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1. What is a kidney stone?
2. Causes of kidney stones
3. Signs and Symptoms
4. Diagnosis
5. Treatment
6. Stone Prevention
What is a kidney stone?
Kidney stones form from tiny crystals in the urine. When the urine is concentrated, these crystals coalesce to form hard deposits. These stones are most commonly made of calcium, but can also be composed of other minerals made in the body.
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Causes of Kidney Stones
There are many underlying causes of kidney stones. The most common cause is dehydration or inadequate fluid intake. Certain metabolic disorders and diseases (such as hyperparathyroidism) can be associated with kidney stones. Another common cause is a family history of kidney stones. Chronic urinary infection and urinary obstruction can also lead to stone formation. Certain mineral levels in the urine, when too high or too low can either inhibit or promote stone formation. These levels are often affected by foods and beverages found in the common diet.
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Signs and Symptoms
Kidney stones most commonly do not cause any symptoms when lying in the kidney. In fact, many people who have kidney stones do not even know that they have them. However, these small deposits can begin causing symptoms when moving around in the kidney, or when passing into the ureter (the tube draining from the kidney into the bladder) as they pass into the bladder.
These symptoms can include
- back pain under the ribcage
- blood in the urine
- lower abdominal or groin pain
- nausea or vomiting
- urinary urgency or frequency
- burning with urination or intermittent stream
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Diagnosis
Our physicians at Comprehensive Urology begin with a thorough history and subsequent physical examination. A combination of examinations may be performed to help diagnose a kidney stone. These may include urinalysis as well as radiographic examinations (ie. ultrasound, plain x-ray, intravenous pyelogram, and computerized tomography (CT) scan). These tests may help delineate the location and size of the stone, as well as reveal if there is any evidence of urinary obstruction.
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Treatment
Dietary modification- Once a kidney stone has been diagnosed, your doctor may recommend certain dietary modifications to help decrease the rate of stone formation. This would be tailored to each specific patient’s clinical situation. Dietary modifications may include increasing fluid intake, increased intake of citrate containing foods (lemons, oranges), limiting salt intake, and limiting red meats.
Medical Treatment- Your physician may also recommend medical therapy to help manage the kidney stone. Certain medications (such as alpha blockers often used for BPH) may help facilitate passage of a kidney stone that is lodged in the ureter. Other medications are used often to help dissolve kidney stones or to help future stone formation.
Surgical Treatment- Surgical treatment may also be offered or recommended depending on each patient’s specific scenario. Reasons to potentially treat a stone include:
- the stone is in the kidney, medical treatment and dietary changes have been made, and the stone is either increasing in size or causing irritative symptoms
- a trial of stone passage has been attempted but it has still not passed and is causing pain
- the stone is causing obstruction of urinary tract and potential damage to the kidney
- the stone is resulting in urinary tract infection
- the stone is deemed too large to pass on its own
Our physicians can help determine if surgical treatment may be right for you.
Modern day surgical options are all minimally invasive, which allow early recovery and return to normal activities. These options include extracorporeal shock wave lithotripsy (ESWL), ureteroscopic laser lithotripsy, and percutaneous nephrolithotomy (PCNL).
ESWL- when stones are located in the kidney and are visible on plain x-ray, they may be treated with shock waves that are generated by a machine which delivers this energy from outside the body, through the skin and soft tissue directly onto the stone. These waves help shatter the stone into smaller particles that may more easily pass through the urinary tract. Sometimes our physician will recommend placing a small tube into the ureter (called a stent) during the procedure in order to help prevent urinary obstruction while these particles are passing.
Ureteroscopy and Laser Lithotripsy- most stones within the urinary tract can be treated with this technique. It is often recommended for those stones that are found within the ureter. This technique involves no incisions, but rather involves using a small fiberoptic device (termed a ureteroscope) and passing it through the urethra, bladder and up the ureter. By using this device, our surgeons can help visualize and extract the stone with small baskets, as well as crush the stone into smaller particles by using a laser beam. At the conclusion of the procedure, the surgeon may elect to leave a stent in the ureter to help assist with passage of these particles.
Percutaneous Nephrolithotomy (PCNL)- this procedure is often performed when the stone is too large (often >2cm) or in a location where the stone will not be effectively treated by either ureteroscopy or ESWL. This procedure involves making a tiny incision on the back in order to introduce a tube directly into the kidney. Once this access is obtained, our physicians can use a variety of instruments in order to treat the large stone effectively.
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Stone Prevention
Once a kidney stone has been diagnosed, our physicians at Comprehensive Urology may order a set of blood and urine tests (termed a metabolic evaluation) that help delineate the levels of certain minerals in the body. These minerals can increase or decrease the risk of stone disease. This information can be used to make dietary as well as medical modifications to help prevent future stone formation.
If a stone has been removed, a stone analysis will help determine the chemical makeup of the stone. This information can also be helpful to our clinicians in order to help formulate a plan for future stone formation.
After these modifications have been made, our team will monitor the response by repeating the metabolic evaluation periodically as well as repeat certain radiographic studies when indicated.
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