The Agony of Kidney Stones
One Patient's Story
By Angela Generoso
Reviewed by William C. Shiel Jr., MD, FACP, FACR
It all started on a typical Maui fall day, with beautiful trade winds and sunny skies over the Kapalua Golf Course. Tom Stokes* and his wife Teresa* were about to start the ninth hole when Tom had to go to the bathroom.
"I was standing over the urinal and noticed blood in my urine," Stokes says.
Confused as to what he should do, Stokes decided to just finish playing golf without mentioning anything to his wife.
"Needless to say, I didn't have a good score from that point on," he says.
Back at the hotel he was still urinating blood, but decided it could wait until he returned home to California the following day.
"There were no other symptoms," he says. "No pain, no other indications."
Stokes' stone was so big it couldn't pass from the kidney to the ureter (the tube from the kidney to the bladder). The stone was approximately 8 mm, while the average inner diameter of the ureter is 4 mm.
Stokes' doctor scheduled a lithotripsy, a treatment where shock waves are used to break up the large stone into smaller pieces that can then pass through the urinary system.
"It's about an hour of pounding, so when you wake up, you're sore," Stokes says. "It feels like someone has been punching you in the kidney a couple times."
Upon waking up, Stokes was told the procedure was successful. He was given a prescription for Vicodin, which he decided was unnecessary, since he had been through surgical procedures before without pain medication. He was told that his situation was different, but Stokes left the hospital at 4 p.m. anyway without filling the prescription.
He later regretted his decision.
"At 10:30 p.m., I was in the emergency room on my knees begging to be given anything at all," Stokes says. "The only way to describe the pain is to have a little man with a razor blade, hacking at the ureter."
Stokes was given drugs and told to stay in the hospital, where he stayed for a day and a half. After being sent home this time, he started taking the Vicodin every four hours.
"By the time Sunday evening came around, 24 hours later, I had not slept," he says. "I walked the whole time, back and forth through my house. I couldn't sit down, and I was taking the Vicodin every hour. I was completely overdoing it."
Stokes was also taking medication to help take the tension off the ureter, but used in combination with the Vicodin, Stokes had a drug conflict, which he describes as an "LSD trip."
"I was hallucinating," he says. "People were talking that weren't there."
The next morning he called his doctor, unable to stand the pain and unable to continue the medication. He had another KUB x-ray done and while looking at the results with his doctor, he began to feel relief from the pain.
Stokes' doctor determined he had passed the stones, although they hadn't actually come out yet. He determined the stones had moved to the bladder, and when he returned home, they came out.
He figured it was over, but as months went by, he started having an urge to urinate that wasn't there before.
"Whenever there was urine present, I immediately had to pee," he says. "Then over time it got worse and worse. Then my bowels got messed up, tightening from the tension, always having to go to the bathroom."
After a number of x-rays were done, Stokes figured it was a kidney stone. He was put on several medications to control his bladder and bowel. The doctors thought it was trauma, but it kept getting worse.
Then one day Stokes was having lunch with a friend, who was also a urologist.
"He said, 'Boy you don't look good,' and I told him I'm having problems with the trauma that occurred from the kidney stone last year," he explains.
After hearing Stokes' symptoms, his friend told him he thought he might have a kidney stone lodged right on the nerve, right at the base where the ureter comes to the bladder, a place that wouldn't be visible in an x-ray.
The next day Stokes had his urologist order a CAT scan.
"When the nurse came back in she said, 'You must be in a lot of pain.' "
She explained they found a 4 mm kidney stone right where his friend thought it would belodged on the nerve at the base where the ureter comes to the bladder.
Stokes next underwent a procedure to go through the penis, in through the bladder, then up to the ureter. The stone would be lasered into pieces and removed.
However, upon undergoing the procedure, Stokes' doctor discovered his ureter was not in a good condition.