Overview

Kidney stones are solid formations of minerals that form inside your kidneys. Kidneys filter the blood and remove waste products from the body through the urine. When the urine becomes concentrated, mineral and acid salts bond together forming stones. After forming in the kidney, the stones may migrate down into other parts of the urinary tract including the ureter, bladder, and urethra. As they pass through the ureter, they may cause pain and blood in the urine.

Stones vary in shape and size. When they remain small, they can be excreted without pain. In other cases, surgery may be needed. Treatment at our Kidney Stone Center is focused on removing kidney stones and preventing existing stones from growing. This may involve medical therapy or surgery at our state-of-the-art surgery center. We also emphasize prevention to keep patients healthy and stop new stones from forming. We provide complete blood and urine evaluation to identify the cause of stone formation and are aggressive in helping you prevent stones in the future.

We are experts in the evaluation and treatment of kidney stones. Schedule a same day appointment today!

Causes

Kidney stones are more likely to form in hot, dry climates such as in the Southeast. Approximately 1 in 10 people in the United States will have a kidney stone at some point during their lifetime. Men are more commonly affected than women with an increased incidence of 2-3 times.

Common risk factors include:

  • Positive family history
  • Prior episodes of kidney stones
  • Obesity
  • High sodium diet
  • High protein diet
  • Sodas
  • Dehydration
  • Medical conditions such as gout, Chrohn’s disease, and chronic diarrhea

Types

The type of kidney stone helps determine the cause and best treatment approach.

Types of kidney stones include:

  • Calcium stones- The most common kidney stone usually in the form of calcium oxalate. Oxalate stones are due to an accumulation of calcium oxalate in the urine and are affected by dietary factors and metabolic disorders. Calcium phosphate stones are less common and usually attributed to certain drugs and autoimmune disease.
  • Uric Acid stones- These stones usually form in people that have a high protein intake and low fluid intake. Gout and chemotherapy can also increase the risk for this type.
  • Struvite stones- Also known as infection stones, they form in response to a urinary tract infection.
  • Staghorn stones- These are usually a mix of struvite and calcium carbonate stones. They grow large, contain bacteria, and can destroy the kidney if left untreated.
  • Cystine stones- These stones are formed in people with an inherited disease called Cystinuria which causes the kidneys to excrete too much of certain amino acids.

Symptoms

What are symptoms of kidney stones?

When kidney stones obstruct the passage of urine from the kidney to the bladder, the resulting obstruction of urine can cause backpressure in the kidney leading to colicky, intermittent or continuous, abdominal or back pain.  The location of the kidney stone frequently causes pain located at different parts of the body.  For instance, a kidney stone located inside or close to the kidney can lead to colicky back pain while a kidney stone located lower in the urinary tract, such as the ureter, can lead to abdominal pain.  In some cases, kidney stones can migrate down to the junction of the ureter and bladder, causing urinary symptoms such as urinary frequency (i.e., feeling the sensation of having to urinate), blood in the urine, or pain in the penis.  During episodes of pain, patients can also experience intense nausea and or vomiting.

Is it normal to have fever, chills with episodes of kidney stones?

When a kidney stone prevents the kidney from draining urine, it is common to have abdominal or back pain, with or without nausea and vomiting.  Occasionally, patients may experience fever and or chills.  This usually indicates that there is an associated infection with the kidney stone and this can be a life threatening event.  Infection in association with kidney stones warrants immediate physician consultation and frequently requires intervention in an expeditious manner.

I was told I had a kidney stone but I never felt any pain.  Is this possible?

Infrequently, patients may have incidentally detected kidney stones, in which the patient feels no pain whatsoever, however the kidney stone was detected on imaging (i.e. CT, MRI, x-ray) performed for another reason.

Does the size of the kidney stone correspond to the intensity of pain?

The size of the kidney stone does not necessarily correspond to the intensity of pain.  Somewhat counterintuitively, the size of the kidney stone does not determine the intensity of pain.  Very large kidney stones can cause minimal or no pain, while small kidney stones can cause excruciating, unbearable pain.

Diagnosis

How are kidney stones diagnosed? 

Kidney stones are frequently diagnosed after a patient experiences abdominal or back pain and has a CT performed.  A CT without contrast detects kidney stones with greater than 98% efficacy.  MRI, in contrast, does not reliably detect kidney stones although it may suggest that a kidney stone is present if the kidney is obstructed.  An x-ray can also detect kidney stones although the reliability can be low.  Ultrasound is also frequently used in the detection of the kidney stone.  If a kidney stone is obstructing the kidney, it can demonstrate resulting hydronephrosis (swelling of the kidney).  Importantly, ultrasound cannot reliably detect kidney stones that reside in the ureter (tubing that carries urine from the kidney down to the bladder).

Why do I need to give a urine specimen?

