Extracorporeal Shock Wave Lithotripsy
All shock wave lithotripsy machines deliver shock waves through the skin to the stone in the kidney. Most but not all of the energy from the shock wave is delivered to the stone.
Stone size is the greatest predictor of ESWL success. Generally:
- stones less than 10 mm in size can be successfully treated
- for stones 10 to 20 mm in size, additional factors such as stone composition and stone location should be considered
- stones larger than 20 mm are usually not successfully treated with ESWL.
Stones in the lower third of the kidney can also be problematic because, after fragmentation, the stone fragments may not be cleared from the kidney. Due to gravity, these fragments dont pass out of the kidney as easily as fragments from the middle and upper thirds of the kidney.
Obesity also influences whether ESWL treatment will be successful. The urologist will calculate the skin-to-stone distance to help determine whether this treatment is likely to be effective.
The possible complications of ESWL include:
When Can Swl Be Used
SWL works better with some stones than others. Very large stones cannot be treated this way. The size and shape of stone, where it is lodged in your urinary tract, your health, and your kidneys’ health will be part of the decision to use it. Stones that are smaller than 2 cm in diameter are the best size for SWL. The treatment might not be effective in very large ones.
SWL is more appropriate for some people than others. Because x-rays and shock waves are needed in SWL, pregnant women with stones are not treated this way. People with bleeding disorders, infections, severe skeletal abnormalities, or who are morbidly obese also not usually good candidates for SWL. lf your kidneys have other abnormalities, your doctor may decide you should have a different treatment. lf you have a cardiac pacemaker, a cardiologist will decide if you can have SWL.
What Are Kidney Stones
Kidney stones are hard collections of salt and minerals often made up of calcium or uric acid. They form inside the kidney and can travel to other parts of the urinary tract.
Stones vary in size. Some are as small as the period at the end of this sentence a fraction of an inch. Others can grow to a few inches across. Some kidney stones can become so large they take up the entire kidney.
A kidney stone forms when too much of certain minerals in your body accumulate in your urine. When you arent well hydrated, your urine becomes more concentrated with higher levels of certain minerals. When mineral levels are higher, its more likely that a kidney stone will form.
About 1 out of every 11 people in the United States will get a kidney stone. Stones are more common in men, people who are obese, and those who have diabetes .
Smaller kidney stones that remain in the kidney often dont cause any symptoms. You might not notice anything is amiss until the stone moves into your ureter the tube that urine travels through to get from your kidney to your bladder.
Kidney stones are typically very painful. Most stones will pass on their own without treatment. However, you may need a procedure to break up or remove stones that dont pass.
Here are eight signs and symptoms that you may have kidney stones.
2 ). Some people whove experienced kidney stones compare the pain to childbirth or getting stabbed with a knife.
4 ). Your doctor might call this dysuria.
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What Causes Kidney Stones
Kidney stones may form when there’s a change in the normal balance of the water, salts, and minerals found in urine. Different kinds of changes result in different types of kidney stones. There are many factors that can trigger changes in the urine, ranging from chronic medical conditions to what you eat and drink.
Diagnosis: Low Urine Ph
Citrate supplements, such as potassium citrate, will raise the pH of your urine, making stones, such as those composed of uric acid, less likely to form. If your blood potassium level is high, your doctor may prescribe sodium bicarbonate or Bicitra.
Lower protein intake
A diet high in protein will reduce urinary pH. As a general recommendation, limit your daily protein intake to 12 ounces per day of beef, poultry, fish and pork. Twelve ounces is equivalent in size to about three decks of cards. This will be plenty of protein to meet your bodys needs.
Increase fluid intake
No matter what your diagnosis, you should drink enough water to produce at least 2 liters of urine per day.
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What Can The Patient Expect After Treatment
The recovery time is usually fairly brief. After treatment, the patient can get up to walk almost at once, Many people can fully resume daily activities within one to two days. Special diets are not required, but drinking plenty of water helps the stone fragments pass. For several weeks, you may pass stone fragments.
Diagnosis: Too Much Calcium In The Urine
These drugs help to decrease urine calcium excretion. They also help to keep calcium in the bones, reducing the risk for osteoporosis. The most common side effect of thiazide diuretics is potassium loss, so in many cases your doctor will prescribe a potassium supplement to go along with the thiazide diuretic.
Lower sodium intake
The human body carefully regulates its sodium levels. When excess sodium is excreted in the urine, calcium is also excreted proportionally. In other words, the more sodium you consume, the more calcium that will be in your urine. Your goal should be to reduce your sodium intake so that you consume less than 2 grams of sodium per day. Watch out for silent sources of salt, such as fast foods, packaged or canned foods, softened water and sports drinks.
