Kidney Stones and How to Treat Them

Urinary tract stones affect approximately 1 in 11 people in the United States. They can be silent and without symptoms, or manifest with severe pain, nausea, etc. Kidney stones are among the top 10 causes of Emergency Department visits, and in fact are the most expensive one by far, compared to others. They are slightly more common in men, and can affect both sexes.

Incidence of kidney stones is rising and recent studies have shown that 10.6% of men and 7.1% of women are affected by kidney stones each year. This shows a significant increase compared to prior studies. Kidney stones can be made of calcium with other substances (about 70% of all stones), uric acid, or other chemicals.

In a nutshell:

• Kidney stones are a common cause of Emergency Department visits or can be incidentally discovered on imaging.
• If symptomatic, urinary stones can cause flank pain, bloody urine, nausea, vomiting, etc.
• Spontaneous passage: mainly influenced by size and location of the stone. More than half of stones smaller than 5 mm (one fifth of an inch) may pass. Certain medications can be used to increase the passage rate.
• Treatment: Kidney stone treatment has to be carefully chosen based on stone and patient factors. Most common procedures include shockwave lithotripsy (ESWL), ureteroscopy (URS) with laser lithotripsy, and percutaneous nephrolithotomy (PCNL).
• Prevention for most common type of stone (Calcium Oxalate): increased hydration (water), low salt diet, low animal protein intake, increase citrate intake (lime and lemmon juice), and low oxalate intake (spinach, kale, nuts, chocolate, strawberries, etc). Do NOT limit your calcium intake (take the recommended daily amounts for your age and gender).

Kidney Stone Symptoms:

Patients will experience no symptoms if they have stones in the kidney that are not obstructing the passage of urine. These stones can be discovered incidentally on imaging studies obtained for other purposes. They are silent and some never manifest with other symptoms, they may grow in size or remain stable, and some may relocate to a spot where they block the urine flow (i.e. in the ureter) and then cause different symptoms.

The symptoms usually include:

• Severe intermittent pain in the flank region (depending on location of stone the pain may be lower, or radiate to the genitalia or groin)
• Presence of blood in the urine
• Nausea and/or vomiting
• Passage of sand-like particles in the urine

If the obstructing stone picture is complicated by a concurrent urinary tract infection, then the patient usually feels very sick with fever, shaking chills, lightheadedness, and sometimes low blood pressure and shock. This situation is considered a medical emergency and needs to be treated right away by a Los Angeles urologist.

Some stones can silently obstruct the urine flow from the kidney and in some cases lead to loss of function of that kidney over a long period of time. Read more about kidney stones at WebMD.com.

Urinary Stone Treatment Options:

There are multiple options available for treatment of kidney stones. A common question that patients may have is: “Will I pass my stone?” Spontaneous passage of urinary stones is influenced by many factors, most importantly the size of the stone (can be measured on CT scan) and its location, as well as individual patient anatomy. Usually stones smaller than 5 mm (about one fifth of an inch) have a greater than 50% chance of passage. Stones that are 7 mm or larger are less likely to pass.

In general the following kidney stone treatment options are available:

Observation and trial of passage, with or without Medical Expulsive Therapy (MET, medications that are thought to help with the stone passage).

Dissolution Therapy: involves medications that will help change the urine acidity and dissolve the stone. This is only used for a certain type of stone (uric acid) and with variable success.

Extracorporeal Shockwave Lithotripsy (ESWL or “shockwave”): This is a non-invasive treatment which uses shock waves that are generated outside the body and focused on the stone to pulverize and break the stone, which then is passed by the patient as sand or small fragments in the urine. It works well for carefully selected stones / patients. Factors that influence this treatment include stone size, stone density (hardness), suitable body size (no too large), and the location of the stone in the urinary tract.

Ureteroscopy (URS): This is a commonly utilized and minimally invasive option, which does not involve any cuts or incisions on the skin. Different scopes are used to enter the urinary tract through the urethra and locater the stone, with the patient under general anesthesia. Laser energy may be then used to fragment or pulverize the stone, and pieces are removed with special baskets that are inserted through the scope. Usually, a “ureteral stent” is then left to prevent obstruction of the ureter due to swelling after surgery, and is removed about a week later in the office. This is an ideal kidney stones treatment method for small and medium stones that have not passed, or did not respond to above treatments.

Percutaneous Nephrolithotomy (PCNL): Usually reserved for larger stones or multiple stones affecting the kidney, this procedure involves a very small incision (about half an inch) on the back and establishment of a tract into the kidney. Special scopes and devices are then used to break the stone(s) and remove them. After this procedure, a “ureteral stent” is placed. Some patients will have a temporary drainage tube in their back. “Tubeless PCNL” does not require the latter and we close the back incision with a stitch.

Pyelolithotomy: Whether done with open surgery or robotic/laparoscopic method, this procedure is rarely performed nowadays and usually reserved for special circumstances. It involves cutting the collecting system of the kidney open and removing the stones.

Is it Possible to Prevent Stones?

Prevention of stone recurrence or progression is a very important aspect of managing Los Angeles patients with recurrent kidney stones and has to be tailored to the patient situation and stone type. In general for most common type of stones (e.g. Calcium Oxalate stones) some simplified preventive measures include:

• Increased hydration (drinking water regularly and having sufficient urine output every day)
• Low sodium (salt) intake
• Low animal protein intake (usually about 6-8 oz per day)
• High citric acid (citrate) intake: can be preventive for new stones and slow the growth of existing ones
• We do NOT recommend limiting calcium intake beyond the recommended daily allowance for each patient
• Low oxalate intake (oxalate can be found in spinach, kale, nuts, strawberries, chocolate, etc).

Contact the Urologists at Comprehensive Urology in Los Angeles

If you or someone you care about is suffering from kidney stones, get in touch with the kidney stone specialists at Comprehensive Urology in Los Angeles. Dr. Arash Akhavein is a recognized expert in urinary stone surgery and minimally invasive endo-urological procedures. He joins us from the Cleveland Clinic, and brings his specialized expertise to Southern California.

Dr. Akhavein and his colleagues offer thorough counseling as well as all of the available options for kidney stones treatment. Our team can provide the necessary workup and carefully chosen treatment for stone disease and related issues to you or your loved ones.

Call 310-341-2557 today to schedule an appointment or contact us online.

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