The urinary tract is responsible for filtering and eliminating waste from the blood, starting from the kidneys and traveling through the ureter to the bladder and then out through the urethra. When a substance does not properly filter through the urinary tract, it can crystallize into “stones” that can become painful and interfere with the urinary tract function.
If you or someone you care about is suffering from kidney or bladder stones, fortunately, there are numerous treatment options available to not only alleviate the pain, but also safely remove the stones. To discuss which treatment option is best suited for you or your loved one, please do not hesitate to schedule a consultation at Comprehensive Urology today! Contact us online or call (310) 499-2756.
What Causes Urinary Stones?
Urinary stones that occur in the kidneys typically occur as a result of excessive calcium, mineral magnesium, uric acid, or cystine that are not dissolved or washed away, resulting in a build up of the substance, which then crystallizes. Bladder stones often form as a result of urine that remains in the bladder, whether due to failure to completely empty the bladder, inflammation of the urinary tract, or use of a bladder catheter. The remaining urine and substances in that urine can crystallize if not evacuated quickly enough.
In some cases, certain metabolic disorders can cause recurrent stones, such as:
- Gout – A disorder that results in high uric acid levels.
- Cystinuria – A condition that causes excessive amounts of cystine in the urine.
- Renal disease – Decreased ability to filter wastes out of the blood, resulting in waste buildup.
- Overactive parathyroid glands – A condition that causes excessive vitamin A or D build up.
At Comprehensive Urology, our board-certified urologists will conduct careful metabolic evaluation to determine the exact cause of urinary stones, such as metabolic disorders, diet and fluid intake, urinary tract infections, or medications.
Signs and Symptoms of Urinary Stones
It is not uncommon for patients to have kidney or bladder stones without experiencing any symptoms, however, a stone can cause irritation when moving around or when passing from the kidney to the bladder. The symptoms often include:
- Blood in the urine
- Urinary urgency
- Lower back pain
- Painful urination
- Interrupted flow in urination
Kidney and Bladder Stones Treatment
Depending on the size of the stone, kidney function, and whether there is an infection, kidney or bladder stones may require no treatment at all since the stone may safely pass by drinking plenty of fluids. However, if it is necessary to break up, remove, or bypass a urinary stone, the following treatments may be recommended:
- Ureteroscopy – A long, thin fiber optic instrument is used to locate and remove the stone from the kidney or bladder through the urethra with a laser or small scoop.
- ESWL (Extra-Corporeal Shockwave Lithotripsy) – The stones are located via X-ray and treated with shock waves from outside the body using a lithotriptor. The shock waves can successfully break up the stone, allowing them to pass through the urinary tract more effectively.
- Percutaneous Nephrostolithotomy (PCNL) – Removal of kidney stones through small incisions on the back to create a small tunnel to access the kidneys. This treatment is typically recommended for very large stones.
Kidney stones form from tiny crystals in the urine. When the urine is concentrated, these crystals coalesce to form hard deposits. These stones are most commonly made of calcium, but can also be composed of other minerals made in the body
What Causes Kidney Stones?
There are many underlying causes of kidney stones. The most common cause is dehydration or inadequate fluid intake. Certain metabolic disorders and diseases (such as hyperparathyroidism) can be associated with kidney stones. Another common cause is a family history of kidney stones. Chronic urinary infection and urinary obstruction can also lead to stone formation. Certain mineral levels in the urine, when too high or too low can either inhibit or promote stone formation. These levels are often affected by foods and beverages found in the common diet.
Symptoms of Kidney Stones
Kidney stones most commonly do not cause any symptoms when lying in the kidney. In fact, many people who have kidney stones do not even know that they have them. However, these small deposits can begin causing symptoms when moving around in the kidney, or when passing into the ureter (the tube draining from the kidney into the bladder) as they pass into the bladder.
