Kicking kidney stones
Why Central Texans are at risk and what can be done

It's a common condition that can cause uncommon pain. Kidney stones can be as small as a grain of sand, the size of a pearl or even, for an unlucky few, larger than a golf ball.

No matter what their size, kidney stones are considered to be one of the most uncomfortable of urological disorders.

But research advances are teaching how to prevent them from forming and allowing for quicker and easier treatment than ever before.

Signs of a stone

Every year, more than 3 million visits are made to health-care providers and more than a half-million men and women end up in the emergency room for problems related to kidney stones, according to the National Kidney and Urologic Diseases Information Clearinghouse.

Kidney stones are more prevalent in certain parts of the U.S. -- including Central Texas. "There is an area sometimes called the 'stone belt' that stretches from coast to coast along the mid- and lowersouth states where kidney stone rates are higher," said Dr. Koushik Shaw, a board certified urologist with The Austin Diagnostic Clinic. "There are many theories on why that is, including higher temperatures or the possibility of higher mineral content in the water supply."

No matter where one lives, kidney stones develop when waste materials in the urine don't completely dissolve. "Sometimes a stone will stay in the kidney and you won't even know it's there," said Shaw.

"Other times, it will travel from the kidney and down the ureter, the tube that carries urine from the kidney to the bladder. Eventually, it may come out when you urinate."

But a stone can cause intense pain as it moves into the bladder. Sometimes it can get stuck as it travels. The most common symptom of a kidney stone is a sharp pain in the back, side or lower abdomen, said Shaw. Other signs include nausea and vomiting, blood in the urine, cloudy urine and the need to urinate more often, and fever and chills.

Despite the discomfort -- for which doctors can prescribe pain medication -- many stones can pass through the body if one stays adequately hydrated.

If the stone doesn't pass promptly or causes severe pain or an infection, a physician may recommend medical treatment.

Treatment advances

Not too long ago, open surgery was a major option for removing kidney stones. Today, there are new, less invasive methods that can be performed in an outpatient setting.

Extracorporeal shock wave lithotripsy is a procedure that uses a machine to send shock waves into a kidney stone to break the stone into tiny fragments so that they can be passed.

The procedure may be done as an outpatient procedure under anesthesia in approximately one hour.

Another outpatient procedure is ureteroscopy. If the stone is lodged in the ureter, a long, thin instrument is inserted into the urethra, the tube that drains urine from the body, and passed through the bladder until it reaches the stone.

The stone is then broken up with ultrasound or laser energy and the patient passes the fragments. Or the stone may be removed with a small basket-like device.

If the stone is very large, another option is percutaneous nephrostolithomy.

Performed under anesthesia, the doctor removes the kidney stone by making a small incision in the back and using a needle and guide wire to fragment the stone and remove the pieces.

Although hospitalization may be needed, most patients return to normal activities in about two weeks' time.

"Your doctor will choose a treatment after considering the size of your stone, the stone's location and any medical condition you might have," Shaw said.

Kinds and causes

No matter which method a physician recommends, whether it's passing the stone naturally or removing it through a medical treatment, a doctor will analyze the stone or stone fragments to determine what kind of stone the patient has.

There are four major kinds of kidney stones, all caused by chemical imbalances in the urine, said Shaw. "Knowing what your stone is made of helps your doctor figure out what caused the stone to form in the first place. Then, steps can be taken to prevent future stones."

Approximately four out of five stones are made up of calcium. Usually the stone also contains oxalate, a compound found in some fruits and vegetables, including rhubarb, spinach, beets, grapes and red raspberries. These stones can be caused by taking too much calcium in pill form, medical conditions that regulate how the body uses calcium, being inactive and a diet high in oxalate, which is found in nuts, chocolate and tea.

Struvite stones, which are found more often in women then men, are usually caused by urinary tract infections.

Uric acid stones form when the urine contains too much uric acid, made by the body when it metabolizes protein sources like meat, fish and chicken. High-protein diets can put one at risk for these stones.

Cystine stones are rare and usually hereditary.

Other risk factors for stones include certain medical conditions such as congenital kidney defects, high blood pressure, arthritis, colitis and Chrone's disease, said Shaw, and certain medications, like diuretics, can cause stones. A diet high in salt, fat, meat and sugar, and low in fiber also increases ones risk.

Prevention is painless

Those who have had a kidney stone have a chance to develop them again, said Shaw, who encourages folks to know their family history. "If someone in your family has had stones, you're more likely to form them and should take steps toward prevention."

The best thing to do to prevent any type of kidney stone is to drink lots of water, said the physician. "Drink six to eight full glasses of water each day.

"Drinking lemonade also can be helpful because it has high levels of citrate, a powerful reducer of stone formation."

Shaw encouraged staying active and eating a healthy, balanced diet as well. Those who are prone to certain types of stones, such as calcium or uric acid stones, may be able to get medication from their physician to help prevent them.

Research continues on how to prevent kidney stones, which have been shown to afflict people since the time of the ancient Egyptians. "If you're unlucky enough to develop a stone, rest assured that treatment options have come a long way.

"If you think you have a stone, talk to your doctor about the many options that can provide you with relief."