Kidney stones can be one of the most painful disorders experienced by men and women. In fact, some women have stated that kidney stones are more painful than childbirth.

This problem has been known to affect many famous people, such as Benjamin Franklin, Francis Bacon, Isaac Newton and Peter the Great. The incidence of kidney stones is very high in the southeastern part of the United States thereby explaining the term, "Stonebelt", given to the area.

New technology has greatly improved the methods of stone removal. In addition, improved medical treatments can prevent recurrent kidney stone formation. The goal of this article is to explain what causes kidney stones, how to remove them, and how we currently prevent recurrent kidney stone formation.

Understanding Kidney Stones

The urinary tract consists of the kidneys, the bladder, and the tube connecting the kidneys to the bladder “kidney tube” or “ureter” and the tube that allows you to empty the bladder (“urethra”). The kidneys act as the body's filtering system. They constantly screen the blood, absorbing the good chemicals and eliminating the unwanted chemicals in our urine. Urine then passes from the kidney, down the kidney tube into the bladder and eventually out of the body via the urethra.

If certain chemicals or minerals buildup in the kidneys, they can form a stone (just like an oyster makes a pearl from an irritating grain of sand). Stones may stay in the kidney or they can travel down the urinary tract, through the ureter causing severe pain. The size, shape, and location of the stone will determine the symptoms that one may experience and will define the most appropriate treatment for stone removal.

Causes of Kidney Stones

Many factors may play a role in kidney stone formation, such as age, gender, a family history of stones, the amount of daily fluids consumed, occupation, climate, urinary tract infection, associated medical problems (such as bone disease), and dietary patterns.

Usually, males suffer from kidney stones more commonly than females, and African American people tend to have far fewer stones than white people, although recent studies have documented an increasing incidence of stones in women and non-Caucasians. Hereditary diseases such as renal tubular acidosis, cystinuria, and hyperoxaluria can cause stone formation as well.

One of the more common and important causes of kidney stone formation is not drinking enough fluids. A reduced fluid intake increases the concentration of stone forming components within the urine, thereby increasing the risk of stone formation.

Determining the chemical composition of the stone and performing analysis of the urine and blood will help your doctor to determine what is causing new stone formation and how to prevent repeat stone formation.

Symptoms of Kidney Stones

Kidney stones may cause all or only a few of the following symptoms:

• Excruciating pain – typically in the back, side, lower abdomen or groin
• Blood in the urine
• A burning sensation during urination'
• Difficulty urinating
• Frequent urination
• Fever or chills
• Nausea or vomiting
• Loss of appetite

Diagnosis of Kidney Stones

Many different conditions can produce symptoms similar to kidney stones. In order to definitively diagnose kidney stones, and their possible effects on the body, a number of investigations are helpful.

A thorough medical history and physical examination performed a medical professional is essential. The urine is checked for the presence of blood (associated with over 90 percent of stones), which may be so small in amount that the blood in the urine can only be seen by a microscope.

The urine is also checked for the presence of infection, which can be associated with kidney stones and potentially be very serious. The patient’s blood is checked to ensure that overall kidney function has not been significantly affected and that there is no infection in the blood stream.

Special imaging tests can be used to locate and determine the size of kidney stones. X-rays, ultrasound and CT scans are all potential ways of diagnosing kidney stones; the decision on which one to use will depend on a number of factors, and is best made by a medical professional.

Treatment of Kidney Stones

Shock wave lithotripsy: Although not really surgical stone removal, a machine has been developed that can "crush" your stones within the kidney or ureter. You will be placed on a special bed and given medication that will prevent you form feeling significant pain or discomfort, and usually makes you feel very sleepy. A gel bolster or “pillow” is then placed along the side to be treated. The stone is localized with x-rays or ultrasound, and shock waves will be directed into the body to shatter the stone. After the stone has been crushed into small particles, like sand, they will pass out with your urine.

However, it is important to know that not all stones will respond well to shock wave treatment. The size of the stone, its location within the urinary tract and the stone composition will all determine whether shock wave lithotripsy will be an appropriate treatment for your individual case. In most cases, this technique can be performed on an outpatient basis, and you can go home that same day.

Ureteroscopic stone removal: For many stones located within the ureter (tube from kidney to bladder) shock wave lithotripsy may not work to fragment the stone. Therefore, a minimally invasive surgical procedure, where a small telescope is passed through the bladder up the kidney tube to the level of the stone, can be used to remove the stone. This procedure does not require a cut in the skin and is performed as outpatient surgery and you can go home that same day. The procedure is done in the operating room with an anesthetic to ensure that you do not feel any pain or discomfort during the procedure.

Percutaneous stone removal: For very large or hard stones that are located in the kidney, a percutaneous (through-the-skin) approach may be required to remove all of the stone material.

A small cut is made in your back (less than one inch in length) allowing placement of a telescope directly into the kidney. The procedure is done in the operating room with an anesthetic to ensure that you do not feel any pain or discomfort during the procedure.

The stone can easily be seen and ground up into small particles and removed using a special instrument that is passed through the telescope. Following this type of stone removal, you will have a small tube in your side during your hospital stay (a few days).

Open surgery: In selected instances, "complex" stones (extremely large or hard stones) may not respond well to shock wave lithotripsy, ureteroscopy, or percutaneous stone removal techniques. Therefore, open surgery may be required where a larger cut is made in your side and the kidney or kidney tube is opened surgically.

Again, this procedure is performed in the operating room with an anesthetic to ensure that you do not feel any pain or discomfort during the procedure. For open stone removal, you will remain in the hospital for five to seven days and will be unable to return to work for two to three weeks.

Non-surgical management: Not all kidney stones are diagnosed because of symptoms. Some people have kidney stones diagnosed during the investigation of other non-related medical issues.

If a kidney stone is relatively small, is not causing any pain, is not in danger of blocking the kidney tube, or other medical issues make treatment of the stones challenging, a decision can be made to just observe the stone or wait until it is safe to treat the stone. This decision is best made by a specialist who is familiar with treating kidney stones.

Important in this decision is making sure the factors contributing to stone formation have been determined and treated satisfactorily with an adequate fluid intake and appropriate medications.