These symptoms can include
- back pain under the ribcage
- blood in the urine
- lower abdominal or groin pain
- nausea or vomiting
- urinary urgency or frequency
- burning with urination or intermittent stream
Our physicians at Comprehensive Urology begin with a thorough history and subsequent physical examination. A combination of examinations may be performed to help diagnose a kidney stone. These may include urinalysis as well as radiographic examinations (i.e. ultrasound, plain x-ray, intravenous pyelogram, and computerized tomography (CT) scan). These tests may help delineate the location and size of the stone, as well as reveal if there is any evidence of urinary obstruction.
Once a kidney stone has been diagnosed, your doctor may recommend certain dietary modifications to help decrease the rate of stone formation. This would be tailored to each specific patient’s clinical situation. Dietary modifications may include increasing fluid intake, increased intake of citrate containing foods (lemons, oranges), limiting salt intake, and limiting red meats.
Your physician may also recommend medical therapy to help manage the kidney stone. Certain medications (such as alpha blockers often used for BPH) may help facilitate passage of a kidney stone that is lodged in the ureter. Other medications are used often to help dissolve kidney stones or to help future stone formation.
Surgical treatment may also be offered or recommended depending on each patient’s specific scenario. Reasons to potentially treat a stone include:
- the stone is in the kidney, medical treatment and dietary changes have been made, and the stone is either increasing in size or causing irritative symptoms
- a trial of stone passage has been attempted but it has still not passed and is causing pain
- the stone is causing obstruction of urinary tract and potential damage to the kidney
- the stone is resulting in urinary tract infection
- the stone is deemed too large to pass on its own
Our physicians can help determine if surgical treatment may be right for you.
Ureteroscopy and Laser Lithotripsy
Most stones within the urinary tract can be treated with this technique. It is often recommended for those stones that are found within the ureter. This technique involves no incisions, but rather involves using a small fiberoptic device (termed a ureteroscope) and passing it through the urethra, bladder and up the ureter. By using this device, our surgeons can help visualize and extract the stone with small baskets, as well as crush the stone into smaller particles by using a laser beam. At the conclusion of the procedure, the surgeon may elect to leave a stent in the ureter to help assist with passage of these particles.
Percutaneous Nephrolithotomy (PCNL)
This procedure is often performed when the stone is too large (often >2cm) or in a location where the stone will not be effectively treated by either ureteroscopy or ESWL. This procedure involves making a tiny incision on the back in order to introduce a tube directly into the kidney. Once this access is obtained, our physicians can use a variety of instruments in order to treat the large stone effectively.
Once a kidney stone has been diagnosed, our physicians at Comprehensive Urology may order a set of blood and urine tests (termed a metabolic evaluation) that help delineate the levels of certain minerals in the body. These minerals can increase or decrease the risk of stone disease. This information can be used to make dietary as well as medical modifications to help prevent future stone formation.
If a stone has been removed, a stone analysis will help determine the chemical makeup of the stone. This information can also be helpful to our clinicians in order to help formulate a plan for future stone formation.
After these modifications have been made, our team will monitor the response by repeating the metabolic evaluation periodically as well as repeat certain radiographic studies when indicated.
Modern day surgical options are all minimally invasive, which allow early recovery and return to normal activities. These options include extracorporeal shock wave lithotripsy (ESWL), ureteroscopic laser lithotripsy, and percutaneous nephrolithotomy (PCNL).
When stones are located in the kidney and are visible on plain x-ray, they may be treated with shock waves that are generated by a machine which delivers this energy from outside the body, through the skin and soft tissue directly onto the stone. These waves help shatter the stone into smaller particles that may more easily pass through the urinary tract. Sometimes our physician will recommend placing a small tube into the ureter (called a stent) during the procedure in order to help prevent urinary obstruction while these particles are passing.
How ESWL Works
Extracorporeal shock wave lithotripsy (otherwise known as ESWL) uses shock waves to break kidney stones into smaller pieces that are easier and less painful to pass through the body. The treatment is both simple and quick. During ESWL therapy, a patient lies down on a water-filled cushion. At this time, a surgeon uses x-rays or ultrasound tests to locate the precise location of the kidney stone. After the stone is located, ESWL treatment is performed, which involves sending high-energy sound waves throughout the body. Though these waves do not harm the muscle or skin tissue of the body, they are effective in breaking the kidney stone into smaller pieces.
