Kidney Stones: Conflicting Diagnoses and Symptoms Explained

Q: Kidney Stones: Conflicting Diagnoses and Symptoms Explained

Hello： <br>1. <br>In terms of ultrasound, it is relatively subjective; usually, the clearest interpretation comes from the operator. <br>Unless the operating physician prints out a very clear image, it can be difficult to make a diagnosis based solely on photographs. <br>In your

Could you please provide more details about the issue with kidney stones?

Hello Doctor,
1.
I had an abdominal ultrasound, and the hepatobiliary specialist said I have a 0.7 cm kidney stone.
I then went to see a urologist who took an X-ray and said that the stone was not visible.
He advised me to drink more water.
Two days later, I consulted another urologist and showed him the abdominal ultrasound images from the hepatobiliary specialist.
He said it didn't look like a stone and that it was fine.
Who should I believe?
2.
Can a 0.7 cm stone be seen on an X-ray? If I have a 0.7 cm stone, what symptoms might I experience?

jay, 20~29 year old female. Ask Date: 2004/11/24

Dr. Xu Weikai reply Urology

Hello:
1.
In terms of ultrasound, it is relatively subjective; usually, the clearest interpretation comes from the operator.
Unless the operating physician prints out a very clear image, it can be difficult to make a diagnosis based solely on photographs.
In your case, a 0.7 cm stone appears as just a small dot on ultrasound; on an X-ray, unless the 0.7 cm stone is a calcium-containing stone, it is easier to detect.
If it is a uric acid or infectious stone, it is usually not easily seen on X-ray.
Generally speaking, ultrasound has a higher sensitivity, which means it often misidentifies non-stone objects as stones.
2.
What symptoms can a 0.7 cm stone cause? That is indeed a big question! The symptoms of stones can range from asymptomatic, hematuria, lumbar discomfort to pain and frequent urination.
In other words, there is no absolute correlation between the size of the stone and the symptoms.
Sometimes, stones that grow to 5 or 6 cm may not present any clinical symptoms at all.
Sincerely,
Dr.
Hsu Wei-Kai
Department of Urology, Taitung Hospital, Department of Health, Executive Yuan

Reply Date: 2004/11/24

More Info

When it comes to understanding kidney stones, conflicting diagnoses and symptoms can often lead to confusion for patients. Your experience of receiving different opinions from various specialists highlights the complexities involved in diagnosing and treating kidney stones. Let's break down your questions and provide clarity on this matter.

1. Conflicting Diagnoses: It's not uncommon for different doctors to have varying opinions based on the imaging studies they rely on and their clinical experience. Ultrasound and X-rays are two different imaging modalities, each with its strengths and limitations. Ultrasound is excellent for visualizing soft tissues and can detect kidney stones, especially if they are larger than 5 mm. However, it may not always provide a clear image of smaller stones or those located in certain positions. On the other hand, X-rays (KUB - Kidneys, Ureters, Bladder) can visualize calcified stones but may miss stones that are not radiopaque, such as uric acid stones. A stone measuring 0.7 cm (7 mm) is generally large enough to be seen on X-ray, but its visibility can depend on its composition and location.

2. Symptoms of a 0.7 cm Stone: A stone of this size can potentially cause symptoms, but not everyone with a kidney stone experiences pain. Common symptoms associated with kidney stones include severe flank pain (often described as sharp or cramping), hematuria (blood in urine), nausea, vomiting, and urinary urgency or frequency. If the stone obstructs the urinary tract, it can lead to hydronephrosis (swelling of the kidney due to urine buildup) and increased pain. However, some individuals may have stones without significant symptoms, especially if the stone is not obstructing urine flow.

3. Trusting Your Diagnosis: In situations where you receive conflicting information, it is essential to consider a few factors. First, ensure that the imaging studies are interpreted by qualified professionals who specialize in urology or radiology. If possible, seek a third opinion from a urologist who can review all your imaging studies and symptoms comprehensively. Additionally, if you have access to a CT scan, this is often considered the gold standard for diagnosing kidney stones, as it can provide a detailed view of the urinary tract and identify stones regardless of their composition.

4. Next Steps: If you are experiencing symptoms or have concerns about the presence of a kidney stone, it may be beneficial to undergo further imaging, such as a non-contrast CT scan of the abdomen and pelvis, which can provide definitive answers. Meanwhile, maintaining hydration is crucial, as it can help facilitate the passage of smaller stones and prevent new stones from forming.

In conclusion, navigating the diagnosis and treatment of kidney stones can be challenging due to the variability in imaging results and clinical interpretations. It is vital to communicate openly with your healthcare providers, seek additional opinions if necessary, and consider further diagnostic tests to clarify your situation. Remember that managing kidney stones often involves a combination of medical treatment, lifestyle changes, and preventive measures to reduce the risk of recurrence.

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