I have a kidney stone. Now what?

Author: Dr. John Maggioncalda

The treatment of kidney and ureteral stones is dependent on a number of factors.  For most patients expulsive therapy will usually suffice. Expulsive therapy involves the use of analgesics, hydration and agents such as Tamsulosin to promote stone passage. If the pain from a stone can be controlled, most stones less than 6mm can be passed. For some patients with large stones or excessive pain or persistent nausea, expulsive therapy is not an option.

For larger stones, 6-7mm or greater, or for patients who fail expulsive therapy, extraction is usually preferred. Stone extraction requires ureteroscopic surgery. This procedure is often performed on an outpatient basis and requires about 45 minutes to complete. Pain post operatively is usually mild to moderate. Shock wave lithotripsy can also be performed as long as the stone is visible in the kidney or ureters. This technique is also performed on an outpatient basis with only heavy sedation.  Post operative pain is usually mild.

Larger kidney stones (>1cm) are more difficult to treat and often require multiple procedures. For patients suffering from large stones a percutaneous lithotripsy is the procedure of choice. This technique requires general anesthesia and is accomplished by dilating a tract into the kidney through the back. A large sheath is passed into the kidney near the stone and specialized instruments are used to fragment and extract the stone pieces. Post operative pain can be significant, and a hospital stay of 1 to 2 days is customary.

If you have a kidney or ureteral stone it important to seek therapy right away. Contact a urologist to make a treatment plan that is customized to you and your stone. It is also important to follow up on a regular basis to monitor the success of the treatment and to form a plan to help prevent more stones from forming.

Radiotherapy Treatment For Prostate Cancer

Author: Dr. Mark Alden

Prostate cancer is the most common cancer in men. It affects over 200,000 men in the United States every year, and over one million worldwide. Despite the popularized idea of its being less aggressive, it is a leading cause of cancer death in men. And many can suffer from it, while dying of other causes. A man’s lifetime risk of developing prostate cancer is approximately 8%.

Fortunately, it can be detected early and cured in a very high percentage of men in whom it is found. For men diagnosed with early stage prostate cancer, they have many excellent choices of treatment, all with high cure rates. The cure rates are generally at or above 90% for those in the most favorable categories.

Radiotherapy is one of the excellent options. In the 21st century, it is both very simple and very complex. It is simple in that patients come in to the center, usually wait five to 10 minutes, walk into the treatment room, lie on the treatment table, FEEL NOTHING for the 10-to-12 minutes the beam is on, walk out, drive home or to work or to their favorite hobby. The process is repeated daily, Monday to Friday for a number of weeks. There are no restrictions on activities or favorite pursuits.

Radiotherapy is complex technologically. In its state-of-the-art form we use IMRT or Intensity Modulated Radiation Therapy. This means that multiple beams are used, and each beam is made up of lots of little beams—like “pixels” — to create a highly 3D-shaped dose “cloud” around the targeted area. Each little “pixel” beam can be regulated from zero dose to full dose depending on what other organs it may pass through. In this way dose to sensitive organs can be minimized, and dose to the target maximized. This ability to get high doses into the cancer and keep the normal organs relatively lightly dosed has resulted in the high cure rates and low side effects of modern radiotherapy.

Why I Screen For Prostate Cancer

Author: Dr. Dan Silverberg

I want to tell you about a man I saw in my office recently. To protect his identity and privacy, I will call him Ted and change a few of the details of his story.

Many of you know Ted. He runs a local restaurant. He greets you when you walk in, asks how you enjoyed your meal and bids you goodbye at the cash register as you leave. If you do not know Ted, you know someone very much like him. Ted is under 60, the father of three children, two in high school and one in college. He has worked long days all of his life to provide for his family. He is a pillar in his community.

Ted is not one to go to the doctor, particularly if he is not sick. Recently, Ted had his prostate checked. He had no symptoms at all, but his prostate exam was abnormal and his PSA level was about 90. It should be less than 4.0. Prostate biopsies confirmed the diagnosis of prostate cancer. Additional testing showed that the tumor had already spread throughout his body. Ted is under treatment now, and responding well, but his prostate cancer has a huge head start. His cancer is not curable, but we hope to be able to control it for a number of years.

As Ted and his wife left my office, shell-shocked after I broke the news to them, I asked myself, where was Ted five years ago? Where was Ted three years ago or even two years ago when we could have done so much more to help him? Where was Ted when we still had a chance to cure him?

Because prostate cancer has no early signs or symptoms, the only way to find the disease while it is still curable is to screen every man over the age of 50 annually. The screening includes a PSA blood test and a digital rectal exam.  If Ted had been screened starting at age 50, his life would be much different now.

Is that a kidney stone?

Author: Dr. John Maggioncalda

Uh-oh, that feeling of pressure giving way to pain, that wave of nausea — yep, it’s a stone. To many, these very unwelcome sensations herald the passing of a kidney stone. The pain may be short-lived or long, the passing brief or not.

Kidney stones affect millions of Americans every year. About one in 10 people will form kidney stones at some point in their lives. The majority of people who get stones are between the ages of 20-50. Men are afflicted more than women (three to one). The most common risk factor for forming stones is a history of stone formation. Those who form more than one stone are at risk of multiple episodes throughout their lives.

Kidney stones can be made up of different compounds. The most common type of stone is a calcium stone. Over 80% of kidney stones are calcium mixed with other agents such as oxalate or phosphate. Uric acid makes up about 15% of stones while cysteine accounts for about 1-2%.

The cause of kidney stones is multifactorial. Dehydration from poor fluid intake is a prominent cause. As urine becomes concentrated, calcium salts can precipitate out, clump together, and form stone material. Residents of hot, dry regions are particularly prone to stones. Other factors include chronic urinary tract infections, metabolic diseases (gout, excessive calcium absorption), inflammatory bowel disease and gastric bypass, hormone imbalances (hyperparathyroidism), renal disease and poor dietary choices. 

If you have a kidney or ureteral stone, it is important to seek therapy right away. Contact a urologist to make a treatment plan that is customized to you and your stone. It is also important to follow up on a regular basis to monitor the success of the treatment and to form a plan to help prevent more stones from forming.