Kidney stones are crystals that form in the urinary tract. Usually found in the kidney itself, stones can also form in the bladder as well. About 70% of the time, they are formed from a substance called calcium oxalate. They can also be made from uric acid, calcium phosphate, or cystine.

The stones vary in shape and size. Some are round, and others are long and jagged. Even very small kidney stones that measure 2mm in size can cause patients a tremendous amount of pain that leads to a visit to the Emergency Room.

Kidney stones have been called the “great mimicker” due to their ability to manifest pain and symptoms in a variety of ways. Commonly they can cause an intense pain in the flank, between the edge of the rib cage and the spine. Many female patients have described the pain as worse than childbirth. They can be accompanied by nausea, vomiting, or blood in the urine. However, they can also lead to lower abdominal pain, urinary frequency, bladder pain, penile pain, testicular pain, etc.

The gold standard in evaluation of the presence of a kidney stone is through a non-contrast helical CT scan. They can also show up on ultrasounds or plain X-rays.

The biggest risk factor for making kidney stones is dehydration. Many Americans do not drink enough water throughout the day and this can lead to crystals forming in the urinary tract that ultimately leads to a stone. There are also genetic factors, and in fact up to 50% of patients who present with stones, have a family history of this. Other risk factors include medications, dietary supplements, and also eating habits that may put a patient at increased risk of forming stones.

At AAUrology, after the initial treatment of the stone, we can perform a thorough metabolic workup to analyze each of the factors listed above and create a comprehensive plan to reduce your risk factors.

Treatment is highly personalized, dependent on the individual stone size, shape, location, and also the patient’s symptoms. For patients with smaller stones who are not in intense pain and not experience symptoms of active infection, medical treatment of kidney stones may be a reasonable first option.  For more urgent situations, or for patients with larger stones, we will discuss the many minimally invasive surgical treatment options available to provide definitive treatment.

Extracorporeal shockwave lithotripsy (ESWL)

This procedure utilizes shockwaves delivered from the outside of the body to fragment the stones in the kidney or ureter tube. The stone is pulverized into small sand or powder like granules, allowing for easier passage through the urinary tract. This is a low risk procedure and also the least invasive option available. Your provider will discuss if ESWL is an effective treatment option for your kidney stone.

Ureteroscopy with laser lithotripsy

This is an excellent option for stones that are blocking the tube between the kidney and the bladder (ureter). A small scope is passed into the urethra without the need for any incisions. This procedure is highly effective as the stone is visualized directly and then broken up with a tiny laser fiber. Residual fragments may be extracted at the time or allowed to traverse passively with urine flow. After ureteroscopy, a ureteral stent may remain inside the body to promote healing and must be removed, usually several days to weeks later. Ureteral stent removal usually does NOT require anesthesia.

Percutaneous nephrolithotomy or Tubeless PCNL

Percutaneous nephrolithotomy, or PCNL, is a minimally invasive surgery for large or multiple kidney stones. Large kidney stones have the potential of causing pain, bleeding, infections, and if left untreated, can lead to eventual deterioration in kidney function. PCNL is designed to be the most effective way to clear a large stone burden.

Typical indications include:

• Larger kidney stones
• A stone obstructing more than 1 calyx in the kidney (known as a staghorn calculi)
• Other procedures such as shockwave lithotripsy (ESWL) and ureteroscopy have failed