STONES in the genitourinary tract may go off like the alarm bell in a firehouse or may be discovered accidentally, lurking silently on an x-ray film. This clinical spectrum is, in itself, fascinating. It ranges from a patient ashen and clammy with pain to a smiling and comfortable individual whose history includes nothing related to renal disease. These clinical differences are not related to the size of the stone or the pattern of ureteral peristalsis. They are instead, a reflection of the degree of ureteral distention caused by urine piling up behind an obstruction. Analgesics, not antispasmodics, are the proper therapeutic agents.
When the initial excitement is over, the occurrence of a stone is a signal for the clinician to put on his endocrinologist's cap and look for specific, treatable stone-forming disorders. The physicochemical nature of stones, ie, the organic matrix with its crystalline shell, will not be dealt with
Berman LB. Renal Geology. JAMA. 1975;231(8):865–866. doi:10.1001/jama.1975.03240200061034