TREATMENT OF YOUR KIDNEY STONES

The role of medicine and diet for kidney stone treatment is mainly for the prevention of future stones or to prevent the growth of existing stones. Prevention will be addressed below.

In rare instances, stones can be dissolved. This is only effective for a smaller, purely uric acid stone and requires frequent medication adjustments and at-home urine testing up to 4 times per day by the patient.

For 90% of stones, there is no proven way to dissolve them or to medically treat a stone that has already formed.

Treatment options for most patients: non invasive, minimally invasive, and surgical procedures for kidney stone treatment and kidney stone removal.

There are some options available to treat all urinary tract stones. Kidney stone size and location is an important factor in deciding which treatment is best for you:

1. Do Nothing : This is best saved for very small stones that could pass easily, or for very large asymptomatic stones in older patients. However, if the stone is causing pain, blockage or infections, it should be treated with some medications.

2. Lithotripsy (shock wave lithotripsy, SWL, ESWL): It is the easiest procedure. The patient lies on a table or in a tub and shock waves are focused on the stone. It is non-invasive, but if the stone is over 1 cm, you will likely need a cystoscopy and stent to help the pieces pass. Patients can go home the same day. Lithotripsy is only 60 - 85% effective for making your kidney or ureter stone free in a single treatment (depending on stone size and location) . The recurrence rate is quite high. 42% of patients will have another stone within two years, probably from small fragments left behind that grow into new stones.

3. Endoscopic treatment (ureteroscopy, with or without laser stone fragmentation): A urologist can look inside the bladder and all the way up to the kidney with a small scope and either remove the stone or break it up with a laser and remove the pieces. It is minimally invasive. There is no incision as the instruments go through the patient's existing "plumbing." Patients can go home the same day. In experienced hands, the stone free rate is 90-95% for stones in the ureter. The stone free rate is 80-90% for stones in the kidney depending on size and location.

4. Percutaneous Removal (Percutaneous Nephrolithotomy) : Very few urologists are proficient at this technique, which is why many urologists will not offer it as an option for their patients. PCNL is the treatment of choice for stones over 15 - 20 mm (1.5 to 2 cm). Associated Urologists of Orange County routinely uses this technique for patients with large stones or stones refractory to other procedures.
While it is minimally invasive, it requires a one inch incision in the back. A channel is made from the skin straight into the kidney. It is invasive, but still considered minimally-invasive. Patients typically spend one night in the hospital (two for older patients). The stone free rate is 90 - 95% for these very large stones that otherwise would require multiple procedures to completely clear.

5. Open surgery: It is extremely rare to need a large incision to remove a stone from the urinary tract.

The choice of treatment will depend on the size and location of the stone. In addition, the more invasive the procedure, the higher the success rate. (Associated Urologists of Orange County)

The Signs and symptoms of kidney stones?

The formation of a kidney stone generally results in severe pain in the lower back just under the ribs. The pain is not consistent but it is very intense and can last anywhere from a few seconds to a few hours. It will eventually go away for a few hours and then recur. In some cases, the pain will move down into the groin area.

Small, smooth kidney stones may remain in the kidney or pass without causing pain (called "silent" stones). Stones that lodge in the tube that carries urine from the kidneys to the bladder (ureter) cause the urinary system to spasm and produce pain. The pain is unrelated to the size of the stone and often radiates from the lower back to the side or groin.

A "small" stone (usually 4 mm in diameter or less) has a 90% chance of spontaneous passage. Stones that are 8 mm in diameter or larger usually require medical intervention.

The following are the most common symptoms of kidney stones. However, each individual may experience symptoms differently. Symptoms may include:

• extreme, sharp pain in the back or side that will not go away
• blood in the urine
• nausea and vomiting
• cloudy or odorous urine
• frequent urination
• a burning feeling when you urinate (pain during urination, stinging, burning)
• fever, chills and loss of appetite (urinary tract infection)

Prompt medical attention for kidney stones is necessary.

The symptoms of kidney stones may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

The Other Causes of Kidney Stones

• Heredity. There is no consensus as to why kidney stones form.: Some people are more susceptible to forming kidney stones, and heredity certainly plays a role. The majority of kidney stones are made of calcium, and hyperuricemia (high levels of calcium in the urine), is a risk factor. The predisposition to high levels of calcium in the urine may be passed on from generation to generation. Some rare hereditary diseases also predispose some people to form kidney stones. Examples include people with renal tubular acidosis and people with problems metabolizing a variety of chemicals including cystine (an amino acid), oxalate, (a type of salt), and uric acid (as in gout).

• Geographical location: There is also a geographic predisposition in some people who form kidney stones. There are regional "stone belts," with people living in the Southern United States, having an increased risk. This is likely because of the hot climate, since these people can get dehydrated, and their urine becomes more concentrated, allowing chemicals to come in closer contact and begin forming the nidus of a stone.
• Diet: Diet may or may not be an issue. If a person is susceptible to forming stones, then foods high in calcium may increase the risk, however if a person isn't susceptible to forming stones, nothing in the diet will change that risk.
• OTC products: People taking diuretics (or "water pills") and those who consume excess calcium-containing antacids can increase the amount of calcium in their urine and increase their risk of forming stones. Patients with HIV/AIDS who take the medication indinavir (Crixivan) can form Indinavir stones.