Urology Center of Englewood

Kidney Stones

Overview

The urinary tract includes the kidneys, the ureters, the bladder, and the urethra. The kidneys create urine by filtering the blood and removing waste and excess water. From the kidneys, urine travels to the bladder through small tubes called ureters. Urine is then stored in the bladder until it is passed to the outside of the body through the urethra.

Kidney stones are a common and painful problem. Stones develop when substances in the urine become concentrated and form a solid. The most common type of kidney stone contains calcium in combination with other substances. Small stones may be able to pass through the urinary tract on their own, but when stones become large or cause symptoms, treatment may be necessary.

Ureteral stones are kidney stones that have left the kidney and entered the ureter. In this overview, the general term “kidney stone” refers to both kidney and ureteral stones.

Who Gets Kidney Stones?

By the age of 70, 11 percent of men and roughly 6 percent of women will develop a kidney stone.[1] Kidney stones tend to be more common in whites than in other racial and ethnic groups, and are also more common in people who have a family history of the condition.

Underlying health conditions that can contribute to kidney stones include dehydration, urinary tract infections, blockage of the urinary tract, kidney disease, bowel problems, gout, and certain inherited conditions that affect the content of urine.[2] [3]

In some cases, it may be uncertain what caused the kidney stone.

What Are the Symptoms of a Kidney Stone?

Not all kidney stones cause symptoms, but some can cause extreme and sudden pain. The pain often involves the back and side, but may also be noticed in the lower abdomen and groin. Patients may also experience blood in the urine, nausea and vomiting, discomfort during urination, or urinary frequency and urgency.[4]

How is a Kidney Stone Diagnosed?

If a kidney stone is suspected, you will likely undergo a physical examination and be asked to provide a urine sample for testing. The diagnosis of a kidney stone is confirmed by viewing the stone with a computed tomography (CT) scan, x-ray, or ultrasound.[4] By using one of these imaging tools, your doctor will be able to determine the number, size, and location of the stones.

Management of a Kidney Stone

Not all kidney stones require treatment. Small stones are often able to pass through the urinary system on their own. Treatment will likely be required, however, if the stone is large, causing persistent pain or bleeding, obstructing the urinary tract, or linked with an infection.[1]

Several treatment options are available. The choice of which treatment to use will depend on several factors, including the number, size, location, and composition of the kidney stones.

Shock-wave lithotripsy: This is the most frequently used treatment for kidney stones. Shock waves from a machine outside of the body are transmitted through the skin until they reach the stone. The shock waves break the stone into pieces that are small enough to pass through the urinary system. If the initial treatment doesn’t break the stones into small enough pieces, additional treatment may be necessary. Some patients may also have a narrow tube called a stent put into the ureter to help the pieces of stone pass.

Ureteroscopy: A ureteroscope is a small instrument that is inserted into the ureter through the bladder. It allows the doctor to see the stone. Once the stone is in sight, it can be grasped and removed or broken into pieces. No incisions are made. Once again, a stent may be temporarily placed in the ureter.

Percutaneous nephrolithotomy: If a stone is large or in a location that makes other treatments difficult, it may be treated with percutaneous nephrolithotomy. In this procedure, a small incision is made in the back. An instrument inserted into the kidney allows the surgeon to reach and remove the stone. If it’s a large stone, it may be broken into pieces before it’s removed. Patients may need to stay in the hospital for a few days after the procedure.

Open or laparoscopic surgery: These are more extensive surgical procedures that may be necessary for particularly complicated cases.

Preventing a Recurrence

Many people who have a first kidney stone will later develop another one.[1] There are steps that you can take, however, to reduce the risk of a recurrence.

Drink plenty of fluids: Your doctor can help you determine the amount of fluid intake that is best for you.

Follow your doctor’s dietary recommendations: Your doctor may advise you to make certain dietary changes, such as eating less animal protein or restricting salt intake.

Undergo any additional tests that your doctor recommends: Depending on your situation, your doctor may recommend additional blood or urine tests. A 24-hour urine test, for example, may provide information about the cause of your stone and can also be used to assess response to treatment.

References:


[1] Worcester EM, Coe FL. Calcium kidney stones. New England Journal of Medicine. 2010;363:954-63.

[2] National Kidney and Urologic Diseases Information Clearinghouse. Kidney Stones in Adults. NIH Publication No. 08-2495. October, 2007.

[3] Curhan GC. Epidemiology of stone disease. Urologic Clinics of North America. 2007;34:287-293.

[4] Miller NL, Lingeman JE. Management of kidney stones. British Medical Journal. 2007;334:468-72.