No one said kidney stones were fun.
Let's pass on some knowledge.
It's your first stone? You're not alone.
1 out of 11 people will have at least one kidney stone episode in their lifetimes.
Where do kidney stones come from?
Your urine is a combination of water, salts, and other chemicals. Sometimes if the concentration of certain salts or chemicals gets too high, they no longer dissolve in the urine and begin to form stones, similar to forming sugar crystals to make rock candy. Sometimes these stones can be caused by medical or genetic conditions.
How do I know if I have kidney stones?
Most people do not get screened for kidney stones. If you develop symptoms concerning for kidney stones (flank pain, blood in urine, frequency, urgency) you may undergo imaging to look for kidney stones or other causes of your symptoms. Sometimes kidney stones are found accidentally when performing imaging for other reasons.
How do kidney stones get diagnosed?
Kidney stones can be diagnosed on X-ray or ultrasound, but most often are found on a CT scan. Usually a CT scan is needed before surgery to confirm the size and location of your kidney stones.
Can I take medications to make my kidney stones go away?
There are specific types of kidney stones that dissolve with medications but this can take months. Most kidney stones, once formed, will not dissolve and will either pass spontaneously or need to be removed with surgery.
Do I need surgery for my kidney stones?
If your kidney stone is causing blockage, it may need surgery if it does not pass on its own within 2-4 weeks. If your kidney stone is not causing a blockage today, there is a possibility (50% chance) it will eventually pass. Dr. Chertack can discuss with you the risks and benefits of surgery versus observing the stone. If your stone is causing a blockage and there is infection, this is considered an emergency and you will need treatment to drain the infected urine before it makes you sick.
What kind of surgery do I need for my kidney stones?
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Three types of surgery are commonly used to treat kidney stones. Ureteroscopy: This surgery involves passing a slender camera through the hole you pee through up to the kidney stone and breaking it up with a laser. This surgery does not require any incisions and is best for stones that have passed from the kidney and become stuck on the way to the bladder, it can also be used for stones in the kidney up to a certain size.
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Percutaneous nephrolithotomy: This surgery involves making a small incision on your back and placing a camera into the kidney and breaking up the stone. This surgery is best for large and very large kidney stones.
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Shock wave lithotripsy: This surgery involves using shock waves outside the body to break up the kidney stone and allowing the small fragments to pass on their own. Dr. Chertack does not perform this type of surgery.
All of these surgeries would be performed in the operating room while you are asleep.
Can I do anything else to prevent kidney stones?
If you have had two or more stones or have any risk factors for making kidney stones, you will need to complete a metabolic workup. You can complete the workup after your first stone but this is not a requirement. The workup consists of blood tests and a 24 hour collection of urine, starting after your first morning void and continuing until the next morning’s void. Depending on the results of this test, Dr. Chertack may recommend some medication for kidney stone prevention.
A 24-hour urine collection can provide key information for dietary changes and medication recommendations
What might my metabolic workup show?
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Dehydration: Your urine production is too low, you should be making AT LEAST 2.5-3 liters of urine daily. You should adjust your fluid intake to maintain this output.
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High urine calcium: Excess calcium in the urine can lead to stones. Eat a normal level (1000-1200mg) of calcium in your diet (low calcium can cause stones!). Dr. Chertack may recommend starting indapamide or chlorthalidone.
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High urine sodium: Excess sodium can lead to increased calcium in the urine. Eating a normal or lower sodium diet will prevent stone formation.
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High urine oxalate: Oxalate is needed to make the most common type of stone, calcium oxalate. If your oxalate level is high, then cutting out high-oxalate food will prevent stone formation.
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High urine uric acid: Excess uric acid can lead to stone formation, but is worse when the urine acid level is too high. Usually this can be treated with drinking more fluids and taking potassium citrate, but some patients may need to take allopurinol.
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Low urine citrate: Citrate is an important chemical to help prevent kidney stones. The best way to increase the level is with potassium citrate, but there are also other options.
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Low urine pH: Low pH means the urine is more acidic and therefore uric acid is more likely to form stones. This can be prevented by making the urine more basic with potassium citrate.
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High urine sulfate: This indicates that your animal protein intake is too high. Prevent stones by limiting your meat intake. This includes beef, pork, poultry, and seafood!
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Low urine magnesium: Magnesium is another chemical that helps prevent stone formation. Taking a magnesium supplement may help prevent stones.
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High blood calcium: This can indicate a hormone imbalance, Dr. Chertack will discuss need for further hormone workup and treatment.
What are the side effects of the medication?
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Thiazides (daily chlorthalidone or indapamide): Changes in your electrolytes may need to be monitored with blood tests. These medications can cause you to pee more, take them in the morning. Occasionally the medications lose their effectiveness, you may need to hold them temporarily if indicated.
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Potassium citrate: They can cause some nausea, indigestion, or diarrhea. You may notice the wax coating pass in the stool, the medication is still working! You may need to take them 2-3 times daily, and the pills can be large. Your potassium levels will need to be monitored.
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Allopurinol: It can occasionally cause rash and muscle aches. Your liver enzyme levels will need to be checked before and after starting the medication.
