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Center for Robotics, Laparoscopy, and Advanced Urology
VOTED AS AMERICA'S TOP UROLOGISTS
A Division of WESTMED Medical Group

Kidney Stone Treatment

Kidney stones, one of the most painful of the urologic disorders, are not a product of modern life. Scientists have found evidence of kidney stones in a 7,000-year-old Egyptian mummy. Unfortunately, kidney stones are one of the most common disorders of the urinary tract. In 2000, patients made 2.7 million visits to health care providers and more than 600,000 patients went to emergency rooms for kidney stone problems. Men tend to be affected more frequently than women. Most kidney stones pass out of the body without any intervention by a physician. Stones that cause lasting symptoms or other complications may be treated by various techniques, most of which do not involve major surgery.

Westchester Medical Group is devoted to help our patients in any capacity. Whether it is preventing or treating stones, we will always work with you and offer the latest medical/surgical advancements available.

Urinary Tract

The urinary tract, or system, consists of the kidneys, ureters, bladder, and urethra. The kidneys are two bean-shaped organs located below the ribs toward the middle of the back. The kidneys remove extra water and wastes from the blood, converting it to urine. They also keep a stable balance of salts and other substances in the blood. The kidneys produce hormones that help build strong bones and help form red blood cells.

Narrow tubes called ureters carry urine from the kidneys to the bladder, an oval-shaped chamber in the lower abdomen. Like a balloon, the bladder's elastic walls stretch and expand to store urine. They flatten together when urine is emptied through the urethra to outside the body.

What is a Kidney Stone?

A kidney stone is a hard mass developed from crystals that separate from the urine and build up on the inner surfaces of the kidney. Normally, urine contains chemicals that prevent or inhibit the crystals from forming. These inhibitors do not seem to work for everyone, however, so some people form stones. If the crystals remain tiny enough, they will travel through the urinary tract and pass out of the body in the urine without being noticed.

Kidney stones may contain various combinations of chemicals. The most common type of stone contains calcium in combination with either oxalate or phosphate. These chemicals are part of a person's normal diet and make up important parts of the body, such as bones and muscles. A less common type of stone is caused by infection in the urinary tract. This type of stone is called a struvite or infection stone. A bit less common is the uric acid stone. Cystine stones are rare.

Urolithiasis is the medical term used to describe stones occurring in the urinary tract. Other frequently used terms are urinary tract stone disease and nephrolithiasis. Gallstones and kidney stones are not related. They form in different areas of the body. If you have a gallstone, you are not necessarily more likely to develop kidney stones.

Who Gets Kidney Stones?

The number of people in the United States with kidney stones has been increasing over the past 30 years. The prevalence of stone-forming disease rose from 3.8 percent in the late 1970s to 5.2 percent in the late 1980s and early 1990s. White Americans are more prone to develop kidney stones than African Americans. Stones occur more frequently in men. The prevalence of kidney stones rises dramatically as men enter their 40s and continues to rise into their 70s. For women, the prevalence of kidney stones peaks in their 50s. Once a person gets more than one stone, others are likely to develop.

What Causes Kidney Stones?

In general, kidney stones form when there is a decrease in urine volume or an excess of stone-forming substances in the urine. Doctors do not always know what specifically causes a stone to form. While certain foods may promote stone formation in people who are susceptible, scientists do not believe that eating any specific food causes stones to form in people who are not susceptible. Dehydration through reduced fluid intake or strenuous exercise without adequate fluid replacement increases the risk of kidney stones. Obstruction to the flow of urine can also lead to stone formation. A number of different conditions can lead to kidney stones. Gout results in an increased amount of uric acid in the urine and can lead to the formation of uric acid stones. Hypercalciuria(high calcium in the urine), another inherited condition, causes stones in more than half of cases. In this condition, too much calcium is absorbed from food and excreted into the urine, where it may form calcium phosphate or calcium oxalate stones. Other conditions associated with an increased risk of kidney stones include hyperparathyroidism, kidney diseases such as renal tubular acidosis, and some inherited metabolic conditions including cystinuria and hyperoxaluria. People with inflammatory bowel disease or who have had an intestinal bypass or ostomy surgery are also more likely to develop kidney stones. Some medications also raise the risk of kidney stones. These medications include some diuretics, calcium-containing antacids, and the protease inhibitor Crixivan (indinavir), a drug used to treat HIV infection.

What Are the Symptoms?

Kidney stones often do not cause any symptoms. Usually, the first symptom of a kidney stone is extreme pain, which occurs when a stone acutely blocks the flow of urine. The pain often begins suddenly when a stone moves in the urinary tract, causing irritation or blockage. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur. Changes in body position do not relieve this pain. Later, pain may spread to the groin. If the stone is too large to pass easily, pain continues as the muscles in the wall of the tiny ureter try to squeeze the stone along into the bladder. As a stone grows or moves, blood may appear in the urine. As the stone moves down the ureter closer to the bladder, you may feel the need to urinate more often or feel a burning sensation during urination. If infection is present in the urinary tract along with the stones, there may be fever and chills. In this case, you should contact a doctor immediately.

