Passing Small Kidney Stones
What To Expect From A Ureteral Stent
Ureteral stents are an implant used to correct a blockage in one of the ureters in your body. The ureters are tubes that allow urine to drain from the kidneys and enter the bladder. When blockages occur, urine backs up in the kidneys, which causes swelling that can lead to permanent kidney damage if left unaddressed.
Blockages can be caused by kidney stones, a tumor or other object pressing on the ureters, or scar tissue that develops in the ureters. A ureteral stent is a thin tube inserted into the ureters to open the passage and allow urine to properly drain from the kidneys.
If your doctor decides this implant is necessary to preserve your kidneys health, youll want to be prepared for what to expect once the stent is implanted and after the stent is removed.
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Calcium Oxalate And Calcium Phosphate Stones
Calcium stones are the most common type of kidney stones, and can be either calcium oxalate or calcium phosphate. As mentioned, good hydration is important to prevent calcium stones. It may be surprising, but results of a randomized clinical trial show that people with calcium kidney stones should not cut back on dietary calcium. In fact, they should consume the recommended daily allowance of calcium . Why? Calcium binds to oxalate in the intestine and prevents its absorption through the gut, so there is less in the urine to form stones. Ideally, calcium should come from food. Talk with your doctor before taking calcium supplements, and increasing fluid intake might be beneficial depending on how much calcium you take.
Foods high in oxalates can increase the amount of oxalate in the urine. Consume these in moderation.
Calcium phosphate stones are less common than calcium oxalate stones. Causes include hyperparathyroidism , renal tubular acidosis , and urinary tract infections. It is important to understand if one of these conditions is behind the formation of calcium phosphate stones.
Good hydration can help prevent recurrence of calcium stones. In addition, thiazide diuretics such as hydrochlorothiazide can help the kidney absorb more calcium, leaving less of it in the urine where it can form stones. Potassium citrate is another medication that can bind to calcium and help keep calcium oxalate and calcium phosphate in the urine from forming into stones.
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Reasons For The Procedure
The primary advantage of lithotripsy is that it is completely non-invasive.
Lithotripsy is well suited to patients with small kidney stones that can be easily seen by x-ray.
When kidney stones become too large to pass through the urinary tract, they may cause severe pain and may also block the flow of urine. An infection may develop. Lithotripsy may be performed to treat certain types of kidney stones in certain locations within the urinary tract.
There may be other reasons for your doctor to recommend lithotripsy.
Diet And Kidney Stones
But lemonade alone isnt the answer to kidney stones. Its only part of a stone-preventing diet.
First, you should reduce the amount of salt in the diet, Stoller says. Get rid of the salt shaker at the table. Use a potassium-based salt substitute. If you have a choice of two products, go to the one with less salt. Eat out less restaurant food is salty and never salt your food before tasting it.
Second on Stollers stone-prevention diet is eating smaller portions of meat and fish at each meal.
We are not saying to eat less meat, just eat less at individual meals, he says.
Third, increase fluid intake to where one is passing 1.5 to 2 liters of urine each day.
Where does lemonade fit in? If you drink and enjoy lemonade, it gives you an additional benefit, Stoller says.
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Treatment For Kidney Stones
Most kidney stones can be treated without surgery. Ninety per cent of stones pass by themselves within three to six weeks. In this situation, the only treatment required is pain relief. However, pain can be so severe that hospital admission and very strong pain-relieving medication may be needed. Always seek immediate medical attention if you are suffering strong pain.
Small stones in the kidney do not usually cause problems, so there is often no need to remove them. A doctor specialising in the treatment of kidney stones is the best person to advise you on treatment.
If a stone doesnt pass and blocks urine flow or causes bleeding or an infection, then it may need to be removed. New surgical techniques have reduced hospital stay time to as little as 48 hours. Treatments include:
When To See Your Doctor
Your doctor will probably schedule a follow-up appointment a week or two after removing a kidney stone. At this appointment, the doctor will make sure youre recovering as planned, and if you have a stent, it will probably be removed at this time. Always keep your follow-up appointments.
