Kidney Stones

General Information

The common types of kidney stones include:

Calcium Oxalate

Calcium oxalate crystals account for about 90% of kidney stones cases. They are caused by the ionic reaction between calcium and oxalate in the urine, which creates the relatively insoluble calcium oxalate salt. These stones can be caused by inadequate fluid intake or excess sodium intake.

Uric Acid

These are the second most common form. Under the right conditions, a diet that is rich in purines such as shellfish or organ meats can cause uric acid stones to form. The high purine content in these foods causes the production of monosodium urate to increase, which can lead to the formation of stones in some individuals.

Struvite

These uncommon stones are the result of an upper urinary tract infection caused by either bacteria or yeast. The microbial growth that occurs because of the infection produces ammonia, which makes the urine more alkaline. This causes the quick development of magnesium-ammonium-phosphate (struvite) stones.

Cystine Stones

These stones are rare and are the result of a condition known as cystinuria, which is a hereditary condition characterized by the leakage of the amino acid cystine into the urine. The cystine crystallizes into a yellowish, waxy mass. Because cystinuria is an inherited condition, cystine stones tend to follow family lineages, and they frequently reoccur in people who are susceptible to them.

Factors like dehydration, dietary habits, and certain medical conditions increase the risk of stone formation.

Symptoms of Kidney Stones

If a stone is small enough, it may pass out through the urethra while urinating and without any problems. However, large stones may not pass and cause obstruction of urine, which can result in sudden and intense pain. The symptoms can be any one of the following:

• Pain in the lower back, flank, or pelvic area
• Nausea or vomiting
• Fever or the ‘shivers’
• Blood in the urine

If any of these symptoms are experienced by an individual, it is recommended that they arrange a consultation with a urology specialist for evaluation.

Diagnosis

A urology specialist will diagnose patients based on symptoms, testing, and medical history. During a medical examination, a selection of tests may be performed, including:

• A urine test to identify potential infection or stone

• Blood testing to assess kidney function and the presence or absence of compounds that can cause the growth of stones

• If there is considerable pain and it becomes necessary to make an urgent diagnosis, your urology physician may refer you for a CT scan, ultrasound, or x-ray.

Treatment

At Tennessee Valley Urology Center, our kidney stone specialists provide expert care in treating kidney stones. Our urology doctors will discuss your symptoms and run some tests to diagnose and agree on the best course of action to help you eliminate the stones. They will also recommend actions to help you prevent kidney stone recurrence and maintain a healthy urinary system.

Treatment options depend on the size and location of the stones:

Trial of Passage: This is a good option for smaller stones. Often treated at home with increased fluid intake, pain medications, anti-nausea medications, and alpha-blockers to help pass the stone naturally.

Shock Wave Lithotripsy (ESWL): ESWL is performed under anesthesia that focuses an ultrasound shock wave onto the location of the stone. This breaks the kidney stones into smaller fragments that can pass out of the ureters naturally. Follow-up X-rays are obtained to document the elimination of stone fragments.

Ureteroscopy (URS): Ureteroscopy is performed under anesthesia and involves the passage of a small scope via the urethra (tube leading from the bladder) into the bladder and then the ureter (tube leading from the kidney). Once inside the ureter, the stone can be identified and either broken up with a laser or removed with a basket.

Percutaneous Nephrolithotomy (PCNL): PCNL is the most invasive procedure and is also carried out under general anesthesia. A nephroscope (a thin, telescopic instrument) is passed through a one-inch incision through the skin in the back and into the kidney. The stone or stones are then broken up and removed.

Ureteral Stent: With each type of procedure, it may be necessary to place a ureteral stent, which is a soft, temporary tube that runs from the kidney to the bladder. It protects the function and drainage of the kidney and allows swelling from the stone to resolve. A stent can be associated with frequency, urgency, and blood in the urine. Some degree of these symptoms should be expected while the stent is present. Symptoms may be helped by Ibuprofen or AZO, a urinary analgesic available over the counter at your pharmacy. Stents will always need to be removed at some point after your procedure.

Prevention is always a better path to take than searching for a cure. However, if you suspect it’s too late, you should see one of our providers urgently. Small kidney stones can be treated from home under the guidance of one of our urology specialists. Larger stones will require clinical care, medical interventions, and possibly a procedure.