Think You May Have Kidney Stones? Now What Do You Do?

Dr. Joseph Pazona, Board Certified Urologist

What Are Kidney Stones?

Our kidneys are designed to filter our blood and make urine. Our urine naturally contains minerals and salts, but if the levels of salt and minerals are too high then they can crystalize and form hard stones. Kidney stones can be as diverse as the items in that kitchen junk drawer you have. (Don’t lie, we all have one.)

That’s right, kidney stones come in many different shapes, sizes, and colors. Sometimes they are small and don’t cause any discomfort at all. Other times they can be quite large and very painful. Ouch! In some cases the stone will leave the kidney, traveling through the ureter to the bladder. If the stone becomes lodged in the ureter it can block the flow of urine and cause the kidney to swell. This is known as hydronephrosis and can be quite painful.  

How Are They Diagnosed?

Most often kidney stones are diagnosed by X-Ray. Generally, when patients are experiencing discomfort or pain a doctor will perform an X-Ray as part of an overall medical exam. Occasionally, patients will be asymptomatic, (a.k.a without symptoms) but kidney stones will be found during an X-Ray exam ordered for the diagnostic purpose of a different, unrelated medical issue.

A urinalysis, or urine test, will often be ordered to accompany the X-Ray exam to determine if there any signs of infection present. Occasionally other imaging tests may be ordered if the X-Ray doesn’t present a clear enough picture of the location of the kidney stones.

How Are Kidney Stones Treated?

It’s best to talk to your physician about the various treatment methods. Determining which option is best for you depends on the type of stone you have, the location, the size of the stone and more. Some common treatment options include:

Waiting for the Stone to Pass

Stones can often pass by themselves if they are small enough. The best way to help speed the process of stones passing through your urine is to drink a lot of water. And by “a lot of water” I really mean a LOT of water! Sip Sip Hooray! See our previous blog post to learn how much & how often I recommend drinking water & even the best water bottle to help keep you on track throughout the day.

Prescription Medication

If it looks like you aren’t able to pass a stone on your own, that’s ok. Don’t sweat it. The next step would be trying a medication to relax the ureter, like Tamsulosin (Flomax). This makes the stone easier to pass.

Surgical Procedure

If we’ve tried the above methods and imaging confirms the stone still hasn’t moved or passed, then the next step would be surgery. Don’t freak out, there are several different surgical options and they are all pretty simple and easy. And if you’re in a significant amount of pain, I’m pretty sure you’d do whatever it takes to get those things out of there. The most common surgical options are:

SWL – Shock Wave Lithotripsy

First you’ll receive an anesthetic to make you nice & comfortable during the procedure. Then we use tiny shock waves fired at the stone to break it up into smaller pieces that can be passed on their own through your urine. Ever play 'Space Invaders'? It’s like that. Pew Pew!

URS – Ureteroscopy

You’ll be put to sleep under general anesthesia and a small scope (a.k.a tiny camera) is inserted through the urethra, bladder, ureter and kidney depending on where the stone is located. The scope lets me see exactly where the stone is and then I use a small instrument inserted through the scope to either retrieve or break up the stone.

PCNL – Percutaneous Nephrolithotomy

If your stones are really large and remain in the kidney a PCNL is likely the best option for you. General anesthesia is given and a small (we’re talking half an inch) incision is made in either your back or side. A hollow nephroscope is inserted into the kidney and just like the URS procedure, an instrument is inserted through the nephroscope to break up the stone. Then any remaining pieces are suctioned out.

What Should I Do Next?

If you think you may have kidney stones don’t just suffer through it. Come in and see me or at least give me a call. I know your neighbor’s grandma’s uncle’s friend probably has an old home remedy for passing stones, but don’t go that route. If left untreated kidney stones can develop into a more serious problem. Also, by the time you spend trying various home remedies that ultimately don’t work. You could have already been in, out, and on your way feeling better much quicker. Just saying!

Feel free to email me if you have more questions or would like to schedule an appointment. I’m always happy to help. 

- Dr. P

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About the Author

Doctor Joseph Pazona is the founder of Pazona MD, a specialty urology practice located in Nashville, TN. He has been published in medical journals on the topic of urology & authored several consumer ebooks on a variety of urologic conditions in addition to the topics of telemedicine, and continuing medical education (CME). When he’s not treating patients or writing he enjoys traveling, hiking, running, cooking, and spending time with his three children and fiancé, Catherine.


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