Kidney Stone symptoms are severe flank pains that radiate to the groin. The pain tends to be stabbing and severe. There is often associated nausea and vomiting as well as occasional signs of infection.
Stones can be caused by diet and genetics. There are some acquired diseases that can cause kidney stones, but these are less common than stones that are due to a poor diet and chronic dehydration.
Because of the acute nature of kidney stones, the initial evaluation is usually in the emergency room. History, physical exam, urinalysis to examine for blood and infection and laboratories to rule out other causes of abdominal pain are common. In addition, x-rays of the abdomen are usually obtained to look for the presence of stones and obstruction of the urinary tract.
Most kidney stones will pass on their own, but stones that are 4-5mm in size, or are causing severe blockage and pain that does not resolve, or stones that are associated with an infection may need emergency or urgent treatment.
In general, there are three ways to treat kidney stones. The type of treatment depends on a number of factors. The most important are the size and location of the stones. Surgeon experience and comfort with the modalities that are available will also dictate the type of approach that is undertaken.
For small stones in the ureter, a small scope is introduced with the patient under a general anesthesia. Through the scope a laser and basket can be placed that allow for fragmentation and removal of the stone. Usually at the conclusion of the procedure a plastic stent is temporarily left in place to keep the ureter from becoming blocked by stone fragments or blood clots.
For medium sized stones in the kidney, a minimally invasive technique called ESWL (Extracorporeal Shock-wave Lithotripsy) can be used. This technique uses sound waves to break the stones into smaller pieces that the patient then passes in the urine. Patients that have very large stones, or stones that are not accessible with x-ray are not good candidates for ESWL.
For very large stones in the kidney (2cm or greater) the patient may be best served by proceeding to percutaneous nephrolithotomy (PCNL). Of the 3 options it is slightly more invasive, but gives the best chance at removing large complex stones in one setting. In this procedure, the kidney stone is approached through a ½ inch incision in the back. This procedure requires a hospital stay. Dr. Neeb has extensive experience with this technique. Your surgeon will discuss all of these options with you.
If you have any questions, or need to schedule surgical treatment for kidney stones, please contact Urology Specialists of Oregon at (541) 322-5753.