Treatment of painful caliceal stones

Abstract

Nonmobile caliceal stones cause pain more often than previously appreciated. The character and intensity of the pain differs from typical renal colic. Twenty-six patients with caliceal stones and pain underwent attempted treatment for pain control via stone removal or disintegration: 15 were treated with percutaneous stone extraction (PSE), 10 with extracorporeal shock-wave lithotripsy (ESWL), and 1 required open surgery after failing PSE. One patient had persistent pain after ESWL and subsequently underwent PSE; 25 of 26 patients had complete relief of pain. Morbidity was minimal. Patients with painful caliceal stones should be offered ESWL, followed by PSE if pain persists.

Acute Urinary Tract Disorders

“…Several prior retrospective studies suggest that a subset of these stones can cause a chronic, dull, vague pain over the kidney, rather than the acute episodic pain of renal colic, with resolution of symptoms after stone management. 41,42 A retrospective review of association between calculus location and symptoms demonstrated that 17% of calyceal stones were associated with pain/symptoms. 43 Passage of a ureteral calculus depends on size and location, with a spontaneous passage rate of 48% for proximal versus 75% for distal ureteral calculi and 76%, 60%, 48%, and 25% for 2 to 4, 5 to 7, 7 to 9, and greater than 9 mm diameter, respectively.…”

Prospective Multicenter Evaluation of Pain Before and After Removal of Nonobstructing Renal Calculi: A CoRE Initiative

“…3 Second, several studies have reported partial or complete resolution of flank pain after treatment for nonobstructing renal stones generally less than 1 cm in diameter. [4][5][6][7][8][9][10] However, these studies were limited by their smaller sample sizes, retrospective methodology, and lack of health-related quality of life (HRQOL) data, which accounts for the impact on emotional and social functioning beyond symptom relief. 11 As such, clinical guidelines state that treatment of symptomatic, nonobstructing calyceal stones is a treatment option, 12,13 but whether these stones can be a source of pain is still considered controversial.…”