Kidney stones may present in various ways. Most often, they present with intermittent radiating pain on one side and can be accompanied by waves of nausea and/or vomiting. Other, may lead to significant changes in voiding patterns, such as increased urgency and frequency of urination, intermittent flow, burning and/or blood in the urine. Sometimes kidney stones are completely asymptomatic and may be picked up as an incidental finding when patients undergo imaging for other reasons. Patients may have a “positive urine analysis” and be found to have microscopic blood or inflammatory markers in the urine. Kidney stones may be diagnosed with medical imaging such as ultrasound, xray and/or CT scan of the Abdomen and Pelvis. Once diagnosed, if a patient is asymptomatic, it is important to follow them to confirm passage of the stone, either with spontaneous passage or with some type of intervention.
Most often, stones that are found within the ureter (the tube that drains the kidney and connects to the bladder) or those that are obstructing the kidney (which means they are causing backup of urine, thereby putting pressure on the kidney) require treatment. An “obstructing stone” prevents drainage of urine from the kidney and can lead to infection, sepsis and over an extended period of time, loss of renal function. These could also lead to formation of ureteral strictures. Kidney stones don’t always require immediate intervention. They may not need any treatment, other than making dietary and or medication changes to avoid an increase in stone size and number.
Management of stones depends on the location, size and number of stones. It must be individualized to each patient and depends often depends on one’s overall medical health. For evaluation, a full dietary intake with a complete medical history and physical is required. Though most stones are composed of calcium oxalate, the reason one forms stones will vary from patient to patient. Issues may include poor hydration status, acidic urine, high salt intake, large meal sizes, too much animal protein (which is found in beef, chicken and fish). Excessive intake of vitamins C, D, high dietary salt intake or calcium supplements can also contribute. You should not make dietary or medication changes until a full evaluation has been completed. For example if you have been diagnosed with osteopenia or osteoporosis (i.e. bone loss), and have kidney stones, do not change your bone health medications without the proper medical advice. Patients with gout or high blood levels of uric acid have a higher risk of forming stones. Interventions shown to decrease stone recurrence rates include drinking at least 2.5 liters of water per day, maintaining a normal calcium diet and adhering to a low salt diet. Appropriate modifications can be made once a 24 hour urine collection is performed.
If you feel you may have a kidney stone, please call our office (212-570-6800) for an appointment. We can offer same day evaluation and treatment as indicated.
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Kidney Stones in 1986
Having experienced kidney stones twice in the past 30 years (see A Kidney Stone, a patient’s perspective) has given me some good insights, which I share with our patients at the New York offices from time to time. There are many aspects involved with diagnosis and treatment of kidney stones. Fortunately, our diagnostic and treatment options have improved significantly. Over time the art and science in treating kidney stones has improved vastly. I say art since not all stones are treated in the same way.
When I suffered my first kidney stone attack in 1984 diagnostic and treatment options were limited. During that episode the pain was unforgettable. It was like nothing I had ever experienced. At the time the mainstay of pain management consisted of narcotics which carry significant side effects. Patients where prescribed Percocet and/or morphine which did dull the pain caused by kidney stones but carried side effects of nausea, dizziness and constipation. The diagnostic options at the time of my first attack consisted of plain x-ray and intravenous pyelography (IVP). IVPs are rarely done today. This type of x ray was time consuming and and required an injection of dye into the bloodstream to locate the stone. X-rays do however deliver significant radiation exposure.
In 1984, I was unable to pass my stone (3-4mm) which was located in my left ureter (tube which transports urine from the kidney to the bladder) and caused intense and constant pain. There was no form of medical therapy at that time. My treatment consisted of a surgical procedure called ureteroscopy and stone extraction. At that time the instruments were large and cumbersome. During this procedure, the doctor inserts the ureteroscope through the urethra, into the bladder and then into the affected ureter. There he uses the instrument to visualize and grasp the stone to remove it. In some cases, the doctor has to break the stone into smaller fragments and remove them one at a time. The smallest pieces are to pass normally during urination. I underwent this procedure which lasted 2-3 hours and I was kept in the hospital for 3 days. The pain from the procedure was severe. After the procedure an ureteral stent was inserted to keep the ureter open and allow urine to flow from the kidney into the bladder. The ureteral stent was kept in place for one week. It left me with significant sympthoms. After it was removed, I slowly returned to my normal day to day activities.
In hindsight, the progress we have made over the last 30 years in treating kidney stones is amazing . Im glad we at New York Urological in Manhattan have access to much advanced methods for treatment today. I’ll be discussing my most recent experience in my next post for comparison of all aspects; from diagnosis through treatment. We know how it feels and understand that prompt and efficient treatment are the key to a better experience.
Snow is such a beautiful thing! Makes everything look so clean and adds this nice serene feel to the scene. However it still causes some delays with transportation and other public services. We’re open and ready to help with your urological problems. Kidney stones don’t wait, urinary frequency doesn’t relent and prostate issues don’t take a break because of the weather.
Be careful in your commute today everyone!
It has been a great year for New York Urological Associates PC. All the doctors and the staff wish to extend all our patients, referring physicians and supporting vendors a warm THANK YOU and wish you all a prosperous and healthy New Year 2014!
2013 was a great year for our office. We welcomed Dr. Marley to our provider roster. We were able to help many patients with their health problems. From simple matters that required minimal intervention and advice to our patients to more complex problems that required lengthy treatments or surgical procedures.
We have to say that kidney stones were the frequent winner in 2013. For some of our kidney stone patients we were able to arrange immediate removal of their stones within our affiliated facilities, while for other patients, we allowed time and medication to enable the stones to pass. We were also able to resolve health concerns for our Prostate Cancer and Urinary Frequency patients.
Our challenges through out the year were not limited to just health care. Our practice as well as other doctor’s offices around the area, have been confronted with administrative challenges. Insurance companies have modified policies. Prescription requirements have become more onerous; we’re trying to keep up with the changes. Now we’re starting 2014 with the advent of the Affordable Care Act and awaiting more information from multiple insurers to see how this fits our current insurance contract. Many of our patients are concerned and so are we.
New York Urological Associates PC welcomes 2014 with open arms, and we’re looking forward to assisting you during the next year.
We’re happy that you have chosen us to resolve your health problems and concerns and strive to provide you with excellent medical care. Our wish is to always improve upon our services to you, our patients, and fix necessary areas. We’re always growing, we’re always changing and adjusting to better serve our community.
Happy New Year!