Kidney Stones: Prevention and Treatment Options

Please ask your questions about urinary tract stones?

Hello Dr.
Du,
I had two kidney stones last October and underwent Extracorporeal Shock Wave Lithotripsy (ESWL) at Taipei Heping Hospital (left: kidney stone; right: ureteral stone, each treated once).
The left stone, measuring 0.4 cm, passed naturally after fragmentation, while the right stone showed poor results, reducing from 0.9 cm to 0.7 cm, leading to a ureteroscopy.
The doctor indicated that I have calcium oxalate stones (the stones are very hard, making fragmentation difficult).
My pH level is 7.1.

In June of this year, an X-ray showed no stones, but last week (on November 24), I experienced hematuria and visited Shutian Clinic.
The X-ray results indicated one stone in each mid-ureter (left: 0.4 cm, right: 0.8 cm), and I underwent ESWL on the right side.
However, the size of the stone did not change at all, and the doctor advised me to observe for two weeks while drinking plenty of water.
If the stone does not pass, I will need to undergo ureteroscopy, but I am very afraid of this procedure (due to my previous experience).
1.
I would like to ask Dr.
Du if there are any other methods to help pass the stones if they do not pass in two weeks? Can the 0.8 cm stone be passed naturally with medication, increased water intake, and vigorous exercise?
2.
I am currently a student and living normally.
Since my stone incident last year, I have been drinking over 3000 cc of water daily and regularly running for exercise.
Why am I still forming stones? (I had an X-ray in June, and within just five months, I have developed stones again.) The doctor mentioned that it is related to my body constitution and that I will inevitably form stones again, making prevention impossible.
Additionally, no one in my family has a history of kidney stones.
I would like to know what medications can help prevent and avoid the formation of stones.
Thank you very much for taking the time to address these questions!
Personal information: 25 years old, male, 168 cm, 60 kg.

Liao Tongxue, 20~29 year old female. Ask Date: 2000/11/29

Dr. Du Shixi reply Urology

Student Liao, you have stones on both sides, and you have undergone lithotripsy treatment.
The immediate priorities are: 1.
To expel the processed stones, and 2.
To prevent the remaining stones from growing larger.
Since your stones are oxalate stones, there are certain foods you should avoid, such as tea, coffee, cola, and beer (there should be informational pamphlets available in the urology clinic).
Additionally, it is important to drink plenty of water.
Your stones have been treated with lithotripsy, so their structure is loose, making them easier to pass compared to stones that have not been treated.

Reply Date: 2000/11/29

More Info

Hello! Thank you for your detailed questions regarding kidney stones, their treatment, and prevention strategies. Kidney stones can be a significant health concern, and understanding how to manage and prevent them is crucial.

Understanding Kidney Stones
Kidney stones, particularly calcium oxalate stones, are among the most common types of stones formed in the urinary tract. They can vary in size and may cause significant discomfort or complications if not managed properly. Your experience with ESWL (Extracorporeal Shock Wave Lithotripsy) indicates that you have been proactive in addressing your kidney stones, but it’s understandable to feel anxious about further procedures.

Treatment Options
1. Observation and Hydration: Since your doctor has advised you to observe the stones for two weeks while increasing your fluid intake, this is a common initial approach. Drinking plenty of water (at least 3,000 cc daily, as you mentioned) can help dilute the urine and may assist in passing smaller stones naturally. However, for stones larger than 0.5 cm, the likelihood of passing them without intervention decreases significantly.

2. Medications: Tamsulosin, a medication often prescribed to facilitate the passage of stones, can help relax the muscles in the ureter, potentially aiding in the passage of stones. However, its effectiveness can vary based on the size and location of the stone. If the stone does not pass after the observation period, your doctor may recommend a ureteroscopy, which is a minimally invasive procedure that allows for direct removal or fragmentation of the stone.

3. Alternative Methods: If the stone does not pass after two weeks, other methods such as ureteroscopy or possibly repeat ESWL may be necessary. Unfortunately, there are no medications that can guarantee the passage of larger stones like the 0.8 cm stone you mentioned.

Prevention Strategies
1. Dietary Adjustments: Since you have a history of calcium oxalate stones, it’s essential to manage your diet. Reducing foods high in oxalate (like spinach, nuts, and chocolate) can be beneficial. Additionally, maintaining a balanced intake of calcium is crucial, as low calcium diets can paradoxically increase stone formation.

2. Hydration: Continuing to drink plenty of fluids is one of the most effective preventive measures. Aim for at least 2-3 liters of water daily, which helps dilute the urine and reduces the concentration of stone-forming substances.

3. Medications for Prevention: Depending on your specific situation, your doctor may recommend medications such as potassium citrate, which can help prevent the formation of calcium oxalate stones by alkalizing the urine. Discuss this option with your healthcare provider.

4. Lifestyle Factors: Regular physical activity, as you are already doing, can also help reduce the risk of stone formation. Avoiding excessive salt and animal protein in your diet can further decrease your risk.

Genetic and Physiological Factors
You mentioned that there is no family history of kidney stones, which can sometimes lead to confusion about why you are experiencing them. Kidney stones can be influenced by various factors, including metabolic issues, dietary habits, and even dehydration. Some individuals may have a predisposition to stone formation due to their unique metabolic profiles, which can lead to recurrent stones despite a healthy lifestyle.

Conclusion
In summary, while you are doing many things right by staying hydrated and active, it’s essential to continue working closely with your healthcare provider to monitor your condition and explore preventive medications if necessary. If you have further concerns about the procedures or your treatment plan, don’t hesitate to discuss them with your doctor. They can provide personalized advice based on your medical history and current situation. Remember, managing kidney stones is often a multifaceted approach that includes lifestyle changes, medication, and sometimes surgical intervention. Stay proactive, and best wishes for your health!

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