Ask the doctor: kidney stones
Approximately 1 in 20 people suffer from kidney stones. What exactly causes kidney stones and how are they treated? We asked Dr. Damon Hoffmann, a Urology Specialist at Washington Health System, a few questions to learn more about kidney stones.
Q. What are kidney stones?
A. Kidney stones are a conglomeration of dietary mineral deposits and acid salts that form inside your kidney or ureter (the tube that drains the kidney into the bladder). Passing kidney stones can be quite painful. There are several ways they can form. Essentially, stones form from an imbalance in the chemistry of the urine resulting in the creation of stone forming ingredients.
Q. What are the symptoms a patient might experience from having kidney stones?
A. Often, if the kidney stone is not blocking drainage of the kidney, there will be no symptoms at all. However, if the kidney stone obstructs the drainage of urine, it can cause stretching on the capsule of the kidney and the ureter. This can cause extreme pain in the back or lower abdomen, blood in the urine, nausea and vomiting. Fever is a symptom that must be taken seriously and should prompt an urgent call to your doctor or an emergency room visit.
Q. Who is most susceptible to having kidney stones?
A. There are several factors that would make someone more susceptible to kidney stones. Dehydration is a very common contributor. Also, family history, age over forty (higher risk than younger people), male gender, obesity, high sodium or protein diet, or people who have had gastric or intestinal bypass surgery are just a few that top the list of being at increased risk for stone formation.
Q. How are kidney stones treated?
Based on their size and location, there are often multiple options available for treatment. Very large stones in the kidney historically required cutting the kidney open to remove them and sometimes resulted in loss of the kidney and significant bleeding. With advanced technology we now can place a small tube through the back into the kidney and pulverize the stones while sucking out the remaining fragments. This has led to very high stone clearance rates with much less morbidity. There is less pain, bleeding, and shorter hospital stays with this modern technology.
Q. How are smaller stones treated?
Smaller stones can be approached with Extracorporeal shockwave lithotripsy (ESWL) or ureteroscopy. ESWL technology allows a stone to be pulverized using ultrasound waves through a water-based cushion that is positioned under the patient near the kidney. This requires no invasive surgery, no incision and only light anesthesia. We have recently acquired a technology that will often allow this to be performed with no x-ray radiation required. Patients often have little to no discomfort from the procedure and may go back to normal duties almost immediately.
Ureteroscopy is another approach that may be utilized. This minimally invasive approach consists of passing a tiny scope through the bladder and into the ureter. The stones can then be broken into small fragments using a laser technology and the pieces can be retrieved using a tiny wire basket. This modality has excellent stone clearance rates and is done in a same day surgery setting.
Q. What do you recommend to patients who form kidney stones?
A. Drink plenty of water. Lemons and other citrus fruits contain citrate which has been proven to be a potent stone preventer. Avoid high salt and high protein diets. Evaluation by a urologist can help define your specific cause of stone formation and preventative measures can be targeted to patients’ individual needs.