After kidney stone removal, complications may occur. Common complications include blood clots near the kidneys, nerve palsies, pancreatitis and obstruction caused by leftover kidney stone fragments. You should see a doctor if you suspect any of these complications. You should also see a doctor immediately if youre having trouble urinating, you have an increasing amount of blood in your urine, your pain is unmanageable, you have chest pain, you have a fever or youre vomiting.
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Why Kidney Stones Can Be A Problem
Stones dont always stay in the kidney. Sometimes they pass from the kidney into the ureters. Ureters are small and delicate, and the stones may be too large to pass smoothly down the ureter to the bladder.
Passage of stones down the ureter can cause spasms and irritation of the ureters. This causes blood to appear in the urine.
Diagnosis of kidney stones requires a complete health history assessment and a physical exam. Other tests include:
- blood tests for calcium, phosphorus, uric acid, and electrolytes
- blood urea nitrogen and creatinine to assess kidney functioning
- urinalysis to check for crystals, bacteria, blood, and white cells
- examination of passed stones to determine their type
The following tests can rule out obstruction:
The contrast dye used in the CT scan and the IVP can affect kidney function. However, in people with normal kidney function, this isnt a concern.
There are some medications that can increase the potential for kidney damage in conjunction with the dye. Make sure your radiologist knows about any medications youre taking.
Prevention Of Future Stones
Once your health care provider finds out why you are forming stones, he or she will give you tips on how to prevent them. This may include changing your diet and taking certain medications. There is no “one-size-fits-all” diet for preventing kidney stones. Everyone is different. Your diet may not be causing your stones to form. But there are dietary changes that you can make to stop stones from continuing to form.
Drink enough fluids each day.
If you are not producing enough urine, your health care provider will recommend you drink at least 3 liters of liquid each day. This equals about 3 quarts . This is a great way to lower your risk of forming new stones. Remember to drink more to replace fluids lost when you sweat from exercise or in hot weather. All fluids count toward your fluid intake. But it’s best to drink mostly no-calorie or low-calorie drinks. This may mean limiting sugar-sweetened or alcoholic drinks.
Knowing how much you drink during the day can help you understand how much you need to drink to produce 2.5 liters of urine. Use a household measuring cup to measure how much liquid you drink for a day or two. Drink from bottles or cans with the fluid ounces listed on the label. Keep a log, and add up the ounces at the end of the day or 24-hour period. Use this total to be sure you are reaching your daily target urine amount of at least 85 ounces of urine daily.
Reduce the amount of salt in your diet.
Eat the recommended amount of calcium.
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Can I Take Out The Stent Myself
You should never attempt to remove a stent on your own, as more harm may be done than you might assume. This can include:
- Kidney, ureter, bladder damage or infection
- Severe pain
- Urinary retention
- Re-blockage of ureter with stone fragments not removed in original procedure leading to severe pain that will require another hospital/ER visit to replace stent
Types Of Kidney Stones
Doctors break down kidney stones into types. Knowing which kind you have could affect the treatment you get. They include:
Calcium stones: These are the most common ones. Even just eating some foods very high in oxalates, such as rhubarb, or taking unusually high levels of vitamin D, can boost your chances of getting this type. You could get this kind if you typically donât drink enough water or if you sweat a lot and donât replace the fluids you lose.
Cystine stones: This is the least common typeThis is the least common type and due to a genetic mutation. In this situation your kidneys have trouble reabsorbing a compound called cystine, which ends up in the urine at higher levels and causes stones to form.
Struvite stones: Infections, especially in the urinary tract, can cause this kind of stone.
Uric acid stones: Eating large amounts of animal proteins can lead to uric acid buildup in your urine. That can eventually form a stone either with or without calcium. Risk factors include gout, diabetes, and chronic diarrhea.
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What To Expect At Home
You visited your provider or the hospital because you have a kidney stone. You will need to take self-care steps. Which steps you take depend on the type of stone you have, but they may include:
- Drinking extra water and other liquids
- Eating more of some foods and cutting back on other foods
- Taking medicines to help prevent stones
- Taking medicines to help you pass a stone
You may be asked to try to catch your kidney stone. You can do this by collecting all of your urine and straining it. Your provider will tell you how to do this.
