Kidney Stones

Kidney Stones Symptoms

Urinary stones is common problem in both men and women. Urinary stones may occur in kidneys, ureters and bladder. Kidneys and ureteral stones commonly present with a flank pain that is quite severe and intermittent. The pain is often localizes in the flank (side of a back) and radiates to the lower abdomen and groin. Nausea and vomiting often occurs with onset of pain. Sometimes, there are fevers and blood in the urine.

Kidneys stones sometimes may also present with recurrent urinary tract infections and blood in the urine. Bladder stones more commonly occur in men with voiding problems and may cause recurrent infections, blood in the urine and exacerbation of urination complaints.

Why do stones hurt? Pain occurs when urine that is continuously produced by the kidneys cannot freely pass by the stone into the bladder. When stone obstructs, urine backs up in the kidney and ureter and stretches the kidney capsule. That stretch is creating pain. With peristalsis some of the urine may squeeze by and pain gets better.

Urinary stones are composed of different substances. Common are uric acid, calcium oxalate, calcium phosphate, magnesium ammonium phosphate (infection stones). Some stones are inherited such as cystine.


Depending upon location, size, composition, and presence or absence of infection, the treatment may range from medications to surgical intervention. Surgery to relieve the obstruction is necessary immediately if infection is present. If you have fevers or chills with your stone, it may mean that infection is present and immediate procedure may be essential - call your doctor or come to the emergency room. For patients without signs of infection treatment with medications to dissolve the stone or facilitate passage of the stone may be available. Consult with Dr. Elterman which treatment is appropiate for you.

Procedures for urinary stones

Ureteroscopy. This is one of the most common procedures performed to removal of the ureteral and kidney stones. It involves using video cameras that are placed under anesthesia though urethra into the bladder and then the ureter. It is performed without additional incisions or punctures, through natural orifices. Once the stone is visualized, the surgeon commonly uses a laser beam to fragment the stone and special instruments - baskets - to retrieve the stone pieces. Commonly following ureteroscopy a stent is placed and is removed later in the office. Benefits of this approach include ability to remove the stone completely and the fact that majority of the stones in bladder, ureters and kidneys can be treated with it. Downside is the fact that scopes with cameras and laser wires need to be physically placed though the urinary tract to the stone.

Extracorporeal Shock Wave Lithotripsy. This procedure is performed under anesthesia and is done without physical placement of any instruments in to the body. Highly concentrated sound energy from the lithotripsy machine is delivered straight to the stone breaking it up with repeated bursts of energy. This approach works best for stones in upper ureter and in the kidney that are under 2 centimeters in diameter. The benefits include its non-invasive nature, the downside is the fact that we rely on body's ability to pass the stone sand and small fragments.

Percutaneous Nephrolithotripsy. This is a very effective approach for treatment of large kidney stones. It works best for the stones that measure greater than 2 centimeters, branched or "staghorn" stones, or the stones that are located in a hard to reach locations in the kidney - lower pole calyx, or a diverticulum. The procedure involves making a small puncture in the flank and inserting a scope and other instruments directly thorough the skin into the kidney. It is done under a general anesthesia. It is common to have a drainage (nephrostomy) tube for a few days after the procedure.

Dr. Elterman is proficient in all surgical approaches for the treatment of the stone and be certain to discuss the options that is best suited for your situation.

Prevention of stone recurrence

A person who developed urinary stone once, is at high risk of developing a stone again. In fact, there is approximately 50% change of stone recurrence within 5-10 years of initial stone attack. This is why it is very important to discuss the ways to decrease your chances of another stone episode. General recommendations include consumption of increased amounts of water, maintaining heart healthy diet, limiting amount of salt intake. More specific and individualized recommendations are given after analyzing the composition of stone, blood work and 24 hour urine collection for stone risk profile. Dr. Elterman is specializing in consulting patients with urinary stone disease.

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