Treatments & Services

Kidney stones form when the delicate balance of electrolytes in the urine is disrupted. The leading cause of kidney stone formation is dehydration, which causes the electrolytes and salt in the urine to form crystals, which eventually grow into kidney stones.
 
Stones form in the kidney and may travel along the course of the urinary tract down to the urethra. When stones get lodged in the ureter, they block the flow of urine out of the kidney, leading to dilation and flank pain. Other symptoms of kidney stones include nausea, vomiting, fever, chills, and blood in the urine. If left untreated, stones can cause damage to the kidneys, which, when combined with an infection, can be deadly.

Kidney stones are diagnosed by an evaluation of your medical history and a physical exam by your doctor. Urine and blood tests will look for signs of infection and measure kidney function, which can indicate if there is a serious complication from obstructing kidney stones. Imaging (x-ray, CT scan, or intravenous pyelography) is very helpful to locate where the stone is in your urinary tract, and whether it needs to be treated. For people with recurrent stones, analysis of a stone directly or 24-hour urine collection test can reveal metabolic abnormalities that may be directly treated to reduce new stone formation.

 There are multiple types of kidney stones, made up of different chemical elements. If we are able to obtain one of your stones and analyze it we may be able to make very specific diet or medication recommendations to help reduce your rate of stone formation. However, there are several straightforward changes that can help prevent stones, regardless of what type you form.

• Increase your fluid intake to >2 liters of liquid per day. Dehydration is the leading cause of stone formation, leading to concentrated urine and crystal formation. By keeping your urine clear or very light yellow, you will be less likely to form these crystals in your kidneys.
• Low sodium diet. Helps manage your whole-body fluid status, which can be thrown off by high intake of salty foods.
• Keep calcium in your diet. Calcium is not the enemy. While calcium is often a component of stones, eliminating it from your diet will actually increase absorption of other chemicals that form stones and will in turn increase stone formation.
• Consider some citrus. Citric acid is a helpful chemical to prevent stone formation. It can be found in any citrus juice or fruit. But be aware that these beverages often contain a large amount of sugar which can be bad for your health in other ways. Look for sugar-free lemonade or other options to help supplement this natural stone-fighting pathway.

Some kidney stones will pass on their own without intervention (spontaneous passage). The rate of spontaneous passage depends on the stone size and location.

• High rate of passage: < 4 mm size and distal ureter (near bladder)
• Low rate of passage: > 6 mm size and proximal ureter (near kidney) 

During observation, pain medications are prescribed, and the patient is instructed to drink a lot of water (> 2 liters/day) and strain the urine to catch the stone if it passes. Observation is not an option with a coexisting infection, severe pain not controlled with medications, uncontrollable nausea and vomiting, and in patients with underlying kidney disease. If observation is not indicated or the stone does not pass while on its own within 2-3 weeks, then intervention is often necessary.

Ureteroscopy – Ureteroscopy involves treating stones in the ureter and kidney with a small fiber optic scope (ureteroscope) inserted through the opening in the urethra (no incisions). Stones are either grasped and removed or broken into tiny pieces with a laser.
After the procedure a small tube (stent) may be placed in the ureter for a few days to allow the lining of the ureter to heal. Some patients remove their stent at home a few days after surgery, others have their stent removed at a follow up appointment.

• Success rates: 75-100% depending on stone size and location
• Possible complications: Damage to the ureter, infection, bleeding, ureteral stricture (narrowing).
• Hospital stay and recovery: Most cases performed as an outpatient procedure. Recovery time is short, and most people are back to normal activity in 2-4 days.

Percutaneous Nephrostolithotomy (PCNL) – Percutaneous nephrostolithotomy involves treating kidney stones in the kidney by making a one-inch incision in the back and creating a tunnel through the kidney to the stone.
 
Through the tunnel, the surgeon uses a scope to either remove the stone with a basket or break it up into tiny pieces using a laser, ultrasound probe, or pneumatic device (jackhammer).
 
After the procedure a tube is placed in the kidney (nephrostomy tube) and/or the ureter (stent) to drain the kidney and allow it to heal. The doctor will remove these after X-rays have shown that the kidney has healed, and all the stones have been removed.
 
X-rays will be done on the day after surgery to confirm that all of the stones have been removed. If stones are still present, then another procedure (2nd look) will be performed to remove any remaining fragments.

• Success rates: 70-99% depending on stone size and location
• Possible complications: Bleeding, infection, urinary injury, pneumothorax (air around the lung), adjacent organ injury
• Hospital stay and recovery: 1-2 day hospital stay with 2-4 weeks until back to full activity

Open/Robotic Stone Surgery – Open and robotic stone surgery involves making a skin incision to access the abdomen or flank and remove the stones. While open stone removal was the original form of treatment for all stones, today it comprises < 5% of all treatments for renal stones.

Only in very specific cases do we consider open or robotic stone extraction, usually in cases where other surgical procedures are being done or if there is a very large stone located in an unusual location.