has been the culmination of a painful episode; last week the damn thing worked its way slowly down the ureter and finally landed in the bladder. A urologist told me the inside diameter of the urethra is ten times greater than the ureter's, but my own doctor said when the time comes for the stone to pass it's going to be panful too. Any of the Teeming Millions gone through this?

Napier
02-09-2009, 09:45 PM
I've had over forty stones, up to 13 mm in diameter, and had enough lithotripsies and basket extractions to have lost exact count - and a good old fashioned lithotomy, too.

I've always passed stones that made it to the bladder with nothing more than an odd tickling feeling, or a sort of scratching an itch feeling.

Not long ago I passed a 5 mm stone that hurt a great deal in the ureter, even with oxycodone and morphine. Suddenly there was this sort of extra painful *poink* feeling as it cleared the UBJ (ureteral-bladder junction), and it was in the bladder. And I immediately realized that the pain meds actually were working, because I was dizzy as hell, but this was the first sense I had that they were even in me. Passing this stone from the bladder to the outside was the same mildly funny sensation that I wouldn't call painful.

Usually they come out of the bladder near the completion of urinating. Sometimes I jump around a little and lean forward because I think the stone is rolling around on the bottom of my bladder, and the passage into the urethra is somewhat forward of the bottom. It never seems to matter, though. The thing pops out when it wants.

BTW, for some reason, a hundred or two hundred years ago, bladder stones were much more common and kidney stones more rare, and now it's the other way around - I haven't heard that anybody has figured out why yet.

In any case, you are probably past the really painful part, based on my experience.

KneadToKnow
02-09-2009, 09:47 PM
Somebody's going to say it, so let me go ahead:

This, too, shall pass.

Chief Pedant
02-09-2009, 10:49 PM
Suddenly there was this sort of extra painful *poink* feeling as it cleared the UBJ (ureteral-bladder junction), and it was in the bladder.

Your post is right on the money, for obvious reasons. ;)

Teeny tiny point: You may have heard UVJ (uretero-vesicular junction) as UBJ. But I like your acronym, too.

Very few stones that get past the UVJ into the bladder have any trouble at all getting through the urethra, which is larger and more distensible. As you point out, size alone is not the only determinant of symptomatology--a little pointy one can get stuck while a big oblong smooth one sails through easier.

On rare occasions I've had patients with a stone stuck right at the very tip of the penis that needed a little help getting "delivered" so to speak, but it's unusual, and even more unusual with stones which originated in the kidney and not the bladder. We always tell people not to worry once a kidney stone makes it to the bladder and when we give 'em the strainer for catching one we have to tell them to look, cuz it's gonna be tiny and they probably won't feel it when they pee it out.

That's an interesting point about bladder stones being more common than kidney stones in the past. I'd be just a bit skeptical if you go back 100 years, though...not sure what diagnostic modalities would have properly ascertained the relative frequencies and made accurate diagnoses with various presentations. I will say my personal observation is that the far west suburbs of Chicago have a higher incidence of kidney stones than the near west suburbs, and I for one think it's the use of relative hard well water versus the softer water of Lake Michigan. It's not terribly unusual for our suburban ED to have more than one patient with ureteral colic at the same time.

dougie_monty
02-10-2009, 12:54 AM
Your post is right on the money, for obvious reasons. ;)

Teeny tiny point: You may have heard UVJ (uretero-vesicular junction) as UBJ. But I like your acronym, too.

Very few stones that get past the UVJ into the bladder have any trouble at all getting through the urethra, which is larger and more distensible. As you point out, size alone is not the only determinant of symptomatology--a little pointy one can get stuck while a big oblong smooth one sails through easier.

On rare occasions I've had patients with a stone stuck right at the very tip of the penis that needed a little help getting "delivered" so to speak, but it's unusual, and even more unusual with stones which originated in the kidney and not the bladder. We always tell people not to worry once a kidney stone makes it to the bladder and when we give 'em the strainer for catching one we have to tell them to look, cuz it's gonna be tiny and they probably won't feel it when they pee it out.

That's an interesting point about bladder stones being more common than kidney stones in the past. I'd be just a bit skeptical if you go back 100 years, though...not sure what diagnostic modalities would have properly ascertained the relative frequencies and made accurate diagnoses with various presentations. I will say my personal observation is that the far west suburbs of Chicago have a higher incidence of kidney stones than the near west suburbs, and I for one think it's the use of relative hard well water versus the softer water of Lake Michigan. It's not terribly unusual for our suburban ED to have more than one patient with ureteral colic at the same time.
Thanks to all. That's more reassuring, though I know I'm not out of the woods yet...
I live in Southern California where the Los Angeles tap water is hard. (I drink bottled water at home). Besides, the hospital doctor prescribed Flomax, and I still have a few capsules, having used most of them to ease the stone's passage down the ureter.

cmyk
02-10-2009, 01:20 AM
Peeing it out is nothing compared to the renal colic. Sometimes I feel a very sudden "yoink", and it can be startling, but I wouldn't call it pain. Other times I felt nothing at all.

dougie_monty
02-10-2009, 02:14 AM
By "renal colic" do you mean here any of the phases of the kidnesytone's developement or movement prior to going into the ureter?

Indistinguishable
02-10-2009, 03:52 AM
I've had over forty stones, up to 13 mm in diameter, and had enough lithotripsies and basket extractions to have lost exact count - and a good old fashioned lithotomy, too.
Just out of curiosity, what has caused you to have so many stones in your life (if you know and are comfortable sharing)?

Napier
02-10-2009, 08:03 AM
>Just out of curiosity, what has caused you to have so many stones...