Normal calcium diet
People who form stones sometimes think that because there is too much calcium in their urine, they should restrict their calcium intake. There is no research that supports this practice. Your body needs dietary calcium to support the skeleton. You should be encouraged to consume two servings of dairy or other calcium-rich foods to maintain bone stores of calcium.
Increase fluid intake
No matter what your diagnosis, you should drink enough water to produce at least 2 liters of urine per day.
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Effective Treatment At St Pete Urology
At St Pete Urology, we provide a multidisciplinary approach to treating and managing kidney stones of all sizes. We have assembled a highly integrated team of nephrologists, urologists, radiologists and dietary and metabolic specialists to ensure comprehensive diagnosis, treatment and proper assessment of the risks leading to the formation of kidney stones. By applying the latest technology in treating kidney stones and a broad range of noninvasive and minimally-invasive procedures for removing small and large stones, we guarantee only the highest quality and successful treatment to all our patients. For more information, visit the St Pete Urology site.
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Large Kidney Stones Require More Extensive Treatment
Large kidney stones are stones that measure approximately 5 mm or larger. Based on their size, they may have trouble moving through the urinary tract out of the body. In fact, they are prone to become lodged causing severe pain and other symptoms.
Large kidney stones require intervention for removal, typically, a surgical procedure. Reasons that initiate surgical treatment include:
- A stone that becomes lodged and wont pass on its own.
- Severe pain that makes it difficult to wait for the stone to pass on its own.
- Having an infection.
- Having a stone that is blocking the flow of urine from the kidney.
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How Do Health Care Professionals Treat Kidney Stones
Health care professionals usually treat kidney stones based on their size, location, and what type they are.
Small kidney stones may pass through your urinary tract without treatment. If youre able to pass a kidney stone, a health care professional may ask you to catch the kidney stone in a special container. A health care professional will send the kidney stone to a lab to find out what type it is. A health care professional may advise you to drink plenty of liquids if you are able to help move a kidney stone along. The health care professional also may prescribe pain medicine.
Larger kidney stones or kidney stones that block your urinary tract or cause great pain may need urgent treatment. If you are vomiting and dehydrated, you may need to go to the hospital and get fluids through an IV.
Types Of Kidney Stones
The different types of stones are made of different types of substances. It’s important to know the type of stone you have, so you can know what may have caused it and how to prevent it.
If you pass a kidney stone, you should take it to your doctor so they can send it to the lab and find out what kind it is:
Calcium stones. Most kidney stones are made from calcium, in the form of calcium oxalate. There are two kinds of calcium stones:
Calcium oxalate. Oxalate is a substance made daily by your liver. Some fruits and vegetables, as well as nuts and chocolate, are high in it. Your body absorbs the substance when you eat these foods. Other things that can make the concentration of calcium or oxalate in your urine to rise are taking high doses of vitamin D, intestinal bypass surgery and certain metabolic disorders.
Calcium phosphate. This type of stone happens more often in people with metabolic conditions, like renal tubular acidosis or with people who take medications to treat migraines or seizures.
Struvite stones. These can form from a urinary tract infection . The bacteria that cause the infection make ammonia build up in your urine. This leads to formation of the stones. The stones can get large very quickly.
Uric acid stones. These form in people who lose too much fluid because of chronic diarrhea or malabsorption eating a high-protein diet or having diabetes or metabolic syndrome. Certain genetic factors also may increase your risk of uric acid stones.
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Keeping Kidney Stone Pain Under Control
If you are experiencing the intense discomfort of kidney stones , pain control is a top priority. A 2018 analysis of multiple randomized trials looked at different pain relief medicines given to people treated in the emergency department for acute renal colic. It compared nonsteroidal anti-inflammatory drugs with paracetamol or opioids. The study found NSAIDs offered effective pain relief with fewer side effects than paracetamol or opioids. NSAIDs directly inhibit the synthesis of prostaglandins, which decreases activation of pain receptors and reduces renal blood flow and ureteral contractions.
Risk Factors You Can’t Control
White men have a greater risk for kidney stones than other groups, starting in the 40s. Women see their risk rise in the 50s. And your odds also go up if you have a family history of kidney stones. Certain medical conditions can boost the risk — high blood pressure, gout, urinary tract infections, certain kidney conditions such as polycystic kidney disease — but treating or controlling these conditions generally helps prevent stone formation.
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Foods That Increase The Risk Of Kidney Stones
Kidney stone pain is so excruciating that it often leaves an indelible mark on your memory. Some women even liken it to the intense pain experienced while giving birth. In fact, the pain associated with passing a kidney stone can be so intense that it may land you in the emergency room.
