Stone Disease

A stone begins when concentrated materials in the urine crystallize. These crystals can lead the development of a stone when other materials build upon them. A stone can form in your kidney or may move down into one of your two ureters (the tubes that carry urine from your kidneys to your bladder), the bladder, or the urethra (the tube that carries urine from your bladder to outside the body.

There are four major types of kidney stones:

  • Calcium is the most common type of stone. Calcium can combine with other substances such as oxalate to form the stone
  • A uric acid stone may form when your urine contains too much acid.
  • A struvite stone may form after an infection in your urinary stream
  • Cystine stones are rare. The disease that causes cystine stones runs in families.

Kidney stones can be very painful. They may be the size of sand or gravel or as large as a pearl (or larger). A stone can block the flow of urine and cause considerable pain. Other symptoms may include fever, nausea, vomiting and even blood in your urine.

Many times a stone will pass through the body without surgical intervention. Other time, your doctor may recommend a Extracorporeal Shock Wave Lithotripsy (ESWL) or a Ureteroscopy, depending on where your stone is located.

ESWL is a process by which shockwaves are generated outside the body and focused on the area where the stone is located. This will case the stone to break apart into sand-like particles and pass through your body. Your doctor will decide prior to the procedure whether you will remain conscious with mild sedation or be completely asleep under general anesthesia.

Depending on the type of lithotripter you are being treated with, you may feel anything ranging from strong to light tapping against your skin where you come in contact with the water-filled membrane that houses the shock-generating unit. You will also hear a sound that will range from a loud bang to very subtle clicks. In most cases you will be medicated so that you should have little or no discomfort during the procedure. There is no electrical shock.

The lithotripter system includes video x-ray equipment (a fluoroscope) that aids your doctor in the visualization and targeting of your stone. The amount of radiation you receive is typically very minimal.

Lithotripsy is usually successful with one treatment, though repeat treatments may be necessary for large stone, dense stone or multiple stones.

A Ureteroscopy is a common procedure whereby a stone can be removed via a special telescope, or in certain cases, a laser can be used to break up the stone into very small bits. This procedure is generally done under anesthesia in the operating room and takes between 30 minutes and 2 hours, depending on the stone and your anatomy.

Your doctor will being by inserting a thin viewing instrument (ureteroscopy) into the urethra (the tube that leads from the outside of your body to the bladder). The ureteroscopy is then passed into the bladder and ureters (the tubes that carry urine from the kidneys to the bladder) in order to view the internal drainage system of the kidney.

After the stone is identified it can be grasped with a basket or grasping instrument and removed intact, or if the stone is too high in the ureter or embedded, a laser may be used to fragment the stone. The fragments are typically left to pass on their own.

After the procedure a small plastic/silicone tube called a stent may be placed to help the ureter heal. Your stent is NOT permanent and can cause significant problems if it is left in longer 4-6 months.