Kidney Stones, Part 2

    Dr. Paul Siami, Deaconess Clinic Urologist
     
    If you’ve ever had kidney stones, you know how painful the condition can be.  My previous article talked about the causes and symptoms of kidney stones, as well as the process of sometimes letting a stone “pass.”  This second article focuses on procedures used to treat kidney stones, and how to prevent stones from occurring or reoccurring.

    There are two main ways to treat kidney stones:  either passing stones on your own, or having a procedure to help stones pass.  Sometimes waiting for the stone to pass isn’t the best option, due to the location or size of the stone, or if infection is present.  If that is the case, there are three primary procedures, which I’ll detail below.  Open surgery is also a final option, but is rarely done to treat kidney stones.

    Shock Wave Lithotripsy (SWL)
     SWL is the most common procedure used to treat kidney stones. SWL is typically used for stones in the kidney and upper ureter (the tube that connects the kidney and bladder).  The procedure uses shock waves to break the stones into small pieces.  This makes stones easier to pass. 

    During SWL, a machine generates shock waves that are transmitted into the kidney stone through a sensor outside your body.  The waves are focused on the kidney stone, so there is little impact to the skin and nearby tissues.  The stone is broken up into small, sandlike pieces, which can then pass easily out of the body in urine.  X-rays are taken before and during the procedure to localize the stone and make sure it’s broken up.

    During SWL, general anesthesia is most often used, and you’ll likely go home the same day.  A few days later, you may have an x-ray to make sure that the stone is completely broken up and out of your body. 
    There are some risks with SWL, including the need for a repeat procedure, infection and bleeding.

    Ureteroscopy (URS)
    URS is most often used if a stone is lodged in the ureter.  A small telescope with a camera is inserted through the urethra and bladder and into the ureter.  A laser fiber is sent through the scope to break up the stone.  The stone fragments can then pass in the urine, and larger pieces may be removed with an attachment on the scope.

    Some differences in URS and SWL are:

    • URS is more invasive
    • URS usually requires a stent (hollow plastic tube) to drain the ureter. SWL generally does not require a stent.
    • Stone-free rates are better with URS than SWL. That means that URS is more likely to remove all stones and stone fragments at once than SWL.
    • Since URS employs a very powerful laser, harder stones respond much better than to SWL.
    • URS is also done under general anesthesia, and you’ll likely go home the same day.  A few weeks or months later, imaging tests may be done.  These check if all stones were removed.
    Bleeding, infection and possible injury to the ureter are possible risks, but are uncommon.

    Percutaneous stone removal (PNL)
    PNL is typically used for larger stones located in the kidney.  This is the most invasive treatment and is used for very large stones.  A small incision is made in the back, and a telescope with a camera is inserted through the incision into the kidney.  Lasers or other devices passed through the scope break up the stone, and the stone fragments are then removed through the scope. 

    For this procedure, you’ll likely be hospitalized overnight afterwards, and you may have a tube in your kidney for a few days to allow drainage of urine. 

    Advantages of PNL are:

    • Best way to treat large stones. Current recommendations are for PNL to treat any stone larger than 1.5 cm.  (about 2/3 of an inch—or the size of a nickel)
    • It has the best result for leaving the kidney without stone fragments, and “washes out” any remaining particles.
    • This procedure relieves the burden of the patient trying to pass any remaining fragments, because they’re removed during the procedure.  They’re literally crushed and sucked out through the scope.
    • Areas that may not be reachable with other methods are sometimes best accessed via PNL.
    As with any surgical procedure, there is a slightly higher risk for infection and bleeding than with URS and SWL.  There may be minor loss of kidney function, but serious complications are uncommon.

    Preventing Future Stones
    Once you’ve had a kidney stone, you’re more likely to have another stone in the future.  But you can take steps to prevent kidney stones.

    Hydration. Drink lots of fluids.  Staying hydrated helps flush minerals out of your kidneys before they can build up and cause stones.  Aim to drink about eight 12 ounce glasses of fluid each day.  Water is best.  These tips can also help:

    • Drink a glass of water at each meal.
    • Drink a glass of water when you brush your teeth, right before bed, to keep you well hydrated throughout the night.
    • Keep a bottle of water with you throughout the day, and take sips whenever you can.
    • Limit alcohol and caffeine because these work as diuretics and tend to dehydrate.
    • Check the color of your urine to see if you’re drinking enough.  Clear or light yellow urine is good, and dark yellow urine means you need to drink more.  Dark urine is more concentrated, which promotes the formation of stones.
    • And here’s a tip you may not have heard, but it’s a good one.  Drinking lemonade can be VERY helpful in preventing stones.  The citrates in lemonade are natural inhibitors of stone formation in the kidneys. 
    Sodium  Limit your intake of sodium, especially from processed foods.  Sodium often “hides” and we consume much more than just what we “shake on” at the table.

    High-Oxalate Food and Drinks Avoid high-oxalate foods and drinks, such as chocolate, nuts, black tea and colas.  90% of all stones are calcium-oxalate stones.

    Calcium  Have the recommended daily amount of calcium in your diet.  Too little calcium in your diet can lead to kidney stones because you want to replace the natural turnover of calcium.  If you don’t have enough calcium in your diet, it’s leached from your bones and is more likely to cause kidney stones.

    Weight Lose any excess weight. Your doctor can help you create a weight loss plan.

    Magnesium  Magnesium supplements can help in reducing kidney stones because the kidney will substitute magnesium for calcium in its processing, but magnesium won’t cause stones.
     
     
    Going forward, the best way to lower your risk of developing future kidney stones is to work with your doctor.  This means following your treatment plan.  Your doctor (urologist) may also suggest further testing and preventive medications.

    Further testing can help determine why you formed kidney stones.  This information can be used to help prevent stones.  Tests can include stone analysis, 24-hour urine sample and blood tests.

    Preventive medications can be prescribed to help prevent the formation of new stones.  These include medications that reduce the amount of calcium excreted in the urine, reduce the amount of uric acid excreted in the urine, prevent certain types of stones- including cysteine, and dissolve uric acid stones.
    After treatment for a kidney stone, it’s up to you to make lifestyle changes to help keep new stones from forming. 

    Follow your doctor’s instructions, drink lots of fluids, and eat right.  These simple steps can help you live free of kidney stone pain.

    Posted: April 10, 2014 by Pam Hight
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