Let Kidney Stones Pass
Stones typically take several weeks to a few months to pass, depending on the number of stones and their size. Over-the-counter pain medications, like ibuprofen , acetaminophen , or naproxen , can help you endure the discomfort until the stones pass. Your doctor also may prescribe an alpha blocker, which relaxes the muscles in your ureter and helps pass stones quicker and with less pain.
If the pain becomes too severe, or if they are too large to pass, they can be surgically removed with a procedure called a ureteroscopy. Here, a small endoscope is passed into the bladder and up the ureter while you are under general anesthesia. A laser breaks up the stones, and then the fragments are removed.
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Where Do Kidney Stones Come From
Kidney stones form develop when certain substances, such as calcium, oxalate, and uric acid, become concentrated enough to form crystals in your kidneys. The crystals grow larger into “stones.” About 80% to 85% of kidney stones are made of calcium. The rest are uric acid stones, which form in people with low urine pH levels.
After stones form in the kidneys, they can dislodge and pass down the ureter, blocking the flow of urine. The result is periods of severe pain, including flank pain , sometimes with blood in the urine, nausea, and vomiting. As the stones pass down the ureter toward the bladder, they may cause frequent urination, bladder pressure, or pain in the groin.
“If you experience any of these symptoms, see your primary care physician,” says Dr. Eisner. “He or she will likely perform a urinalysis and a renal ultrasound, abdominal x-ray, or CT scan to confirm kidney stones are the source of your pain and determine their size and number.”
Calcium Is Not The Enemy
But it tends to get a bad rap! Most likely due to its name and composition, many are under the impression that calcium is the main culprit in calcium-oxalate stones. “I still see patients who wonder why they are getting recurring stones despite cutting down on their calcium intake,” said Dr. Jhagroo. “I’ve even had patients say that their doctors told them to reduce their calcium intake.” A diet low in calcium actually increases one’s risk of developing kidney stones.
Don’t reduce the calcium. Work to cut back on the sodium in your diet and to pair calcium-rich foods with oxalate-rich foods.
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Treating And Preventing Kidney Stones
Most kidney stones are small enough to be passed in your pee, and it may be possible to treat the symptoms at home with medication.
Larger stones may need to be broken up or removed with surgery.
Its estimated up to half of all people who have had kidney stones will experience them again within the following 5 years.
To avoid getting kidney stones, make sure you drink plenty of water every day so you do not become dehydrated.
Its very important to keep your urine pale in colour to prevent waste products forming into kidney stones.
The kidneys are 2 bean-shaped organs that are roughly 10cm in length.
Theyre located towards the back of the abdomen on either side of the spine.
The kidneys remove waste products from the blood. The clean blood is then transferred back into the body and the waste products are passed out of the body when you pee.
Does The Patient Need Anesthesia
Yes, even though there is no incision, there will be pain. You and your doctor will discuss whether light sedation and local or general anesthetics will be used. The choice depends on the technique, the type of stone and the patient. SWL can be delivered with just mild sedation, but in general, some type of anesthesia–either local, regional or general–is used to help the patient remain still, reduce any discomfort, and this improves the breaking of the stone.
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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
Who Is At Risk For Kidney Stones
Anyone may develop a kidney stone, but people with certain diseases and conditions or those who are taking certain medications are more susceptible to their development. Urinary tract stones are more common in men than in women. Most urinary stones develop in people 20 to 49 years of age, and those who are prone to multiple attacks of kidney stones usually develop their first stones during the second or third decade of life. People who have already had more than one kidney stone are prone to developing further stones.
In residents of industrialized countries, kidney stones are more common than stones in the bladder. The opposite is true for residents of developing areas of the world, where bladder stones are the most common. This difference is believed to be related to dietary factors. People who live in the southern or southwestern regions of the U.S. have a higher rate of kidney stone formation, possibly due to inadequate water intake leading to dehydration than those living in other areas. Over the last few decades, the percentage of people with kidney stones in the U.S. has been increasing, most likely related to the obesity epidemic.
A family history of kidney stones is also a risk factor for developing kidney stones. Kidney stones are more common in Asians and Caucasians than in Native Americans, Africans, or African Americans.
Uric acid kidney stones are more common in people with chronically elevated uric acid levels in their blood .
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