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Listen to Dr. Stormont answering questions about urology conditions. |
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| | Kidney Stones Podcast
Dr. Stormont, many of us have heard of kidney stones, but are not sure what they are. Can you give a little overview of the condition? How widespread is it? How can you tell if you have it?
Ironically, you usually can’t tell you have a stone until it starts to pass out of the kidney. Then, believe me, you know that something is wrong!
It is often said that a kidney stone attack is the most painful event a human can experience. Unfortunately, stones are quite common, occurring in up to 10% of Americans. Also, they have a terrible recurrence rate: up to 50% of cases will recur within 5 years if they’re left untreated. So you can see how important prevention is!
Because stones are unpredictable, it’s important that people have access to expert local care. In the St. Croix Valley it’s not a problem, because we have the expertise to treat both simple and complex stone problems at Lakeview Hospital. You don’t have to travel to the Cities to find help.
What are kidney stones?
Kidney stones are hard, stone-like masses that can form in one or both kidneys. They are usually painless when forming in the kidney, but cause pain as they try to pass down towards the bladder. Sometimes stones sit in the kidney and never cause problems. And if they do move out of the kidney,they usually pass harmlessly out of the body within hours. If they get stuck, severe pain, blood in the urine, infection and rarely damage to the kidney can occur.
What causes the stones to form?
Stone formation is complicated and does involve a genetic component (some people unfortunately make stones even when they are doing everything right). Generally, their formation can be understood by basic chemistry: Low volume, highly concentrated urine results in the precipitation of crystals,which can aggregate and lead to stone formation. Most stones are made of calcium oxalate, but sometimes they’re made of uric acid, struvite, cystine, or a mixture of these.
While there can be different reasons a person makes stones, the underlying cause is usually dehydration. Some of the more common risk factors include being male, having a family history of stones, having a diet high in animal protein, salt or oxalates (which is found in chocolate, nuts,tea,coffee and colas), obesity, and having poor mobility. Also, if people sleep on their sides, most stones tend to form in the kidney they’re laying on.
Is there any way a person can tell if stones are forming in their kidneys?
Kidney stones are suspected when a person has a history of pain in the kidney area, but it usually takes an x-ray (meaning a CT Scan) to determine the size, location and type of stones. Sometimes an ultrasound or plain x-ray is all that is needed to identify the stone.
Is there any way to prevent kidney stones?
The best way to prevent stones is to increase fluid so that urine volume is 2 liters per day, although some physicians recommend trying to achieve 3 liters.
Keep in mind that it isn’t the amount of fluid CONSUMED, it’s the amount of fluid VOIDED that is most important. This is because people who live in hot climates or exercise a lot will require more fluid to make the 2 liter per day minimum than those who don’t.
But Dr. Stormont, how does one go about measuring one’s urine?
You’re right – it isn’t very practical to measure your daily urine, so just keeping it clear and “pale” yellow is your best bet. It’s important to remember that you should be engaged in the dilution process all day long, which may require more trips to the bathroom.
Is there something in particular that a person should be drinking to cause dilution?
The type of fluid you consume is not as critical as the amount, but the simple answer to which fluid is best to drink is “water.” A general recommendation would be to try to make at least half of your total daily intake of fluid, water.
Are there any fluids that a person shouldn’t be drinking?
Although there is some disagreement about this, in general, people who are apt to form stones should avoid an excess of caffeine, black tea, grapefruit and apple juice. Contrary to popular belief, alcohol and milk have not been shown to cause stones.
Next to water, lemonade clearly is the best fluid to consume, because it is rich in citrate -- a stone inhibitor. Restricting calcium does not seem to reduce stone formation, and sufficient calcium intake is required to prevent osteoporosis, thus adequate calcium intake is important, the USDA recommendation being 1,000mg/day.
Although not as important as the amount of fluid intake, it seems important to avoid high oxalate foods and excess sodium (as in table salt). Vegetarians are less likely to form stones, and animal protein should be limited to 12 oz per day.
Sometimes special tests are necessary, especially for those “repeat offenders” or those with multiple stones, to determine an underlying metabollic cause.
If a person suspects they might have kidney stones, what should they do?
Just as we tailor prevention plans to fit each patient, treatment during a stone attack should be individualized, as well. In most cases, stones pass on their own, with the best treatment being drinking plenty of fluids, taking pain killers as needed, and possibly a medication (like tamsulosin) to help expel the stone. Most stones, unfortunately, cannot be dissolved once they are formed. Stones that are too large to pass, or are causing significant problems such as bleeding, pain or infection, may require surgical treatment. Lakeview Hospital offers state of the art Minimally Invasive Treatments that can successfully treat the majority of stones. As I mentioned before, there’s no need to travel to the Cities for care. Of all the alternatives, extracorporeal shock wave lithotripsy (or ESWL) is the most typical and least invasive way to remove kidney stones 1.5 cm or smaller.
What does ESWL treatment involve?
Patients lie on a special bed, and are asleep for this hour-long procedure, during which sound waves “crumble” the stone into sand like particles. Occasionally a temporary, soft plastic tube called a stent is inserted in the kidney to help the fragments pass. There is no hospitalization required, and usual activities can be resumed within a day or two. There is usually very little pain, with most of the fragments passing within a week or so. Sometimes, it can take months for all the fragments to pass, and some may require other treatment if the stone doesn’t completely shatter.
There’s also another minimally invasive procedure known as flexible ureteroscopy, which removes a ureter or kidney stone, often with the aid of a laser to fragment it prior to removal. Recovery from this procedure takes a little longer than ESWL, because while there is no incision, it is more involved and a temporary stent is always required.
I imagine most of these stones are pretty small; how big can kidney stones become?
While most stones are about 5 mm in size (about the size of an unpopped kernel of popcorn), they’ve rarely been known to become as large as golf balls. Removal of large stones like that usually require a procedure with an incision. This is called a percutaneous nephrolithotomy (PNL), which is more invasive with more side effects and has a longer recovery than the other treatments. Sometimes this is the best option for a very large stone and is done only at major medical centers.
Dr. Stormont, what’s your advice to people where kidney stones are concerned?
Without question, the best course of action is prevention, which is best accomplished by drinking generous amounts of fluid every day, and trying to make half of it water. But, for those who are worried about the condition or suspect they are forming kidney stones, there is ample physician expertise and state of the art equipment at Stillwater Medical Group that offers excellent local preventive medical and surgical care.
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