Kidney stones affect more than 5% of the population. It may be difficult to believe, but there is actually a great deal of mystery about how these stones are formed. One thing is for certain: the pain involved in eliminating these tiny “rocks” can be excruciating.
What is a kidney stone?
Urinary or “kidney” stones are hard deposits of minerals from inside the kidney. Kidney stones have many causes, and there is still a lot of mystery and hypothesis about how they form. However, stones typically form when the urine becomes more concentrated, and minerals start to crystallize and stick together. When these formations break loose and begin to travel within the urinary system, they can cause irritation and blockages, resulting in severe pain and infection.
Kidney stones may not cause symptoms until they detach and begin to move around inside the kidney or ureters. Generally, the pain associated with these stones occurs in the side and back in the flank, beneath the ribs. Here are a few of the more common symptoms:
- Severe flank pain
- Pain radiating to the abdomen and groin
- Painful urination
- Pink, red or brown urine (blood in urine)
- Cloudy urine with an unusually foul smell
- Fever and chills
- Urinating more often and/or in small amounts
Diagnosis and treatment
If a patient has a kidney stone, it is probably very painful and often diagnosed in the ER. If the patient is not symptomatic, then it’s usually diagnosed by evidence of blood in the urine or incidentally on imaging studies done for other reasons. When there are signs of infection, or if the patient has only one kidney and an obstructing stone, then immediate surgery is done to place a stent in the ureter to relieve the blockage, drain any infection, and protect the kidney function.
“If there is infection, it requires a ureteral stent, which about the size of a piece of spaghetti. It has a small curl on each end that keeps it in the ureter,” said Blake Anderson, MD, a urologist with Dayton Physicians Network. “The stent allows the infected urine to bypass the stone and empty through the bladder and out of the body through the urethra, to avoid complications.”
If a stone is obstructing and will not pass on its own, it requires treatment. One option is called a ureteroscopy, where a scope is used to pass tiny laser fibers into the affected area, to break the stone into tiny pieces, or dust, that pass on their own or are basketed out by the surgeon. Whenever possible, a sample of the material is collected for testing, to determine the exact makeup of the stone and help with prevention of future occurrences.
New scope technology has provided kidney stone solutions that were impossible just a few years ago. Some patients have ureters that are too small in diameter to get through, for example, and the scope helps to do procedures like dilation or implanting stents to expand the ureter and allow the stone to pass or allow the surgeon to access the kidney with the ureteroscope in a future procedure. For patients with less-hard stones which are also visible on x-ray, another good treatment option is Shock Wave Lithotripsy (SWL), which uses high-energy shock waves delivered from outside the body to turn the stones to dust and allow the debris to pass through in the urine.
Non-obstructing stones can cause pain, as well, primarily in the flanks and often require treatment. Imaging procedures help to make sure they aren’t growing. Larger stones may need a more invasive procedure where a scope is inserted directly into the kidney from a small flank incision about the size of the tip of one’s index finger. This is called percutaneous nephrolithotomy or PCNL. Ultrasonic energy or lasers can be used through this scope to break up and remove the stones.
Risk and prevention
Risk factors for kidney stones are generally related to family history and whether you have experienced them before. Prevention begins largely with diet: limiting intake of animal protein and salt are key to minimizing the risks of urinary stone development. Primary to that prevention is making sure to get enough fluids.
“People have routines that are hard to change, and altering the diet and fluid intake may be challenging,” said Dr. Anderson. “We typically recommend less than 12 ounces per day of animal protein intake, as well as lower salt use, less than 2000 mg per day, and staying hydrated enough to make at least 2-2.5 liters of urine per day.”
When to see a doctor
Many people pass stones on their own, without medical help or incident. However, it’s always best to consult a doctor if you see blood in the urine or experience flank pain, even if you have had stones before and passed them without treatment. Your doctor will do a complete examination and workup, including blood tests and kidney function assessment, to determine the exact cause of your symptoms and prescribe treatment accordingly.
If you suspect you could have kidney stones, call 937-293-1622937-293-1622 to schedule an appointment with one of our board-certified urologists.More Perspectives