How Are Stones Diagnosed?

Stones that do not cause symptoms are often found on x rays taken during a general health exam. If they are small, these stones would likely pass out of the body unnoticed.

More often, kidney stones are found on a CT scan, x ray, or sonogram taken on someone who complains of blood in the urine or sudden pain. These diagnostic images give the doctor valuable information about the stone's size and location. Blood and urine tests help detect any abnormal substance that might promote stone formation.

What Are the Treatment Options for Kidney Stones?

Conservative therapy: Most kidney stones eventually pass through the urinary tract on their own within 48 hours, with ample fluid intake. Pain medications can be prescribed for symptom relief. There are several factors which influence the ability to pass a stone. These include the size of the person, prior stone passage, prostate enlargement, pregnancy, and the size of the stone. A 4 mm stone has an 80% chance of passage while a 5 mm stone has a 20% chance. The doctor usually asks you to save the passed stone(s) for testing. (You can catch it in a cup or tea strainer used only for this purpose.)

Medical therapy: Certain drugs or lifestyle changes can be used to help dissolve stones. See preventive therapy for more information.

Surgical Therapy: Surgery may be needed to remove a kidney stone for the following reasons: if it does not pass after a reasonable period of time and causes constant pain; if it is too large to pass on its own or is caught in a difficult place; if it blocks the flow of urine, causes ongoing urinary tract infection, damages kidney tissue or causes constant bleeding. Various surgical options are now available to patients with kidney stones. Our practice offers all of the latest innovations in stone treatment.

    Option 1: ESWL - This stands for a procedure called extracorporeal shock wave lithotripsy. ESWL is one of the most popular techniques today. In ESWL, shock waves that are created outside the body travel through the skin and body tissues until they hit the denser stones. The stones break down into sand-like particles and are easily passed through the urinary tract in the urine. In most cases, ESWL may be done on an outpatient basis. Recovery time is short, and most people can resume normal activities in a few days.

    ESWL

    Option 2: Ureteroscopic Stone Removal and Laser Lithotripsy - In this procedure, the surgeon passes a small fiberoptic instrument called a ureteroscope through the urethra and bladder into the ureter. The surgeon then locates the stone and either removes it with a basket or fragments it using a laser. A small tube or stent may be left in the ureter for a few days to help the lining of the ureter heal.

    Option 3: PCNL - This stands for percutaneous nephrolithotomy. This treatment option is reserved for cases when the stone is quite large or in a location that does not allow effective use of ESWL or ureteroscopy. In this procedure, the surgeon makes a tiny incision in the back and creates a tunnel directly into the kidney. Using an instrument called a nephroscope, the surgeon locates and removes the stone. For large stones, some type of energy probe (ultrasonic or electrohydraulic) may be needed to break the stone into small pieces. Generally, patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the healing process.

How Can One Prevent Stones From Forming?

Rather than undergo treatment, most patients would obviously prefer never to have the stone in the first place. While prevention is not a guarantee, it will always benefit a patient. To help determine possible causes for your stones, we may order laboratory tests, including urine and blood tests. As part of a workup, you will be asked about your medical history, occupation, and eating habits. You may be asked to collect your urine for 24 hours after a stone has passed or been removed. The sample is used to measure urine volume and levels of acidity, calcium, sodium, uric acid, oxalate, citrate, and creatinine (a product of muscle metabolism). We will use this information to help determine the cause of the stone. A second 24-hour urine collection may be needed to determine whether the prescribed treatment is working. If a stone has been removed or if you've passed a stone and saved it, the laboratory should analyze it because its composition helps in planning treatment.

#1 change a patient can make: DRINK WATER. A simple rule is you should try to drink enough liquids throughout the day to produce at least 2 quarts of urine in every 24-hour period. People who form calcium stones used to be told to avoid dairy products and other foods with high calcium content. But recent studies have shown that foods high in calcium, including dairy products, may help prevent calcium stones. Taking calcium in pill form, however, may increase the risk of developing stones. You may be told to avoid food with added vitamin D and certain types of antacids that have a calcium base. If you have very acidic urine, you may need to eat less meat, fish, and poultry. These foods increase the amount of acid in the urine.

People prone to forming calcium oxalate stones may be asked by their doctor to cut back on certain foods if their urine contains an excess of oxalate: Examples of such foods include the following: beets, chocolate, coffee, cola, nuts, rhubarb, spinach, strawberries, tea, and wheat bran. People should not give up or avoid eating these foods without talking to their doctor first. In most cases, these foods can be eaten in limited amounts.

If these lifestyle changes are not enough, you might be prescribed certain medications to help dissolve some of the minerals that compose stones or change the acidity of your urine.




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Center for Robotics, Laparoscopy, and Advanced Urology
WESTMED Medical Group
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White Plains, NY 10604
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