KIDNEY STONES

Christopher Tornehl, MD
Urology
Western Wisconsin Urology
Eau Claire

Those who have experienced kidney stones frequently claim the stones ‘hurt more than labor’ or that passing the stone was the ‘worst pain of my life.’ Roughly 2-3% of Americans currently have a kidney stone and 12% of white men will develop a stone by age 70. Furthermore, the recurrence rate for people suffering with kidney stones is 50% at 10 years. Stones are therefore a common reason for emergency room visits and trips to the urologist.

Kidney stones form when the concentration of certain crystals in the urine is too high. As the crystals stick to each other, stones form and then grow within the kidney. Stones usually do not cause pain unless they are causing blockage of the urinary tract, often within the ureter, which is the tube that drains urine from the kidney to the bladder.

There are several types of kidney stones: calcium based stones, struvite stones, uric acid stones, and cystine stones.

Symptoms such as back pain, nausea and vomiting, and blood in the urine have been attributed to stones. The pain can be extreme, occur suddenly and fluctuate in intensity. Patients often describe having difficulty finding a comfortable position. Stones usually cause pain in the upper back just below the rib cage. As the stone passes down the ureter towards the bladder, the pain also travels to the lower abdomen, groin and genitals. When a person also experiences fevers or has a urinary tract infection with kidney stones they should seek medical help immediately as this can be very dangerous. CT scans and x-rays are then used to pinpoint the precise location of the stone.

There are several types of kidney stones: calcium based stones, struvite stones, uric acid stones, and cystine stones.

Calcium based stones are the most common and occur as calcium oxalate, calcium phosphate or a mixture of the two. Struvite stones have been attributed to certain types of bacteria linked to chronic urinary tract infections. Uric acid stones are commonly found in patients with gout, a high protein diet or those receiving chemotherapy. Cystine stones are the rarest and are usually caused by a metabolic disorder known as cystinuria.

People often wonder why they develop kidney stones. Numerous factors play a role in stone development including family history, anatomic variations, metabolic conditions and diseases, diet and dehydration. Blood and urine studies can be performed to determine risk factors and target medical treatments and dietary changes can be recommended for patients with recurrent stones or who are at high risk for recurrence.

While the majority of stones can be passed spontaneously, many require intervention. The size, location and composition of stones play a role in helping choose the best treatment option.

• Small stones will frequently pass without further surgical interventions.
• Extracorporeal shock wave lithotripsy (ESWL) is commonly used for stones in the kidney or in the upper part of the ureter. Shock waves are focused on the stone, fracturing it into tiny pieces that can then be passed while patients are administered light sedation.
• Ureteroscopy allows urologists to pass small telescopes into the urinary tract and use lasers or small baskets to fracture and retrieve stones from the
  kidney or ureter.
• Percutaneous nephrostolithotomy (PCNL) is used for large stones within the kidney and involves accessing the kidney through a tube placed through the back.

A number of different instruments can then be used to remove the stone.

Patients undergoing ureteroscopy and PCNL will need general anesthesia.

In the past, many people required open surgery to remove stones; however with technologic advancements these types of surgeries are rarely required anymore. Urologists can help individuals choose the best medical and surgical treatments available for kidney stones.

If you would like more information on kidney stones or would like to schedule an appointment with Dr. Tornehl, Western Wisconsin Urology, call 715.835.6548 or visit www.oakleafmedical.com. Dr. Tornehl sees patients in Eau Claire, Chippewa Falls, Menomonie and Shell Lake..