Kidney Stones Management

If you’ve been diagnosed with kidney stones (urolithiasis), you may have several options for treatment. These include:

  • medical therapy
  • extracorporeal shock wave lithotripsy (ESWL)
  • percutaneous nephrolithotripsy (PCNL)
  •  ureteroscopy

What is a kidney stone?

A kidney stone is a solid mass formed from substances in the urine. These substances are normally passed in your urine, but they can become highly concentrated and crystalize when there is not enough urine volume. This is typically a result of inadequate daily fluid intake. These stone-forming substances are:

  • Calcium
  • Oxalate
  • Uric acid
  • Phosphate
  • Cystine (rare)
  • Xanthine (rare)

These and other chemicals are the “waste products” that must exit the body.
Kidney stones usually range in size from as small as a grain of sand or gravel to the size of a chickpea. They can even be as large as golf balls.

Smaller stones (those less than the size of a chickpea) can pass through the urinary tract on their own, but can be associated with significant pain. Depending on their size, you may or may not notice these stones. Larger stones can get trapped in the ureters (tubes which drain the urine from the kidney into the bladder). When this happens, the stones keep urine from exiting the body.


Blocking the flow of urine causes severe pain or bleeding. Stones that can’t pass on their own are treated with surgery. This decision is based on the stone size, number of stones/overall amount, locations, and other factors such as shape, type, and patient preference.

Types of Kidney Stones

There are four types of kidney stones: calcium oxalate, uric acid, struvite, and cystine.

The most common type of kidney stone is a calcium oxalate stone. This type of stone happens when calcium and oxalate join in your urine. It can happen when you have high quantities of oxalate, low amounts of calcium and aren’t drinking enough fluids.

Stones caused by uric acid are also fairly common. These come from a natural substance called purine, which is the byproduct of animal proteins (meat, chicken and fish). These types of kidney stone run in families, so talk to your healthcare provider about your family history.

Risk factors for developing kidney stones

There are several risk factors for developing kidney stones. These risks can include:

  • Not drinking enough liquids.
  • Having a diets that leads to increased excretion of any of the substances listed above.
  • Having a family history of kidney stones.
  • Having a blockage in the urinary tract.

Certain medical conditions can also increase your risk of developing a stone because you have higher or lower levels of the substances that make up a kidney stone. These conditions can include:

  • Hypercalciuria (high calcium levels in the urine).
  • High blood pressure.
  • Diabetes.
  • Obesity.
  • Osteoporosis.
  • Gout.
  • Kidney cysts.
  • Cystic fibrosis.
  • Parathyroid disease.
  • Inflammatory bowel disease.
  • Chronic diarrhea.
  • Some surgical procedures, including weight loss surgery or other stomach/intestine surgeries.

There are medications that can increase your risk of developing a stone. These medications can include:

  • Diuretics (“water pills”).
  • Calcium-based antacids.
  • Crixivan® (used to treat HIV infections).
  • Topamax® and Dilantin® (used to treat seizures).
  • Cipro® (ciprofloxacin).
  • Ceftriaxone (antibiotics).

Certain foods can also place you at risk of a kidney stone. These foods include:

  • Meats and poultry (foods high in animal proteins).
  • Sodium (diets high in salt).
  • Sugars (fructose, sucrose and corn syrup).

Signs and symptoms of kidney stones

You can actually have a kidney stone in your kidney for years and not know it’s there. However, when it starts to move or becomes very large, you may start to feel a few symptoms. Symptoms of a kidney stone can include:

  • Feeling pain in the lower back or side of body. This pain can start as a dull ache that may come and go. It can become severe and result in a trip to the emergency room.
  • Having nausea and/or vomiting with the pain.
  • Seeing blood in the urine.
  • Feeling pain when urinating.
  • Not being able to urinate.
  • Feeling the need to urinate more often.
  • Experiencing fever/chills.
  • Having urine that smells bad or looks cloudy.

Smaller kidney stones may not cause pain or other symptoms. These small stones pass out of the body in your urine.

Procedures

There are three types of minimally invasive surgery – ureteroscopy, shockwave lithotripsy and percutaneous nephrolithotomy.

Ureteroscopy

To perform this procedure, a small instrument, called an ureteroscope, is inserted in the urethra, through the bladder, and into the ureter. This instrument allows stones to be seen and then retrieved in a surgical “basket” or broken apart using a laser. These smaller pieces of kidney stones are then more easily able to exit the body through the urinary tract.

Shockwave lithotripsy

In this procedure, the patient is placed on a special type of surgical table or tub. High-energy shock waves are sent through water to the stone(s) location. The shock waves break apart the stones, which are then more easily able exit the body through the urinary tract.

Percutaneous nephrolithotomy (PCNL)

When kidney stones can’t be treated by the other procedures – either because there are too many stones, the stones are too large or heavy, or because of their location — percutaneous nephrolithotomy is considered. In this procedure, a tube is inserted directly into the kidney through a small incision made in your back. Stones are then disintegrated by an ultrasound probe and suctioned out so that you do not have to pass any fragments. A urethral stent is placed after the procedure (an internal tube from the kidney to the bladder which is removed one week after surgery in the office). Patients are typically kept overnight for observation and discharged home in the morning.