After the stone is broken apart, the resulting pieces are easier to pass through the body, resulting in an experience that is less painful for the patient. Extracorporeal shock wave lithotripsy takes about an hour to perform, and a patient may receive sedatives or local anesthesia during the procedure. In some certain cases, doctors will recommend placing a ureter and a stent into a patient while the procedure is being performed. A stent is a small piece of flexible plastic mesh that holds the ureter open and prevents stone pieces from blocking the ureter. Typically, these objects are only used when a kidney stone is particularly large, though ultimately the decision is made by a urology specialist.
Recovery from ESWL
Extracorporeal shock wave lithotripsy is performed as an outpatient procedure, meaning that a patient is free to return home within a few hours of the procedure. After receiving the treatment, patients should expect to pass their broken down kidneys stones over the next few days. Though the stones may cause mild pain, the pain is much less substantial than it would be without ESWL treatment.
Who is a Good Candidate for ESWL?
ESWL is a treatment that is effective for anyone who is suffering from a kidney stone. However, the treatment is particularly effective for people who meet the following criteria:
- People with a kidney stone that is blocking urine flow or causing pain
- Stones that are large (between 4 mm and 2 cm in diameter)
- Stones that are either in the kidney are near the kidney.
Though ESWL is an extremely safe treatment, it should not be performed on women who are pregnant, people who have a bleeding disorder, patients with a pacemaker, or individuals with a kidney infection, urinary tract infection, or kidney cancer. To find out if you are an ideal candidate for extracorporeal shock wave treatment, schedule a consultation with one of the urologists at Comprehensive Urology today.
Bladder stones are crystallized minerals that develop due to a high concentration of certain minerals and substances in the urinary tract. The kidneys are responsible for filtering out waste from the blood stream, which then pass through the bladder to be eliminated from the body when urinating. When minerals are not properly filtered and expelled during this process, the build up can crystallize into what are called urinary or bladder stones.
If you or a loved one is suffering from bladder stones, there are numerous treatment options available to alleviate the pain and safely remove the stones. To discuss which treatment option is best suited for you or your loved one, please do not wait to schedule a consultation at Comprehensive Urology today! Contact us online or call (310) 499-2756.
Signs and Symptoms of Urinary Stones
In many cases, urinary stones form when the bladder is not completely emptied, often as a result of a urinary tract infection, use of a catheter, or acquired bladder diverticula. Patients may experience the following symptoms:
- Painful urination
- Blood in urine
- Cloudy or dark urine
- Lower abdominal pain
- Frequent urination
- Difficulty controlling urine flow
Not every patient will experience signs or symptoms of bladder stones, even if the stones are large. The stones have to cause irritation or block the flow of urine for the symptoms to develop.
What Causes Bladder Stones?
Bladder stones are typically comprised of crystallized calcium, uric acid, mineral magnesium, or cystine that has not been dissolved or flushed away. This build up of minerals or substances generally occurs when an individual cannot fully empty their bladder, however, it is not uncommon that other underlying conditions may contribute to an individual’s inability to urinate. These conditions may include:
Enlarged Prostate Gland – Whether caused by prostate cancer or benign prostatic hyperplasia, an enlarged prostate can interfere with urine flow, causing urine to remain in the body longer, where it can form crystallized stones.
Neurogenic Bladder (Damaged Nerves) – If the nerves that control the bladder muscles are damaged, it may be difficult for a patient to fully urinate. The nerve damage can be caused by a stroke, spinal cord injury, or other health condition.
Urinary Tract Infections – When the urinary tract is infected, the urethra becomes inflamed and swollen, interfering with urine flow. Additionally, many patients find it too painful to urinate during an infection and may avoid it for as long as possible.
Radiation Therapy – Undergoing radiation therapy in the pelvic area can cause inflammation and swelling, which can block the urethra and dissuade patients from urinating.
Kidney Stones – Stones that crystallize in the kidney can develop from different causes, however, these stones may travel into the bladder and grow even larger.