Can I take an over-the-counter (OTC) supplement or herbal medication?
Currently there are no OTC medications, supplements, or herbal remedies that are proven to prevent kidney stones or dissolve stones that already exist. Although some medications may make these claims, they have not been proven to be true with research studies.
I don’t like water, what should I do?
You’re not alone! Water is the best option to stay hydrated, but there are other options. The most important thing to remember is that no matter what you drink, it is the amount of urine made that helps prevent kidney stones. Some patients like to flavor their water with either lemon or crystal light. Citrus juices, like orange and grapefruit, contain citrate and can help prevent kidney stones. Many beverages are neither good nor bad for kidney stone prevention - this includes milk, non-citrus juices, coffee, tea, and alcohol. Dark colored soda pop are the worst option as they contain a chemical that can increase your kidney stone risk.
Do you have a list of high oxalate foods to avoid?
Sure! Check out this website with a helpful list. Remember, you only need to avoid high-oxalate foods if Dr. Chertack specifically recommends it, otherwise it will not decrease your risk for kidney stones and you will only be missing out on chocolate!
Ureteroscopy is a great treatment option for many patients
What is ureteroscopy?
You will be asleep during this surgery. A slender camera will be inserted through the hole you pee through, and passed up to the level of your kidney stone. The kidney stone will be broken into pieces with a laser and these pieces removed. There are no incisions during this surgery. It normally takes 1 hour, although it depends on the size and location of the stone.
I was told I need a stent, what is that?
A stent is a thin, flexible plastic tube like a straw. It fits within your body’s tube (the ureter) that drains the kidney down to the bladder. It has one end that curls in the kidney and one end that curls in the bladder. Often after ureteroscopy, the tissue of the ureter is swollen and irritated. The ureter may also have been stretched during surgery to allow the camera to pass. If a stent is not placed, the ureter may temporarily collapse, preventing your kidney from draining and causing pain. Dr. Chertack places a stent temporarily to allow your urine to safely drain. Usually the stent stays for one week after surgery.
Sometimes Dr. Chertack leaves strings attached to the end, these strings exit the hole you pee through. If the strings are present, you can pull the stent out yourself at home. This works best if you do it in the morning in the shower while urinating, this helps prevent more discomfort. Please call the clinic if you have any issues!
If Dr. Chertack does not leave strings, you will need to come to clinic to have the stent removed via a short procedure called cystoscopy, where Dr. Chertack will look in your bladder with a camera and remove the stent.
What are the risks of surgery?
The most common side effects are from the stent. This can cause you to feel burning with urination and make you need to use the bathroom more frequently. It can also cause pain on your sides and may also cause a small amount of blood in the urine, this is not dangerous. These side effects resolve after stent removal.
Other side effects include concerning bleeding, infection, injury to your kidney or bladder. All of these side effects are uncommon. Even if all your kidney stones are treated, there is always the possibility you make more kidney stones in the future.
If Dr. Chertack cannot safely treat your stones either due to infection or because he cannot reach the stone with the camera, he will place a stent and reschedule your surgery in 2-4 weeks.
What do I need to do to prepare for surgery?
You will likely have already had imaging to confirm the stone size and location, this may need to be repeated if your imaging is out of date.
Do not eat or drink anything after midnight the night before surgery.
Any other restrictions regarding your medications will be discussed in advance with the anesthesia team.
You do not need to stop your blood thinner medications prior to surgery.
You will be tested for urine infection prior to surgery, if this is present you may need to take antibiotics for a few days before surgery. Please provide a urine sample 2 weeks before surgery to give time to treat any infection.
Dr. Chertack will prescribe a medication called tamsulosin. This medication relaxes your ureter, making it easier to find the stone during surgery. He will prescribe it so that you can start taking it one week prior to surgery. It can occasionally cause some dizziness and you may find that it decreases your semen volume, these side effects go away after stopping the medication.
What restrictions do I have after surgery?
You can eat whatever you want after surgery.
You can do any physical activity you feel comfortable performing after surgery.
No driving for 24 hours after surgery.
No lifting restrictions.
You may have some discomfort with the stent in place, this should resolve soon after stent removal.
What medications will I receive after surgery?
Tamsulosin helps relax the ureter while the stent is in place, take this until 3 days after stent removal.
Pyridium prevents burning with urination, take up to three times daily while stent is in place. It will make your urine turn orange.
Senna prevents constipation, take daily until you are having regular bowel movements.
Ibuprofen will help prevent inflammation and flank pain, take up to four times daily.
You will be prescribed a medication to prevent bladder spasms, take this as prescribed while the stent is in place.
You do not need narcotics after this type of surgery.
What is my follow-up?
You may need to come to clinic one week after surgery to have your stent removed. You will then see Dr. Chertack in 6 weeks with a kidney ultrasound to make sure your kidneys are draining without blockage. If this is your first kidney stone, Dr. Chertack will discuss dietary changes and possibly performing a metabolic workup, otherwise you do not require regular follow-up. If this is your second kidney stone or you have risk factors, you will need a metabolic workup and annual X-ray and ultrasound to confirm no new kidney stones.