Kidney Stones

Urolithiasis is the process of forming stones in the kidney, bladder, and/or urethra (urinary tract). Kidney stones are a common cause of blood in the urine and pain in the abdomen, flank or groin. Kidney stones occur in 1 in 20 people at some time in their life. Stone disease is among the most painful and prevalent urological disorders. There are many different types of urinary stones, but calcium-based stones are by far the most common.

Although historically urinary stones were more common in men, recent studies have suggested a rise in the number of women with urolithiasis.

Stones in the kidney often do not cause any signs and can go undiagnosed. When a stone leaves the kidney, it travels to the bladder through the ureter. Often the stone can become lodged in the ureter. When the stone blocks the flow of urine out of the kidney, it can cause the kidney to swell (hydronephrosis), often causing a lot of pain, nausea and vomiting.

Common symptoms of kidney stones are:

A sharp, cramping pain in the back and side, often moving to the lower abdomen or groin. Some women say the pain is worse than childbirth labor pains. The pain often starts suddenly and comes in waves. It can come and go as the body tries to get rid of the stone.
A feeling of intense need to urinate.
Urinating more often or a burning feeling during urination.
Urine that is dark or red due to blood. Sometimes urine has only small amounts of red blood cells that can’t be seen with the naked eye.
Nausea and vomiting.
Men may feel pain at the tip of the penis.

How are kidney stones treated?

Treatment depends on the type of stone, the location of the stone, the size of the stone and the patient’s clinical signs and symptoms.

Passing a stone

Small stones in the ureter can often pass without any treatment. The smaller the stone, the more likely it will pass. If you have a small stone in your ureter (the tube that connects your kidney to your bladder) and your pain is controlled without any signs of infection, you may be a candidate for trial of passage. This typically consists of staying hydrated at home and possibly taking a medication called Tamsulosin (Flomax) which may help passage of distal ureteral stones. You may need pain medication when there is discomfort.

Waiting up to 4–6 weeks for the stone to pass is safe as long as:

The pain is bearable
There are no signs of infection
The kidney is not completely blocked
Td the stone is small enough that it is likely to pass

You will be given a strainer to void into so you can catch your stone if you pass it. If you pass your stone, please notify your provider. Typically, you will see a provided back in the office within four weeks with a kidney ultrasound and X-ray to see if the stone has passed. Sometimes your pain can go away but the stone may still be present. If the stone has not passed, surgical treatment of that stone may be recommended.

Surgery options

Surgery may be needed to remove a stone from your kidney or ureter if:

Your stone does not pass during a trial of passage.
Your pain is unbearable.
You are having nausea or vomiting and cannot stay hydrated.
The stone is affecting kidney function.
Electively chosen to treat the stone.

Today, stone surgery is minimally invasive and usually involves small or no incisions, minor pain and minimal time off from work.

Surgery options include

Ureteroscopy (URS)

Treats kidney and ureteral stones.
General anesthesia is used.
Involves using a long telescope called a ureteroscope that is placed into your bladder (through your urethra where you urinate from) and up to your ureter and kidney.
Typically, a laser is used to break up the stone into dust like fragments that will pass. Sometimes, larger fragments are removed with a small basket that fits through the ureteroscope.
Usually, a temporary stent is left in the ureter. The stent is used to hold the ureter open so that urine can drain from your kidney to your bladder. Sometimes these are left on a string that comes out your urethra (where you urinate from) for easy removal at home in 4 –10 days. Other times, no string is left on and your provider will remove it with a quick procedure in clinic. It is important to remember that these are temporary. Leaving a stent in for long periods can lead to further stones, infections and loss of kidney function.
- Ureteral stents can be discomforting to some. Common symptoms are frequency and urgency of urination, mild flank pain, painful urination or blood in your urine. Other patients won’t notice the stent at all. These symptoms are usually tolerable and can be diminished by medications prescribed by your provider.
No incisions are needed.
Typically, this is an outpatient procedure, and you can go home the same day.

Shock wave lithotripsy (SWL)

Used to treat kidney and ureteral stones.
SWL does not work well on hard stones, such as cystine, some types of calcium oxalate and calcium phosphate stones, or very large stones.
Lower pole kidney stones or distal ureteral stones (close to the bladder) often are not treated well with SWL.
General anesthesia is used.
Your provider will use a machine that produces shock waves that are focused directly on the stone using X-rays to locate the stone. Repeated firing of shock waves on the stone usually causes the stone to break into small pieces. These smaller pieces of stones pass out in the urine over a few weeks. Most stone pieces pass painlessly. However, larger pieces may get stuck in the ureter, causing pain and needing other removal procedures.
No incisions are needed.
Typically, this is an outpatient procedure, and you can go home the same day.

Percutaneous nephrolithotomy (PCNL)

PCNL is the best treatment for large kidney stones (>2cm in size).
General anesthesia is used.
A small 1 cm incision is made in the back. A rigid telescope, called a nephroscope, is passed into the kidney. An instrument that breaks up the stone and suctions out the pieces is passed through the nephroscope.
After the stone is removed, often a ureteral stent is left in the ureter to allow the kidney to drain. Sometimes a nephrostomy tube is also placed. This is a tube that drains your kidney into an external bag outside your body. This can usually be removed in 1–2 days.
- A stent is a small plastic tube used to hold the ureter open so that urine can drain from your kidney to your bladder. After a PCNL, no string is left on your stent and your provider will remove it with a quick procedure in clinic in a couple weeks. It is important to remember that these are temporary and must be removed when your provider tells you to. Leaving a stent in for long periods can lead to further stones, infections and loss of kidney function.
- Ureteral stents can be discomforting to some. Common symptoms are frequency and urgency of urination, mild flank pain, painful urination or blood in your urine. Other patients won’t notice the stent at all. These symptoms are usually tolerable and can be diminished by medications prescribed by your provider.
Typically requires an overnight stay in the hospital

Preventing kidney stones

Prevention of future stones is a critical part of the care of patients with urolithiasis. Metabolic evaluations can be performed that dramatically decrease a person’s risk of subsequent stones. General recommendations for stone prevention include:

Increasing fluid intake to more than 2 liters/day.
Increasing the intake of citrate-containing fluids (such as lemonade and orange juice).
Avoiding high sodium intake.

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Kidney Stones

Surgery options include

Preventing kidney stones

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