Kidney
stones are very frequently seen in southeast Texas, and in fact are quite common
in any hot and humid climates around the world. The management of stones has
changed dramatically over the past 15 years with the advent of lithotripsy and
laser therapies.
There
are many people who have stones and have no symptoms whatsoever, and may not
always need treatment. When we find a patient has kidney stones we have to
decide whether it is prudent to treat them or leave them alone. Stones can
present in many different ways. When they form in the kidneys and pass down
the ureter (the tube from the kidney to the bladder) they usually cause very
severe pain, and in this situation, pain is the presenting symptom. Sometimes
a patient will have unexpected blood in the urine, and subsequent evaluation
will reveal stone(s).
The
evaluation can vary from X-rays to CT scans to ultrasounds to evaluation of
chemicals in the blood, urine, and in the stones themselves. The degree of evaluation
depends greatly upon the age of the patient, the recurrence incidence, and the
degree of problems the patient is experiencing. Unfortunately it is not uncommon
for the physician to be unable to determine a precise cause in any individual
patient, but some attempt is usually made to clarify the issue as well as possible.
The
majority of stones are very small and will either pass unassisted by the doctor’s
intervention, or require no treatment at all. When treatment is needed options
range from laser ureteroscopy to lithotripsy. Uretersocopy is a technique whereby
the urologist can pass a tiny, thin telescope through the normal urinary passages,
urethra and bladder, and up and into the ureter. Once the urologist can see
the stone the options for removal include basketing and laser. If we are able
to actually grasp the stone and pull it out this is called basketing. If it
seems preferable, the physician can use a laser fiber to attempt to break up
the stone into very tiny fragments so that the tiny fragments can pass unassisted.
Lithotripsy, or ESWL has been in use for the past 15 years or so. This is an
essentially non-invasive technique whereby shock waves are sent from outside
the body through the body structures directly to the stone. Shocks are generated
onto the stone resulting in it’s being broken into many very tiny fragments
that will usually then pass without further assistance.Keep in mind that sometimes
combinations of treatments are needed, and sometimes repeats of the same procedure
is needed. For example, with ESWL, in probably 20% of patients more than one
treatment is needed. ESWL is a very safe procedure, but there are rare patients
in whom the shocks can result in kidney damage.It is rare enough that in 15
years of doing ESWL I have not had a single patient exhibit any significant
side effects from the procedure.
Diet has
some role in treatment. Occasionally we can make some specific recommendations
regarding avoiding some foods and drinks, but more often than not, the most
important item is WATER!! We advise all stones to drink more water….this
is very important in trying to avoid more stone formation. Occasionally medications
are used to prevent further stone formation, but this is not common. Another
thing to keep in mind is that although most stones are made of calcium, one
does not need to severely limit dietary calcium. Some people, even physicians
may tell you this, but it is not true. Especially in women there could be
more severe ramifications from avoiding calcium…most specifically the
development of weakening bones called osteoporosis. But remember, more water!!