A urine analysis or urine culture is frequently taken to help in the diagnosis of kidney stones.  A urine analysis can detect blood which may be present when a kidney stone is present.  Additionally, a urine analysis can also show signs of inflammation, and at times, infection related to a kidney stone.  A urine culture helps determine a specific type of bacteria that may be present with a kidney stone.

Why do I need to give blood specimens?

Routine blood work is frequently collected and aids in the diagnosis of kidney stones.  An elevated white blood cells (WBC) count suggests that an infection may be present with a kidney stone.  Additionally an elevated creatinine (kidney enzyme) suggests that kidney function may be impaired.

Treatment

How are kidney stones treated?

There are a number of treatment options for kidney stones.  A number of factors must be taken into consideration such as: size, location, presence of infection, presence of renal impairment, comorbid conditions, duration of symptoms, inability to tolerate oral intake, and intensity and duration of pain.

Can kidney stones be treated medically, i.e. without surgery?

Depending on the size, location, intensity of symptoms, and type of kidney stones, kidney stones can sometimes be treated without surgery.  Medical management may include increasing fluid intake, straining the urine for stones, and oral medication such as Tamsulosin which has been shown to increase the rate of stone passage.  If medical management fails, patient’s symptoms worsen, or blood work indicates worsening infection or renal impairment, treatment typically proceeds to surgical intervention.

Can medicine dissolve kidney stones?

Kidney stones can sometimes be dissolved with medication depending on the composition and size of the kidney stone.  Commonly, this requires that the patient previously have had a kidney stone specimen sent for stone analysis.

What are the different surgical treatments?

There are three main types of surgeries that are performed for kidney stones: ESWL (extracorporeal shock wave therapy), endoscopic treatment with lasers, and percutaneous surgery.  The determining factors are frequently the size and location of the kidney stones and patient preference.

What types of stones are best treated with ESWL?

ESWL is a type of surgery in which ultrasound is applied the outside of the body leading to a fragmentation of kidney stones.  ESWL are best used when the kidney stone is close to the kidney or close to the bladder while still located in the ureter.  Size and stone composition frequently determine whether a kidney stone can successfully be treated with this surgical approach.  ESWL is typically performed under general anesthesia.

What types of stones are best treated with endoscopic treatment?

Endoscopic treatment of kidney stones can be used to treat kidney stones anywhere in the urinary tract.  Endoscopic therapy involves inserting small, telescope instruments through the patient’s native urinary tract.  Laser fibers inserted through the instruments are then used to break up the stones into smaller pieces that can be passed spontaneously.  No incisions are needed.  Depending on the size of the kidney stone, multiple endoscopic treatments may need to be performed in order to fully treat the kidney stone.  Frequently a stent is left in the kidney to allow passage of the kidney stone fragments.  This procedure is typically performed under general anesthesia.

I was told my kidney stone needed to be “stented” prior to being treated.  What does this mean exactly?

There are many reasons a kidney stone is stented prior to definitive treatment.  Occasionally, a kidney stone is associated with infection in which case the kidney needs to be drained, or decompressed, prior to treating the kidney stone.  Additionally, the ureter is sometimes too narrow to allow safe passage of endoscopic instruments to the level of the kidney stone.  Stent placement allows the ureter to dilate and frequently accommodate endoscopic instruments at the next visit.  Finally, placing a stent concomitantly or prior to ESWL helps preventing stone fragments from obstructing the kidney and can help in spontaneous fragment passage.

What is percutaneous nephrolithotomy and when is it performed?

Percutaneous nephrolithotomy involves placing larger endoscopic cameras and instruments directly into the kidney through the back.  This type of surgery is typically reserved for large kidney stones that are not amenable to ESWL or laser lithotripsy.   Percuneous nephrolithotomy is performed under general anesthesia.

Prevention

We emphasize prevention to keep patients healthy and stop new stones from forming. Lifestyle changes and medications may reduce your risk of kidney stones.

  • Drink enough water so that your urine is light and clear.
  • Take care to stay hydrated during summer heat and when exercising.
  • Limit foods rich in oxalates such as okra, spinach, sweet potatoes, rhubarb, peanuts, tea, and chocolate.
  • Reduce salt and animal protein intake.
  • Avoid overconsumption of sodas and alcohol.
  • Eat foods rich in calcium instead of taking calcium supplements.
  • Drinks such as limeade, lemonade and other fruits and juices high in natural citrate may help prevent stone formation.
  • Medications can be helpful depending on the type of kidney stones.

Advanced Urology: The Premier Urology Group in the Southeast

Our mission is to better the lives of those we touch.  Our foundation is exceptional service, personalized care, and cutting edge treatments.  We work hard to continuously improve our accessibility, service, and quality.  We strive to build lifelong relationships with our patients and referring providers.