Kidney Stones Choosing Your Kidney Stone Care Treatment Guide

Treatment Guide
Kidney Stones
Choosing Your Kidney Stone Care
Through a multidisciplinary approach, Cleveland Clinic
nephrologists and urologists in the Glickman Urological & Kidney
Institute explore all medical and surgical options to ensure
that our kidney stone treatment program will aggressively work
toward a successful outcome for each patient.
While there are many kidney stones treatment options, you also
should consider the experience of the program. Cleveland Clinic’s
Cleveland Clinic kidney stone specialists tailor
urology and nephrology programs are ranked No. 2 in the nation
kidney stone treatment plans to their patients’
by U.S. News & World Report.
individual needs. This guide provides an overview
Please use this guide as a resource as you examine your
of the type of treatment options offered.
treatment options. Remember, it is your right as a patient to ask
questions and to seek a second opinion.
Same-day appointments are available.
Call toll-free 800.223.2273 ext. 45600.
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GLICKMAN UROLOGICAL & KIDNEY INSTITUTE
KIDNEY STONES | TREATMENT GUIDE
About Kidney Stones
What are the symptoms of kidney stones?
The most common symptoms of kidney stones are blood
in the urine and/or pain in the side or back. The severity
and location of the pain may vary depending on such
factors as stone location and degree of obstruction.
Other symptoms include:
• feeling the need to urinate often
• inability to urinate (When kidney stones are
large or there is more than one, they may block the flow of urine.)
•nausea
•vomiting
Cloudy, foul smelling urine, fever, chills or weakness may
What are kidney stones?
all be signs of a serious infection.
Kidney stones, a very common disorder of the urinary tract, are small
Some kidney stones are called “silent stones” because
masses of crystals that form in the kidneys. Urine normally contains
they do not cause any symptoms at all.
chemicals that prevent the crystals from forming. However, if crystals do
form, often they remain small enough that they can travel through the
urinary tract and pass out of the body unnoticed.
When crystals combine into a larger mass to form a kidney stone,
the stone can stick to the lining of the kidney or settle in an area where
urine cannot carry it out of the body. Larger stones may become lodged
in the urinary tract and cause cramping, blood in the urine, pain,
How are kidney stones diagnosed?
If symptoms are present, a physician may order X-rays
or an ultrasound examination of the kidneys, ureters
(tubes that carry urine from the kidneys to the bladder)
and the bladder.
A urine test may be used to find very small kidney stones
blockage or infection.
in the urine. The urine is strained and any stones found
are analyzed to determine their chemical composition.
What causes kidney stones?
More than 90 percent of people with kidney stones have a chemical abnormality of blood or urine that contributes to the tendency to form
the stones. Not drinking enough water or other fluids also may contribute
to the formation of stones. Inadequate fluid intake causes the kidneys to
produce less urine as well as urine that is highly concentrated. The smaller
the daily volume of urine, the more likely it is that a person will form kidney
stones. This is especially true if a person has one of the previously mentioned chemical abnormalities.
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Same-day appointments are available. | Call toll-free 800.223.2273 ext. 45600.
GLICKMAN UROLOGICAL & KIDNEY INSTITUTE
KIDNEY STONES | TREATMENT GUIDE
Treatment Options
Observation and stone passage. In many cases, a person can pass the
stone through urination. This may be a painful process that can take a
couple of days or more. A physician may prescribe pain relievers and
medication to relax the ureter. The patient will be asked to strain the urine
and save the stone so that it can be analyzed. The likelihood of stone passage depends on the size and location of the stone. For example, a 5mm
stone will have about a 60 percent chance of being passed if a medication
to relax the ureter is prescribed. However, on average this would take two
weeks.
Minimally invasive interventions. When a person cannot pass a kidney
stone through the urine, there are minimally invasive treatments available:
• Ureteroscopy. This outpatient procedure involves inserting a small
Cleveland Clinic urologists were among the first
instrument called a ureteroscope through the urethra (the tube through
in Ohio to use shock wave lithotripsy, and more
which a person passes urine from the body) and up the ureter (the tube
that drains the kidney to the bladder) to visualize the stone. The stone is
then fragmented with a laser and the fragments may be retrieved with a
than 3,000 patients have undergone it here.
