Kidney Stones

The most common cause for kidney stones is an inherited tendency to form stones. At the present time, there is no way to change this genetic tendency, but changing what you eat and drink can reduce or stop the formation of stones.

Avoid salt and salty foods (in some patients, this may be the most important of the instructions).

Reduce protein intake. Red meat and organ meat (including liver, pancreas, wieners and sausages) are the worst offenders. Poultry and fish in moderation are okay.

Drink large amounts of fluid, especially water (2-3 quarts per day, or one 8 ounce glass of water every three hours). A good index is to check the color of the urine. If it appears to be concentrated, dark yellow, you need to drink more water. Adding lemon juice to the water is helpful since this will get citrate into the urine. Citrate helps to prevent stones in many patients, so lemonade is a good fluid to drink.

Avoid excess foods or fluid containing oxalate. The worst offenders for oxalate are tea and dark green vegetables (turnips and spinach). Other foods that contain significant amounts of oxalate are as follows:

potatoes
beets
chocolate or cocoa
bell peppers
wheat germ
nuts

We do not ask patients to avoid these, but if eating large quantities, we recommend cutting back.

5) For most patients, moderate dietary calcium intake (dairy products) is okay, but calcium supplements (Tums, Rolaids, etc.) may increase the risk for stone formation. This risk is decreased by taking these medications with meals. If calcium supplementation is recommended, the calcium supplement CITRACAL is less likely to form stones, especially when taken with meals. We usually do not recommend restricting dietary calcium. For patients in whom dietary changes alone are not sufficient, we may have to use medication. The most commonly used medicine is potassium citrate, also called Urocit-K. This can also be found in a nutritional supplement called Theralith XR. Less often, other medications may be considered, such as Thyazide, Allopurind or magnesium citrate, depending on the type of stone.

For patients who are having frequent stones or require surgical procedures for treatment of stones, a metabolic evaluation which consists of blood tests, urine tests, imaging (if necessary) and stone analysis can be done to determine the exact defect that is causing the kidney stones. This metabolic evaluation can decrease stone formation rates up to 80 percent if the patient is willing to follow the recommendations and take appropriate medication. Unfortunately, many patients will forget their pain and slowly resume their previous diet which caused the stones or stop taking their medication, and suddenly end up back in an emergency room in terrible pain.

The process may include: 1) a visit to a qualified physician for a history, physical examination, blood tests, stone analysis, imaging studies (if needed), and to set up the urine tests. 2) evaluation of the results of the tests and a decision by the physician regarding the use of medication and specific dietary recommendations. 3) education of the patient about the findings and adherence by the patient to the recommendations.

We now have many exciting and less invasive technologies to treat kidney stones which avoid the prolonged post-op recoveries that were needed in the past. More important and much better for the patient than employing these less invasive procedures is not having a stone in the first place. We now have the knowledge and technology to prevent most stones so this is an option which should be considered if you are someone who has frequent stones or has had a procedure for treatment of stones in the past.

Specific Kidney Stone Prevention
Large Kidney Stone Treatment

At Urology Centers of Alabama, we are committed to helping our patients find ways to more successfully avoid recurrent kidney stones. To accomplish this goal, we have developed the Kidney Stone Prevention Clinic with the specific purpose of assisting the recurrent kidney stone patients and the physicians who treat these patients. This clinic is directed by dr. Rodney Dennis and co-directed by Dr. Bryant Poole. For patients who are having freqient stones or require surgical procedures for treatment of stones, a metabolic evaluation which consists of blood tests, urine tests, imaging (if necessary) and stone analysis can be done to determine the exact defect that is causing the kidney stones. The metabolic evaluation can decrease stone formation rates up to 80 percent. The process may include: 1) a visit to a qualified physician for a history, physical examination, blood tests, stone analysis, imaging studies (if needed), and to set up the urine tests. 2) evaluation of the results of the tests and a decision by the physician regarding the use of medication and specific dietary recommendations. 3) education of the patient about the findings and adherence by the patient to the recommendations. We now have many exciting and less invasive technologies to treat kidney stones which avoid the prolonged postop recoveries that were needed in the past. More important and much better for the patient than employing these less invasive procedures is not having a stone in the first place. We now have the knowledge and technology to prevent most stones so this is an option which should be considered if you are someone who has frequent stones or has had a procedure for treatment of stones in the past.

Treatment of Large Kidney Stones by Percutaneous Nephrolithotomy: Outcomes and Data Many patients with stones too large to be fragmented into smaller pieces and passed require percutaneous nephrolithotomy. This procedure uses a needle to gain access into the kidney at a specific location. A wire is placed and a tract dilated to allow passage of a nephroscope to fragment and remove large stones without having to pass them. Some urologists will send their patients to Radiology for a local access procedure and then to surgery for stone removal, while others will place the access sheath themselves. If the stone is not too large (<2.5 cm), it can often be removed at one procedure. If it is too large (>2.5 cm) or involves the entire collecting system (staghorn calculus), multiple procedures such as percutaneous nephrolithotomy, lithotripsy, or ureteroscopy may be needed to remove the stone. Previously UCA had accumulated data for 1993 through 2007 as follows: Total PCNL's 232 Stone free 95% (70% after the first procedure; 25% after additional procedures) Additional procedures needed: Second PCNL, lithotripsy (stone fragmentation externally), ureteroscopy, hospital stay an average of 2.8 days Complication rate: 6.9% overall (most minor such as UTI, pain, nausea, fluid in pleural area) Major complications: Deaths 0 0% Pulmonary embolus 1/232 0.4% Perinephric hematoma 1/232 0.4% Persistent bleeding Treatment 3/232 1.2% Transfusion 5/232 2% Bleeding was evaluated with arteriogram in 2/232, the vessel was embolized resolving the bleeding, and no abnormality was seen. In all others persistent bleeding resolved and was thought to be from a UTI. In summary, large renal stones greater than 2.5 cm often require PCNL, a minimally invasive procedure. Overall, success rates are 95%. Some patients require multiple procedures to safely remove all stone. We always attempt to remove all stone at one setting if we are able to do so. Our technique of obtaining the access allows the entire procedure to be done under anesthesia.