Kidney Stones

Nephrolithiasis is the presence of stones in the kidney; Urolithiasis is a more general term for stones anywhere within the urinary tract. This includes stones in the bladder, kidney, ureter (the tube leading from the kidney to the bladder), and urethra. Diagnosis is usually based on clinical history (sudden onset of excruciating pain in the flank along with blood in the urine, nausea or vomiting). The cause and chemical composition of the stone may have some bearing on its diagnosis, management and particularly on prevention of recurrence.

The peak incidence of stone disease occurs at the ages of 20-40 years, although stones are seen in all age groups. singular to female ratio is 3:1. Calcium oxalate stones, the most common variety, have a recurrence rate of 10% at 1 year, 35% at 3 years, and 50% at  5 years after the first episode. Kidney stones develop when crystals separate from the urine and aggregate within the urinary tract. Magnesium-ammonium-phosphate stones occur in the presence of infection.  Uric acid stones form in patients with gout. Certain drugs and supplements, such as vitamin C, can also increase the risk of stones.

Most kidney stones pass within 48 hours with expectant treatment including hydration and analgesics. Ureteral stones less than 5 mm will pass spontaneously about 90% of the time.

For stones that do not pass or which are judged too large to pass spontaneously, a variety of procedures can be employed to remove the stone. No one technique is suitable for all stones in all patients, but the general options are as follows.

The least invasive procedure is called Extracorporeal Shock Wave Lithotripsy (ESWL). With this procedure, sound waves are focused on the stone. The sound then pulverizes the stone and the stone particles then pass through the urinary tract pushed along by the urine.

For stones that are too large, too hard or not easily seen with ESWL, two other procedures can be employed depending upon the location of the stone. For very large stones in the kidney, Percutaneous Nephrolithotripsy (PCNL) is employed. In this procedure, which requires general anesthesia and a short hospital stay, a tube is inserted directly into the kidney through the flank. The stone is then broken up and particles ‘vacuumed’ out of the kidney. As opposed to ESWL, there is no limit to the amount of power and energy that can be applied to the stone during PCNL, so even the hardest stones can be pulverized.

For smaller stones within the ureter and kidney, a procedure called ureteroscopy can be employed.  In this procedure, performed under anesthesia on an outpatient basis, a special scope is used to navigate through the urethra, into the bladder and up the ureter. A laser fiber is then threaded through the telescope and brought into contact with the stone under direct vision. Fragmented particles are either removed or are allowed to pass spontaneously. Frequently, after the procedure, a thin silicone tube called a stent is inserted  temporarily to allow any swelling in the ureter to subside. This is either removed by the patient several days after the procedure, or is removed by the doctor in the office.

Kidney Tumors

Kidney tumors can be benign or malignant, and generally warrant a urological evaluation. Some of these growths can be left alone, while others warrant surgical removal. Certain tumors can be managed less aggressively, with minor, outpatient procedures, that can even be utilized to destroy small cancerous growths of the kidney and thereby avoid major surgery.

There are many variables that the urologist utilizes to decide how to manage each type of tumor. Our physicians stay current on the latest technologies and treatment options, and will help guide you towards the best approach for your situation.

Hydronephrosis

Hydronephrosis describes when one or both kidneys become swollen from backed-up urine.

Hydronephrosis is fairly common, and often is not very serious. However, in some instances it can have very serious consequences and may need to be treated urgently. The blockage can be in the kidney, the bladder, or the ureter (the tube that transports urine from the kidney to the bladder). It also can occur when something happens to cause urine to flow backward from the bladder up into the kidney.

The treatment for hydronephrosis will depend on what has caused the kidney swelling. Some cases are resolved fairly simply. For instance, a UTI may be treated with antibiotics. If a kidney stone or other urinary stone is causing a blockage, the kidney stone may pass by itself, or may require other removal to eliminate the blockage. Some situations do not need any treatment at all.

Other conditions might be more complex and may require additional treatment.

These treatments may include:

• Catheter drainage of excess urine.

• Insertion of a ureteral stent:

  The doctor may insert a tube that widens the ureter so that urine can drain into the bladder.

• Placement of a nephrostomy tube:

   Often performed as an outpatient procedure, this allows urine to drain through the back, into a drainage bag.

• Antibiotic treatment:

   This is used to control infection and may be used for long-term treatment to control repeated urinary tract infections.

• Surgical treatment:

   Some blockages, such as surgical scar tissue or tumors, need to be managed surgically. In some circumstances, the surgeon may remove a damaged portion of the ureter and then reconnect the healthy portion. This procedure can  correct urine flow so that the urinary system works normally.