Intense pain, difficulty urinating, and nausea are all common signs of obstructing urinary stones. Often, depending upon the size and location of stone, few of them pass away with plenty of fluid and time, but symptoms that refuse to go away may indicate a larger stone, or a smaller severely obstructing stone. Such a stone in a diabetic can be hazardous if left untreated. Fortunately today, numerous methods are available to treat these stones and almost all can be done in an outpatient setting. If you’re in the South Florida area and need your stone related pain checked out, call Dr. Sanjay Razdan at his office in Miami, Florida to schedule your consultation or request an appointment. Dr. Razdan is one of the few urologists in South Florida who are fellowship trained in Endourology and Robotic Surgery, a specialized branch of urology dedicated to minimally invasive, high tech, cutting edge treatment, of stones and other urological conditions.
Kidney Stones Q & A
What are kidney stones?
Normally, metabolic byproducts are secreted by the kidney into the urine and they stay dissolved in it. Sometimes, when the concentration of these substances goes higher than the threshold level they can precipitate and form stones. Most common culprits being – calcium, oxalate, and uric acid. Such a situation then is an ideal one for stone formation. In contrast to the common belief, kidney stones once formed don’t dissolve and they can either stay in the kidney and keep growing there or may migrate down the tubes called ureters to be eventually expelled out or to reach and stay in the bladder. Possibility of these migrating stones getting stuck in the ureter always exist.
What can cause kidney stones?
While there is no single cause of kidney stones, there are a few common risk factors that contribute to their formation.
- Sedentary Lifestyle
- Poor dietary habits
- Consistently low urine volume
- Persistent diarrhea
- Obesity
- Family history of renal stones
- Some metabolic diseases like hyperuricemia, renal tubular acidosis, parathyroid enlargement, etc.
- Prolonged state of being bed-ridden
- excessive consumption of red meat
- certain medications
Kidney stones are divided into four types based on how they are formed:
Calcium stones
The most common kind of kidney stone, these stones are made of calcium oxalate or calcium phosphate. Excessive amount of calcium in urine can lead to its precipitation increasing the risk of symptomatic stone formation. Even with normal amounts of calcium there can be conditions which can lead to stone formation.
Struvite stones
These stones occur as a response to urinary tract infections and can grow quickly without warning. Some bacteria change the acidity level of urine and produce an environment congenial for stone formation. Since these stones grow slowly they are often without symptoms and hence are diagnosed late when the stone is large. Patients with long term tubes in the urinary system, incomplete emptying of the bladder, neurological diseases etc predispose individuals to form this kind of stone.
Uric acid stones
Uric acid stones form if one does not keep himself hydrated enough for long periods of time. Uric acid is poorly soluble in urine and needs a lot of fluids to stay dissolved. Acidic low volume urine is the perfect recipe for these stones to form. High-protein diet can also contribute to the formation of uric acid stones.
Cystine stones
The rarest type of kidney stone, these occur if you have a hereditary disorder known as cystinuria, which leads to unusually high levels of an amino acid known as cystine in your urine.
What are the main symptoms of kidney stones?
Kidney stones can stay undiagnosed as they may cause no discomfort. Obstruction to the flow of urine anywhere in the tract by stones causes intense spasmodic pain and various other symptoms:
- Pain in your flank
- Radiating pain along your abdomen and groin
- Discolored urine (typically red or brown)
- Increased need to urinate
- Pain during urination
- Nausea and vomiting
- Chills or fever in severe cases
Diagnosis
When without symptoms, stones are found when tests are undertaken during routine health examination. With symptoms, an ultrasound or CT scan helps coming to a diagnosis.
How are kidney stones treated?
Small non obstructing stones can be safely observed under the guidance of a urologist.
It is important that a large or a symptomatic stone should be removed to preserve the functioning capacity of the kidney. Prolonged obstruction to the flow of urine may cause permanent damage to the kidney. In diabetics stones can cause obstruction associated with infection potentially leading to a serious condition.
Various methods to treat kidney stones are:
Extracorporeal shock wave lithotripsy
In extracorporeal shock wave lithotripsy (ESWL), Dr. Razdan uses electromagnetic shock waves to break the kidney stone into smaller pieces that can then pass through the urinary tract. This procedure is suitable only for certain specific stones at convenient locations. Besides the location other determinants for the use of this modality are size, stone composition and body habitus of the patient. Often a stent is passed before therapy to facilitate the stone fragment getting expelled out of the body.
Ureteroscopy
Ureteroscopy is used to treat small stones especially in the ureter. Using a small camera called a ureteroscope, introduced through the normal urethra, Dr. Razdan locates the stone and uses lasers to either remove the stone or break it into passable pieces. Use of laser is harmless to the patient and the primary advantage being not necessitating admission to the hospital.
Percutaneous Nephrolithotomy
An ideal approach for large sized stones in the kidney. Larger telescope is passed through a small incision on the back through which either laser or ultrasound waves are passed to break the stone and fragments brought out. Very large stones can be tackled in one sitting by this procedure.
Future stone prevention
- Adequate hydration every day to prevent dehydration
- Salt restricted diet
- Recommended dietary calcium
- Avoid excessive green leafy vegetables
- Red meat in moderation
- Plenty of fruits to be eaten
- Doctors may prescribe some medications
If you’re in the South Florida area and are suffering from symptoms that you think might be kidney stones, call Dr. Razdan now to request your consultation or request an appointment online.