I don't mind sharing, but I don't know what caused me to. I have calcium oxylate stones. I went through a series of tests maybe 15 years ago that involved blood and urine analysis, including capturing all my urine for a week (this was for chemical analysis, not just to look for little stones, which can be done with straining). I was tested specifically for overabsorption of calcium and of oxylate, and some kind of study involving vitamin C somehow related to the generation of anti-agglomeration coating of calcium oxylate crystallites, and I don't remember what all else. I wound up in the fairly common category of people that form calcium oxylate stones without any detected cause.

In recent years I have been taking Polycitra and, more recently, Theralith. I've had some trouble with muscle cramping but on the whole the stones have been well controlled compared to years past.

crowmanyclouds
02-10-2009, 10:07 AM
... a little pointy one can get stuck while a big oblong smooth one sails through easier. ...Some visual aids (http://herringlab.com/photos/) for those that might be curious.

CMC fnord!
Lucky bastard with hyperuricemia (http://en.wikipedia.org/wiki/Hyperuricemia) and cute, tiny, uric acid stones (http://herringlab.com/photos/1-UA80-M18-P2.jpg) :). (and gout :(), allopurinol (http://en.wikipedia.org/wiki/Allopurinol) is my best friend!

KneadToKnow
02-10-2009, 10:12 AM
Some visual aids (http://herringlab.com/photos/) for those that might be curious.

CMC fnord!
Lucky bastard with hyperuricemia (http://en.wikipedia.org/wiki/Hyperuricemia) and cute, tiny, uric acid stones (http://herringlab.com/photos/1-UA80-M18-P2.jpg) :). (and gout :(), allopurinol (http://en.wikipedia.org/wiki/Allopurinol) is my best friend!

Ow! Ow! Ow! (http://herringlab.com/photos/25-M98-P2.jpg)

Icerigger
02-10-2009, 10:44 AM
I had two stones last year about 5mm each. I was in great pain as they passed to the bladder and felt nothing but a slight burning when they passed. They give you a paper funnels to pee through to catch the stones. Great fun!

Icerigger
02-10-2009, 11:04 AM
More detail TMI.

My kidney stone story. Last August I was mowing the lawn on a very hot day when I came into the house to pee. When I tried to go nothing came out but blood. I have to say I was in a state of shock, naturally this was not good and something was very wrong. I went to the hospital and was diagnosed with a bladder infection and put on antibiotics. Two weeks later I still had blood in my urine and placed ABs again for two weeks.

After a month no blood! Good. Problem solved, yes. No, Then one day I had to pee again and the blood was back and I had an excruciating pain in my lower back that doubled me over, I have never felt such pain. Went to the hospital and they did a CAT scan ($8,000) and found out I had two stones, one in the kidney and one on the way to the bladder, this one was the one giving me trouble. No treatment except Rush Limbaugh's fix until it passed 10 days later. The second stone two weeks after that. After the stone chemical analysis was done it was determined I don't drink enough water (the joys of 24hr urine collecting) and my pH was screwed up. Now I am on Sodium Bi-carb tablets and drink two quarts of water a day. I have had no problems since then. Knock on Wood.

Good Luck.

kenobi 65
02-10-2009, 11:06 AM
I've had 3 kidney stones (though, thankfully, none for over 9 years now). I concur with the other posters...the extreme pain was as the stone scraped its way through "tight spots in the road" between kidney and bladder. The rest of the way out, there was little or no discomfort.

engineer_comp_geek
02-10-2009, 02:35 PM
I've had three kidney stones. The first one got stuck halfway through my penis when I was urinating. It wasn't painful, but it wasn't exactly comfortable either. It felt like having a piece of sand stuck up in there. It came out a few hours later the next time I went pee. I had no pain at all beforehand and hadn't even realized I had a kidney stone until then.

The second got stuck in between my kidney and bladder (as most do). When it finally moved into my bladder it caused a lot of discomfort, but wasn't really painful, just uncomfortable. Once it decided to come out it just popped right out.

The third one got broken up into little bits while it was still in between my kidney and bladder. I never felt any of the pieces come out.

Chief Pedant
02-10-2009, 02:46 PM
I've had three kidney stones. The first one got stuck halfway through my penis when I was urinating. It wasn't painful, but it wasn't exactly comfortable either. It felt like having a piece of sand stuck up in there. It came out a few hours later the next time I went pee.

I'd guess this first one got drawn into the last bit of urine and that it was not "stuck" from a mechanical problem passing, per se, but simply didn't have enough urine to wash it through. Assuming (and it's likely) it was formed in the kidney, if it was asymptomatic in its passage through the ureter it should have easily passed the urethra if caught in the main stream of urine. Still, you never know which little corner of a stone is going to snag which little kink of tissue somewhere...

Sofis
02-10-2009, 04:05 PM
Some visual aids (http://herringlab.com/photos/) for those that might be curious.

One of those is labeled "Stuvite with staple".

People: don't staple your kidneys. It's not good for them.

Dragwyr
02-10-2009, 06:55 PM
I've had 4 kidney stones. The only time I had any problems after the stone hit the bladder was one time when it got stuck in my my urethra. It made me feel like I had to pee all the time. After a week of that it finally worked its way out. It wasn't painful, but it certainly was damn uncomfortable.

echowit
02-11-2009, 03:29 AM
Have had my 3rd Kidney stone in my bladder since last Sept. Just waiting for the next leg of the trip. My experience with the 1st two was that there's little pain or discomfort once it's there but the road bumps from the kidney to bladder put me on vicodine.

I've heard something about too much Vitamin C being a cause and I was taking extra C as a supplement so I'm looking into that.

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