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Kidney stones - (renal lithiasis)
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Kidney stones - (renal lithiasis)

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Urinary System

Kidney stones are stones formed from chemicals in urine that crystallize and stick together. Some cause problems, and others we may never know they're there.

If you've ever passed a kidney stone, you're not likely to forget the experience - it can be excruciatingly painful. What's more, kidney stones (renal lithiasis) are increasingly common.

Not all kidney stones cause symptoms. They're often discovered when you have X-rays for an unrelated condition or when you seek medical care for problems such as blood in your urine or recurring urinary tract infections. The pain becomes agonizing only when a stone breaks loose and begins to work its way down from your kidneys to your bladder.

Kidney stones usually form when your urine becomes too concentrated. This causes minerals and other substances in urine to form crystals on the inner surfaces of your kidneys. Over time, these crystals may combine to form a small, hard mass, or stone.

Treatment

Treatment for kidney stones varies, depending on the type of stone and the cause. You may be able to move a stone through your urinary tract simply by drinking plenty of water — as much as 2 to 3 quarts a day — and by staying physically active.

Stones that can't be treated with more conservative measures — either because they're too large to pass on their own or because they cause bleeding, kidney damage or ongoing urinary tract infection — may need surgical treatment.

Surgical procedures include:

  • Extracorporeal shock wave lithotripsy (ESWL). This is the most commonly used surgical procedure for treating kidney stones. It uses shock waves to break the stones into tiny pieces that are then passed in your urine. In some cases, you may be partially submerged in a tub of water during the procedure. In others, you may lie on a soft cushion. You won't be hurt by the shock waves, and you won't feel them. But a loud noise is produced each time a shock wave is generated, and you'll wear earphones to protect your hearing.

  • Your doctor will likely use X-rays or ultrasound to help determine the position of your stone as well as to monitor the status of the stone during treatment. In many cases, the stone will begin to crumble after 200 to 400 shock waves.

  • Complications that may occur with ESWL include blood in the urine, bruising on the back or abdomen, and discomfort as the stone fragments pass through the urinary tract. In addition, if the stone doesn't shatter completely, you may need another treatment such as a second ESWL or ureteroscopic stone removal. After treatment, it may take months for all the stone fragments to pass.

  • Percutaneous nephrolithotomy. When ESWL isn't effective, or the stone is very large, your surgeon may remove your kidney stone through a small incision in your back using an instrument called a nephroscope.

  • Ureteroscopic stone removal. This procedure may be used to remove a stone lodged in a ureter. The stone is snared with a small instrument (ureteroscope) that's passed into the ureter through your bladder. It may also be shattered using ultrasound, a laser or a technique known as electrohydraulic lithotripsy. These methods work especially well on stones in the ureter that can't be treated using other methods.

  • Parathyroid surgery. Some calcium stones are caused by overactive parathyroid glands, which are located on the four corners of your thyroid gland, just below your Adam's apple. When these glands produce too much parathyroid hormone, your body's level of calcium can become too high, resulting in excessive excretion of calcium in your urine. Most often, this is the result of a small benign tumor in one of your four parathyroid glands. A doctor can surgically remove the tumor.

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
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