FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine
WATER AND SOUND WAVES: PART OF ARSENAL AGAINST
Question: I've had kidney stones two times in the last nine years, and I had to have lithotripsy the second time. How can I keep from having a third bout with kidney stones?
Answer:
About one out of every 1,000 people have had kidney stones, and 50 percent of
these individuals will have a second attack within 10 years of their first episode.
Your history, therefore, is a fairly common one. For the kidneys to function
properly, the waste products they excrete must be dissolved in the urine. If
the
amount of water is too little to keep the wastes dissolved, they can crystallize
and form kidney stones. The most common stones are composed of calcium oxalate
and/or calcium phosphate and account for 80 percent of kidney stones. Struvite,
uric acid and cystine stones make up the remaining 20 percent. Kidney stones
pose a serious health risk because of their potential to obstruct the ureter,
the tube which connects the kidney to the urinary bladder. Blockage of the ureter
produces increased back pressure on the kidney that can destroy this vital organ
if the normal flow of urine isn't restored in time. A stone in the ureter is
also very painful, as you and anybody else who has ever had one can confirm.
The pain is actually advantageous since it gets the victim to the doctor before
kidney damage can start.
The most important thing you can do to prevent a third kidney stone episode is to increase your urine production to three quarts each day. For most people this means a glass of water every other waking hour. If you're not used to drinking this amount of water, it may seem as though you are either drinking water or urinating most of the day. But just remember the kidney stone pain -- it should provide very good motivation to drink as much water as you should! The treatment for kidney stones can be simple or complex. In the best situation, the stone is small enough to pass through the ureter without other aid. Passage of the stone can be expedited by a high urine flow produced from drinking large amounts of fluid. Pain medication is usually needed, and sometimes other drugs are used to reduce the risk of infection.
Some types of stones
can be dissolved with medication and an abundance of water, but most require
other treatment. In some cases an instrument can be passed into the bladder
and then up the ureter until the stone is reached. Small stones can be grabbed
and pulled out while larger stones need to be broken up first with a stone-crushing
tool or, occasionally, a laser. Extracorporeal shock wave lithotripsy (ESWL)
-- the treatment you had -- pulverizes the stone by aiming
high-frequency sound waves directly at it. ESWL has greatly reduced the need
for surgery to physically open the ureter and take out stones that are too large
to be removed in other ways. As you know, recovery from ESWL is much quicker
than recovery from traditional surgery. "Family Medicine" is a weekly
column. To submit questions, write to John C. Wolf, D.O., Ohio University College
of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701. Past columns are
available online at http://www.FamilyMedicineNews.org.
"Family Medicine" is a weekly column.
To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.
Past columns are available online at http://www.FamilyMedicineNews.org.