Kidney stones are also known as calculi (plural), or calculus (singular). When it is in the kidney, it is a renal calculus. The tube draining the kidney to the bladder is the ureter, and a stone in the ureter is a ureteral calculus.
It is estimated that 20% of us will have a kidney stone in our lifetime. Of those who get a stone, 50% will recur.
Passing a stone is usually very painful. However, many patients can pass a stone with only a “muscle ache” sensation in the back, and they may not be aware the pain was from a stone until it “pops out.”
Kidney stones can run in families, but there are environmental factors for many patients.
Some causes of stones include:
- Diet (too much oxalate, too much protein, or rarely too much calcium)
- Inflammatory bowel disease
- Urinary tract infections
- Vitamin C (over 2 grams per day)
- Calcium supplements if taken without food or if used excessively
Your mother was wrong! It is now known that a LOW CALCIUM DIET will result in MORE STONES for the majority of stone patients. It does not make immediate sense but the majority of patients who make stones DO NOT have a calcium problem. Calcium is most often “just along for the ride.” It is not recommended to decrease dairy calcium consumption unless you have had a metabolic evaluation that showed high urinary calcium which decreased on a low calcium diet.
Treatment of Kidney Stones
The role of medicine and diet for kidney stone treatment is mainly for the prevention of future stones or to prevent the growth of existing stones. Prevention will be addressed below. In rare instances, stones can be dissolved. This is only effective for a smaller, purely uric acid stone and requires frequent medication adjustments and at-home urine testing up to 4 times per day by the patient.
For 90% of stones, there is no proven way to dissolve them or to medically treat a stone that has already formed.
Non-medical treatment options for most patients: non invasive, minimally invasive, and surgical procedures for kidney stone treatment and kidney stone removal.
In general, there are five options available to treat all urinary tract stones. Kidney stone size and location is an important factor in deciding which treatment is best for you.
1. Do nothing:
This is best saved for very small stones that could pass easily, or for very large asymptomatic stones in older patients. However, if the stone is causing pain, blockage or infections, it should be treated.
2. Lithotripsy (shock wave lithotripsy, SWL, ESWL):
It is the easiest procedure. The patient lies on a table or in a tub and shock waves are focused on the stone. It is non-invasive, but if the stone is over 1 cm, you will likely need a cystoscopy and stent to help the pieces pass. Patients can go home the same day.
Lithotripsy is only 60 – 85% effective for making your kidney or ureter stone free in a single treatment (depending on stone size and location). The recurrence rate is quite high. 42% of patients will have another stone within two years, probably from small fragments left behind that grow into new stones.
3. Endoscopic treatment (ureteroscopy, with or without laser stone fragmentation):
A urologist can look inside the bladder and all the way up to the kidney with a small scope and either remove the stone or break it up with a laser and remove the pieces. It is minimally invasive. There is no incision as the instruments go through the patient’s existing “plumbing.” Patients can go home the same day. In experienced hands, the stone free rate is 90-95% for stones in the ureter. The stone free rate is 80-90% for stones in the kidney depending on size and location.
4. Percutaneous removal (also called percutaneous nephrolithotomy, PCNL):
Very few urologists are proficient at this technique, which is why many urologists will not offer it as an option for their patients. PCNL is the treatment of choice for stones over 15 – 20 mm (1.5 to 2 cm). OC Urology routinely uses this technique for patients with large stones or stones refractory to other procedures.
While it is minimally invasive, it requires a one inch incision in the back. A channel is made from the skin straight into the kidney. It is invasive, but still considered minimally-invasive. Patients typically spend one night in the hospital (two for older patients). The stone free rate is 90 – 95% for these very large stones that otherwise would require multiple procedures to completely clear.
Click Here to see a video of how large stones are broken and removed during PCNL
5. Open surgery:
It is extremely rare to need a large incision to remove a stone from the urinary tract. The choice of treatment will depend on the size and location of the stone. In addition, the more invasive the procedure, the higher the success rate.
Kidney Stone Prevention
Everyone in the emergency room with a stone loudly proclaims “I will do anything to avoid another stone.” In reality, very few people will stay on a prophylactic treatment program for many years. Once they feel better, they stop therapy until the next painful stone. The average person who passes a small stone without the need for a procedure (whether it is his first stone or it has been many years since the previous stone) will not benefit much from specific testing and treatment. They are also unlikely to stay on any treatment recommended.
Kidney stone prevention is most important for patients with recurrent stones, multiple stones at one time or patients with very large or difficult to treat stones. Testing includes a 24-hour urine collection, blood testing and chemical analysis of the stone if possible. The possible treatments include diet changes (usually low oxalate diet or decreasing protein), citrate or magnesium supplementation and occasionally medication.
Contact us at (714) 639-1915 to make an appointment to discuss treatment and prevention of kidney stones.
OC Urology is the office of Dr. Matthew L. Greenberger. Dr Greenberger has been in practice since 2000. He was the first urologist to perform laparoscopic kidney surgery at Oregon Health Sciences University and brought that expertise with him to Orange County. Since that time, he has continued a general urology practice with a focus on evidence based best practices for the evaluation and management of patients with urological issues. He is an expert in minimally invasive management of kidney stones and prostate diseases. He is proud to be the first urologist at St Joseph Hospital to provide the latest in treatment for BPH, Aquablation.
The information on this site is solely for purposes of general patient education and may not be relied upon as a substitute for professional medical care. Consult your own physician for evaluation and treatment of your specific condition.