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 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.

What causes the kidney stones?

A Kidney stones form when there is a decrease in urine volume or an excess of stone-forming substances in the urine. The most common type of kidney stone contains calcium in combination with either oxalate or phosphate. Other chemical compounds that can form stones in the urinary tract include uric acid and the amino acid cystine.

Dehydration through reduced fluid intake or strenuous exercise without adequate fluid replacement increases the risk of kidney stones. Obstruction to the flow of urine can also lead to stone formation. Kidney stones can also result from infection in the urinary tract; these are known as struvite or infection stones.

Men are especially likely to develop kidney stones, and whites are more often affected than blacks. The prevalence of kidney stones begins to rise when men reach their 40s, and it continues to climb into their 70s. People who have already had more than one kidney stone are prone to develop more stones. A family history of kidney stones is also a risk factor for the development of kidney stones.

A number of different conditions can lead to kidney stones:

• Gout results in an increased amount of uric acid in the urine and can lead to the formation of uric acid stones.
• Hyperuricemia (high calcium in the urine), another inherited condition, causes stones in more than half of cases. In this condition, too much calcium is absorbed from food and excreted into the urine, where it may form calcium phosphate or calcium oxalate stones.
• Other conditions associated with an increased risk of kidney stones include hyperparathyroidism, kidney diseases such as renal tubular acidosis, and some inherited metabolic conditions including cystinuria and hyperoxaluria. Chronic diseases such as diabetes and high blood pressure (hypertension) are also associated with an increased risk of developing kidney stones.
• People with inflammatory bowel disease or who have had an intestinal bypass or ostomy surgery are also more likely to develop kidney stones.
• Some medications also raise the risk of kidney stones. These medications include some diuretics, calcium-containing antacids, and the protease inhibitor Crixivan (indinavir), a drug used to treat HIV infection.

The Types of Kidney Stones

A kidney stone develops from crystals that separate from urine and build up on the inner surfaces of the kidney. Normally, urine contains chemicals that prevent or inhibit the crystals from forming, however, in some people, stones still become formed. Crystals that remain small enough will travel through the urinary tract and pass out of the body in the urine without even being noticed.

CALCIUM STONES
Calcium stones are the most common type of stones. Calcium is a normal part of a healthy diet and is used by bones and muscles. Calcium not used by the body goes to the kidneys where it is normally flushed out with the rest of the urine. In some people, however, the calcium that stays behind joins with other waste products to form a stone.

STRUVITE STONES
Struvite stones are a type of stone that contains the mineral magnesium and the waste product ammonia. It may form after an infection in the urinary system.



URIC ACID STONES
Uric acid stones may form when there is too much acid in the urine.






CYSTINE STONES
Cystine stones consist of cystine, one of the building blocks that make up muscles, nerves, and other parts of the body, can build up in the urine and form a stone. Cystine stones are rare. The disease that causes cystine stones (cystinosis) runs in families.

What is a kidney stone?

A kidney stone is a hard mineral and crystalline material formed within the kidney or urinary tract. A kidney stone is also a solid piece of material that forms from crystallization of excreted substances in the urine. The stone may remain in the kidney or break loose and travel down the urinary tract. A small stone may pass all of the way out of the body, but a larger stone can get stuck in a ureter, the bladder, or the urethra. This may block the flow of urine and cause great pain.

A kidney stone may be as small as a grain of sand or as large as a pearl, and some are as big as golf balls. Approximately 80 percent of kidney stones are less than 2 centimeters in width. They may be smooth or jagged, and are usually yellow or brown in color.

Kidney stones are a common cause of blood in the urine and often severe pain in the abdomen, flank, or groin. Kidney stones are sometimes called renal calculi. One in every 20 people develops a kidney stone at some point in their life.The condition of having kidney stones is termed nephrolithiasis or urolithiasis. (healthsystem.virginia.edu)