So large kidney stones, which we define usually as one-and-a-half to two centimeters in size,
require some unique approaches. Now we treat those primarily with a percutaneous approach.
And what that means is we make a very tiny, mini incision over the kidney and go in with
a camera, directly into the kidney. We have special tools that allow us to break up and
vacuum out the stones, so we can clear out all the pieces very effectively. Afterwards,
we do keep the patients in the hospital, but in the past it used to be five or six day
hospital stay, and the vast majority of our patients now get home the next day after the
procedure.
The biggest risk factor for kidney stones is not drinking enough fluid. As simple as
that sounds, we see this all the time. Patients come in, they get dehydrated, and the stones
start to form. And it's simply, there's crystals in the urine, and the crystals get too concentrated
and they stick together and they form stones. So one of the things that we have to do with
patients to work on preventing stones is work on fluid intake. And it can be a real challenge.
Surgeons, in particular, are at risk for stones because they're often in the operating room
for long periods of time where they can't drink fluids. But other examples would be teachers
who are in a class so they don't want to be constantly taking bathroom breaks. I've had
a highway patrolman who had recurrent stones because he was stuck on the highway for eight
hours a day and had no access to a bathroom. So there's unique challenges with each group
of patients that we have to work with to try and overcome.
Historically, males had more stones than females, but what we've seen in recent years
is that that trend is changed, and it is evening out. It is almost 50/50 now. And we think
that has a lot to do with the lifestyle of women. Many women are in the workplace, their
diets have probably changed, and so the risk factors that men used to have, women likely
have as well now, too. And my own practice really has been pretty much a 50/50 mix of men and
women with stones.
One of the challenges that we have is often it is easier to get fast food and to get take-out
food nowadays with everybody being so busy. Unfortunately there's a lot of risk factors
related to this. The high salt content in take-out food is a big time risk factor for
kidney stones, so when we see patients we again have to work on their diet and on their
treatment plan to see if we can modify some of these risk factors that are just inherent
to the lifestyle that people have today.
Well one thing with kidney stones, usually people know when they have one. They tend
to get rip-roaring pain in the back that brings them into the emergency department. That being
said, anybody who has blood in the urine with no explanation for it should certainly go
see their doctor and see if there is something going on, and it could be a kidney stone,
although there's other more serious things that also could be going on. Anybody who sees
a stone pass when they go to the bathroom should also be assessed, because sometimes
there's more stones to come.
Patients who've had recurrent treatments elsewhere and are finding that they are not having success,
they're not getting their stones cleared out, that would be a group of patients we'd be
more than happy to see. A lot of our referrals do come from other urologists for patients
who have very complex stone disease, and that's something that we really focus on is the treatment
of these challenging stones.