Our success rate is greater than 80 percent.
basket. A ureteral stent is often left for one week after this procedure. The
main risk is possibility of injury to the ureter. A major injury occurs in one
out of 1,000 procedures.
• Shock wave lithotripsy (SWL). SWL is a noninvasive technology that
allows urologists, using a specialized table, to focus waterborne shock
Urologists at Cleveland Clinic perform on
average four to six percutaneous nephrolithotomy
procedures per week –more than the average
waves through a localized area of the body and on the kidney stones to
urologist in the United States performs annually.
disintegrate them. The stones are broken into small particles, which can
Cleveland Clinic urologists also employ a
then be passed through urination. The procedure takes approximately one
“tubeless” approach in select patients to avoid
hour and patients are generally discharged from the hospital a few hours
the pain and inconvenience of a tube coming
after the treatment.
out the back.
Most kidney stone patients are eligible for SWL, although some are not
suitable candidates. Factors such as size, location, hardness and number
of stones, height, weight and pregnancy may indicate the need for a
different treatment.
Surgical intervention – percutaneous nephrolithotomy. A surgical procedure called nephrolithotomy may be performed if the kidney stone is large
or cannot be treated in any other way. During this inpatient procedure, the
surgeon makes a small one-inch incision in the patient’s back in order to
access the kidney and remove the stone.
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Same-day appointments are available. | Call toll-free 800.223.2273 ext. 45600.
GLICKMAN UROLOGICAL & KIDNEY INSTITUTE
KIDNEY STONES | TREATMENT GUIDE
To make an appointment with a kidney
stone specialist in the Glickman Urological
& Kidney Institute, call 216.444.5600 or
800.223.2273, ext. 45600.
Meet Our Kidney Stone Specialists
Cleveland Clinic
Medical
Juan Calle-Cano, MD
Surafel Gebreselassie, MD
Phillip Hall, MD
Prevention is the Best Medicine:
The Kidney Stone Clinic
James Simon, MD
People may suffer for years and not know why they
Omar Ortiz-Alvarado, MD
continue to develop kidney stones. Experienced nephrologists and urolo-
Khaled Fareed, MD
gists in Cleveland Clinic’s Kidney Stone Clinic investigate the cause of
kidney stone formation in patients through 24-hour urine analysis, blood
tests and metabolic labs. They then develop prevention strategies tailored
to individual patients. Patients of the Kidney Stone Clinic receive a better
Surgical
Manoj Monga, MD
Director, Stevan B. Streem Center for
Endourology & Stone Disease
understanding of why their kidney stones develop and what changes they
Mark Noble, MD
can make in their everyday lives to prevent them.
Sri Sivalingam, MD
Patients are provided with personalized diets based upon the results of
Robert Stein, MD
Co-Director, Robotic Surgery
the stone panel analysis. While encouraging increased fluid intake is a
universal recommendation, all dietary interventions are not the same.
Patients are seen during the initial visit with the urologist and a dietitian
each follow-up visit to assess dietary implementation. Tailored dietary
intervention plans are mutually agreed upon with the patient, label read-
Cleveland Clinic Florida
Barbara Ercole, MD
ing is discussed and other health-related issues are incorporated into the
William Gans, MD
dietary instruction for a comprehensive approach to managing kidney
Nicolas Muruve, MD
stones. The Cleveland Clinic Kidney Stone Clinic is the only clinic in Ohio
Sneha Vaish, MD
where a dietitian works in partnership with physicans to plan treatment for
patients as appropriate.
For their convenience, patients can see dietitians in a Cleveland Clinic
Cleveland Clinic Urology, Las Vegas
family health center in their community. All stone-forming patients are
Leslie Larsen, MD
encouraged to actively engage in dietary counseling as simple dietary
Scott Slavis, MD
changes can have a dramatic impact on preventing future stone formation.
It is recommended that patients consult their insurance plans to determine
coverage for dietitian services.
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For more information about our staff, including complete
profiles, visit clevelandclinic.org/staff.
Same-day appointments are available. | Call toll-free 800.223.2273 ext. 45600.
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