Medical Devices – When using a catheter, some patients may not be able to completely drain the urine, leaving small amounts behind that can crystallize.
Bladder Diverticula – Small pouches can develop in the bladder wall as a result of nerve damage, urinary blockage, congenital factors or other health condition, which can collect urine and prevent it from passing out through the urethra.
Treating Bladder Stones
The expert urologists at Comprehensive Urology offer a wide variety of treatments for breaking up, removing, or bypassing bladder stones. Depending on the size of the stone, some patients may be able to safely pass the stones without medical treatment, however, some patients may need the following:
Transurethral Cystolitholapaxy– Using a long, thin fiber optic instrument, our urologists can locate bladder stones and remove them with a laser or small scoop through the urethra.
Extra-Corporeal Shockwave Lithotripsy (ESWL) – Using an x-ray, our urologists can locate stones and then break them up with shock waves from a lithotriptor. The device can be safely used from outside the body and can successfully break up the crystallized mass into small enough pieces that can be passed through the urinary tract.
Percutaneous Suprapubic Cystolitholapaxy – When a stone is too large to be broken up with transurethral methods or when treating young children, it may be necessary to make a small incision in the patient’s lower abdominal wall to use larger instruments to break up the mass. An indwelling catheter may be placed to assist with urination.
Open Suprapubic Cystolitholapaxy – In cases where bladder stones are too large to break up or remove with minimally-invasive methods, or when another surgery is necessary, such as a prostatectomy or treatment of bladder diverticulum. An incision is made in the lower abdomen and then into the bladder to remove the masses. An indwelling catheter may be placed, as well as a second catheter in lower abdomen.
Bladder and kidney stones often develop as a result of dehydration or an imbalance of substances that crystallize in the urine. However, prior to determining the exact cause of urinary stones, the expert team at Comprehensive Urology will first focus on alleviating the symptoms and eliminating the stones with one or a combination of treatments. Once the stones have been passed or removed, we will conduct a metabolic evaluation to create a personalized urinary stone prevention plan.
If you or a family member is suffering from kidney or bladder stones, please do not hesitate to schedule a consultation with Comprehensive Urology in Beverly Hills today.
What is Involved in a Metabolic Evaluation?
A metabolic evaluation is a set of diagnostic tests that help determine the cause of stones in your kidneys or bladder. These tests include a urine test, blood work, and analysis of a passed or removed stone, if available. The metabolic work up will provide key information that may be used to prevent stones from recurring.
The most common causes of urinary stones that are identified in a metabolic evaluation include:
- Dehydration – The body is unable to wash out minerals and substances that build up into stones
- Low Citrate – Citrate is a molecule that helps bind calcium in the urine, allowing it to pass through the urinary tract rather than bind and crystallize into stones. Too little citrate in the body can result in stones.
- Excessive Sodium or Protein – Too much salty or fatty foods can cause an increase of sodium or protein in the urine, which can buildup and crystallize, especially if the body is dehydrated.
Urinary Stone Prevention
Depending on the cause of kidney or bladder stones, it may be possible to prevent recurrence by adjusting your dietary habits. Following a metabolic work up, our urologists will create a prevention plan and recommend regular metabolic work ups to monitor your progress. The most common steps for preventing urinary stones include:
- Drink at least two liters or half a gallon of water a day, increasing the amount during the hotter months
- Reduce sodium intake to no more than 2500 mg a day
- Limit calcium intake to a moderate level, such as 300 or 1200 mg a day
- Cut down on fat intake by limiting meat or other fatty foods in your diet
Q: Q: Does ESWL hurt?
Q: : Are there any complications to ESWL?
Q: : I only have one kidney. Can ESWL be performed on me?
Schedule an Appointment at Comprehensive Urology Today
At Comprehensive Urology, we know how painful and embarrassing kidney stones can be. But thanks to new technology, treating patients with kidney stones is easier and more effective than ever before. If you suffer from kidney stones and are interested in our non-invasive extracorporeal shock wave lithotripsy treatment, please call the expert urologists at Comprehensive Urology today. To schedule a consultation with one of our specialists, call (310) 499-2756.
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