Urinary stone disease - size isn't all that matters

Urinary stone disease is a very frequent disease with a life-time-risk of about 10 -15% in industrialized countries. Meanwhile mostly asymptomatic stone formation takes place within the renal pelvic system (renal stone disease), the typical clinical manifestation results when these stones enter and consequently obstruct the ureter (ureteral stone disease). Hence, in case of acute flank pain, ureteral stone disease is one of the most important differential diagnosis and requires always an immediate as well as accurate diagnostic work up. In here, CT-scans have shown to be most accurate and outperform ultrasound, especially concerning the overall assessment of the stone situation in the patient. Beside the diagnosis of the stone disease, the medical history, vital signs as well as blood and urinary tests are of importance in the primary work up of the patient since the identification of a potential concurrent infection within the urinary tract is of highest importance. Both, renal stone disease (mostly asymptomatic) as well as ureteral stone disease (often associated with acute and destructive flank pain) are usually not associated with an immediate threat. Ureteral stone disease with a concurrent urinary tract infection in contrary is one of the most dangerous situations in urology and, if missed, associated with urosepsis and high morbidity even lethality.The immediate drainage of the obstructed and infected urinary tract is the most important emergency action in these patients.