Kidney stones are essentially solid masses of minerals and salts that form inside one or both of your kidneys. They come in all sorts of shapes and sizes, ranging from as small as a grain of sand to as large as a golf ball.
According to the National Health and Nutrition Examination Survey , kidney stones affect approximately 1 in 11 people in the US.
Whats worse is that people who have had a kidney stone once are likely to develop another within seven years, unless you actively work to prevent them.
Drinking plenty of water to dilute the stone-causing minerals and salts in the urine is an essential prerequisite for preventing this problem.
Along with fluid intake, your food choices also can either precipitate or deter the formation of kidney stones.
Thus, you must work with a dietitian to come up with a stone-preventive renal diet. Making the correct food choices is as much about what you should eat as it is about the foods to avoid.
A particular food that may contribute to the development of a particular kidney stone may have no significance for other kinds of stones. Thus, knowing the type of kidney stone you have a tendency to form will help determine which foods to avoid.
Kidney Stone Causes And Risk Factors
Both men and women can get kidney stones, but menâs chances of getting them are about double that of womenâs.
Itâs often hard to figure out what caused a kidney stone. But they happen when your urine has high levels of certain minerals. These include:
- Uric acid
If you donât have enough urine in your body to water down the high concentration of minerals, stones can form. Think about stirring up your favorite drink from a powder mix. If you donât add enough liquid say, water or juice the powder will clump up and turn into hard, dry chunks.
Things that can raise your risk for kidney stones include:
- What you eat
- Some medications like triamterene , a diuretic that treats high blood pressure antiseizure drugs corticosteroids and protease inhibitors like indinavir sulfate for HIV.
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What Other Treatment Choices For Kidney Stones Are Available
Drug treatment is being studied with such drugs as such as calcium channel blockers , steroids and alpha-adrenergic blockers. The idea is that the stone might be dissolved with medication. Other drugs such as K-citrate, thiazides or allopurinol are prescribed to prevent new stones from developing. Most doctors agree that more medical trials are needed.
When SWL is not appropriate or doesn’t work, some people will need ureteroscopy, a technique that goes through the bladder to reach the stone or percutaneous nephrolithotomy, a technique that goes through a small incision created in your back. Some people, in extremely rare cases, even need open surgery, a technique that involves a larger incision in your abdomen. The medical terms for kidney stone surgery are ureterolithotomy or nephrolithotomy.
Whats The Outlook For Kidney Stones
The outlook for kidney stones is very positive, although there is a risk of recurrence . Many kidney stones pass on their own over time without needing treatment. Medications and surgical treatments to remove larger kidney stones are generally very successful and involve little recovery time.
Its possible to get kidney stones multiple times throughout your life. If you keep developing kidney stones, your healthcare provider may work with you to discover why the stones happen. Once the cause is found, you may be able to make dietary changes to prevent future stones.
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What Is Shock Wave Lithotripsy
Shock Wave Lithotripsy is the most common treatment for kidney stones in the U.S. Shock waves from outside the body are targeted at a kidney stone causing the stone to fragment. The stones are broken into tiny pieces. lt is sometimes called ESWL: Extracorporeal Shock Wave Lithotripsy®.
These are what the words mean:
- extracorporeal: from outside the body
- shock waves: pressure waves
So, SWL describes a nonsurgical technique for treating stones in the kidney or ureter using high-energy shock waves. Stones are broken into “stone dust” or fragments that are small enough to pass in urine. lf large pieces remain, another treatment can be performed
Can Kidney Stones Cause Bladder Spasms
A bladder spasm is a condition affecting millions of people around the world. Just as many also suffer from kidney stones. Both embarrassing and painful, kidney stones and bladder spasms may have a possible connection to one another.
While there are many different causes of bladder spasms, it may very well be kidney stones that is causing your complaints.
It is within your best interest to get medical attention as soon as possible if you have either bladder spasms or a kidney stone.
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When To Go To The Er For Kidney Stones
When to Go to the ER
When you suddenly experience severe pain in the abdomen, your mind races to what could be causing the problem is it your gallbladder, a cyst , or your kidneys? Has your time on this earth finally reached an end? While that last question may be a little dramatic, most people experiencing sudden, extreme pain usually only think about one thing while in the moment how to make the pain stop.
When the cause is kidney stones, a trip to the emergency room is typically your best bet. But, what if youre not yet experiencing excruciating pain? How do you know when severe is severe enough?
Is It Urgent That The Patient Be Treated With A Procedure Like This
lf the stone does not pass on its own, it will require treatment. lf you have an infection, severe pain, or if your kidney function is threatened, your doctors will act quickly. lf you only have one kidney or have had a kidney transplant, your stone will be treated more quickly. lf you have large stones or stones in both kidneys, your doctors will not wait to treat you.
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