Effective Treatment Options for Kidney Stones and Urinary Issues in Older Adults

Calculus

Hello, Dr.
Hsu.
My father is 63 years old and was recently diagnosed with kidney stones (larger stones) and urinary tract stones.
What treatment options are currently available? I heard that there is nearly a 98% chance of recurrence after treatment; is that true? Which option is less painful and has a lower risk of recurrence, considering my father is very averse to surgery? Are all these treatment methods covered by health insurance? Additionally, my father has benign prostatic hyperplasia, which causes frequent urination and difficulty urinating.
Can both issues be addressed in one surgery? Thank you for your response.

A Yi, 30~39 year old female. Ask Date: 2008/06/02

Dr. Xu Weikai reply Urology

Hello, I am not sure how large your father's kidney stone is, so could you please provide more details: size, location, and whether there are any complications (such as infection or hydronephrosis), as these factors will influence the treatment plan.
Generally, for kidney stones, extracorporeal shock wave lithotripsy (ESWL) is currently the simplest and quickest treatment method available.
This can be done on an outpatient basis.
If the stone is too large, we may consider percutaneous nephrolithotomy (PCNL), which involves using a nephroscope for treatment.
This procedure will leave a 1 cm incision on the body.

Regarding stone recurrence, I prefer to refer to it as a reoccurrence of the condition rather than a relapse, as it is not related to the surgical method but rather to daily dietary habits.
For instance, consuming a diet high in sodium can increase the likelihood of stone formation.
The amount of water intake also plays a significant role in recurrence.

Prostate surgery is considered a major procedure and involves bleeding risks, so it is generally not combined with kidney stone treatment.
After all, if surgeries are combined, the operation time is extended, which increases the relative risk.
If there are any areas that need further clarification, please feel free to ask, and we can discuss and explore this further.

Sincerely,
Dr.
Hsu Wei-Kai
Department of Urology
Taitung Hospital, Ministry of Health and Welfare

Reply Date: 2008/06/02

More Info

When it comes to treating kidney stones and urinary issues in older adults, particularly in your father's case at the age of 63, there are several effective treatment options available. The management of kidney stones and urinary tract issues often requires a tailored approach, especially considering the patient's overall health, existing conditions, and personal preferences.

Treatment Options for Kidney Stones
1. Conservative Management: For smaller stones (typically less than 5 mm), conservative management may be sufficient. This includes increased fluid intake to help flush out the stones naturally. Pain management with medications may also be necessary, especially if the stones cause discomfort.

2. Medications: Certain medications can help facilitate the passage of stones. For example, alpha-blockers like Tamsulosin can relax the muscles in the ureter, making it easier for stones to pass. Additionally, medications that alter urine pH or reduce uric acid levels can help prevent stone formation.

3. Extracorporeal Shock Wave Lithotripsy (ESWL): This non-invasive procedure uses shock waves to break up larger stones into smaller pieces that can be passed more easily. It is generally well-tolerated and does not require anesthesia, although some discomfort may occur during the procedure.

4. Ureteroscopy: This involves inserting a small scope through the urethra and bladder into the ureter to directly visualize and remove stones. This method is effective for stones located in the ureter and can be done under general anesthesia.

5. Percutaneous Nephrolithotomy (PCNL): For larger stones (typically greater than 2 cm), PCNL may be necessary. This is a more invasive procedure where a small incision is made in the back to remove the stone directly from the kidney. While effective, it does involve a longer recovery time and potential complications.

Addressing Urinary Issues
Given that your father has benign prostatic hyperplasia (BPH), which can lead to urinary frequency and difficulty, it is crucial to address both the kidney stones and urinary issues concurrently. Treatment options for BPH include:
1. Medications: Alpha-blockers (like Tamsulosin) can help relax the muscles of the prostate and bladder neck, improving urine flow. 5-alpha-reductase inhibitors may also be prescribed to reduce the size of the prostate over time.

2. Minimally Invasive Procedures: If medications are ineffective, procedures such as transurethral resection of the prostate (TURP) or laser therapy can be performed to relieve urinary obstruction.

Recurrence and Prevention
It is true that kidney stones have a high recurrence rate, with studies suggesting that nearly 50% of patients may experience another stone within five to seven years. To mitigate this risk, lifestyle modifications are essential:
- Hydration: Encourage your father to drink plenty of fluids, aiming for at least 2-3 liters of water daily to dilute urine and prevent stone formation.

- Dietary Changes: Depending on the type of stones (calcium oxalate, uric acid, etc.), dietary adjustments may be necessary. For example, reducing sodium and animal protein intake can help lower the risk of certain types of stones.

- Regular Follow-ups: Regular check-ups with a urologist can help monitor kidney health and catch any potential issues early.

Insurance Coverage
Regarding insurance coverage, many of the treatments mentioned, including medications, ESWL, and surgical options, are typically covered by health insurance plans, but this can vary by provider and specific plan. It is advisable to check with your insurance provider to understand what treatments are covered and any out-of-pocket costs.

Conclusion
In summary, there are multiple effective treatment options for kidney stones and urinary issues in older adults. The choice of treatment should consider your father's preferences, the size and location of the stones, and his overall health. It is essential to have a thorough discussion with a urologist who can provide personalized recommendations and address any concerns about pain and recurrence.

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