Kidney Stone Signs and Symptoms [Dr. Dileep Bhat]

My name is Dr. Dileep Bhat, I'm a urologist at the Brookings Health System and I've been here for a year now. Before that, I practiced Urology in Mitchell for 34 years. I did my medical school training in India, and then I did my General Surgery and Urology residency training programs in New York City.

What are kidney stones?
 
Kidney stones are, obviously, stones that form in the urinary tract—that could be the kidneys, the two ureters that bring the urine down from the kidney to the bladder, in the bladder or in the urinary passage.

What are the symptoms of kidney stones?

Sometimes, you can have kidney stones with no symptoms, because symptoms usually develop when they start blocking the urine flow, but you can have blood in the urine. It could be what we call gross hematuria, where the blood is quite obvious in the urine, or it could be microscopic hematuria, where you can't see it with the naked eye, but you can see it under the microscope. If it blocks the kidney, then you can have severe pain. Urinary pain will be in the flank, coming around to the front. Also, kidney stones can cause urine infections. Those are some of the things that can lead to diagnosis of kidney stones. 

What causes kidney stones?
 
Kidney stones form because there's too much of a certain chemical in the urine. Most kidney stones are calcium stones. So it's usually calcium, that is, too much calcium being put out by the kidneys, they get deposited in the urine, and that's how kidney stones form. There are other chemicals that form stones too. There are what we call uric acid stones, there are what is called cysteine stones, and there are infection stones that form in infected urine called struvite stones. 
 
Sometimes, it can be genetic, and so a lot of times there will be a strong family history of kidney stones. It can be a genetic defect that some kids are born with and they get kidney stones really early in life. Even babies, sometimes, can have kidney stones. 
 
Other reasons for kidney stones is diet—a diet that is very rich in fat, high meat content or high salt content. If you don't drink enough water, you get dehydrated. That can lead to kidney stones.

Who is at risk for kidney stones?

If you've got a family member who has had kidney stones, then obviously, you are at higher risk for kidney stones. Also, some patients who have bowel absorption problems. Sometimes, there are patients who have had bypass surgery, or they have inflammatory disease of the bowel, like ulcerative colitis, regional ileitis, or Crohn's Disease. They can also have kidney stones because of the altered metabolism in the body. 

How do you diagnose kidney stones?

Typically, a patient presents to the hospital unit or comes to the emergency room or the clinic complaining of pain or blood in the urine. Obviously, we check the urine for blood in it or for any signs of infection. Also, the most common test, or standard tests which are designed to diagnose kidney stones is a CT scan. That tells us, first of all, if there's a kidney stone. If it's a kidney stone, is it in the kidney, in the ureter or the bladder? And also, it tells us if there is a blockage causing backflow of the urine to the kidneys. 

How do you treat small kidney stones?
 
Typically, anything four millimeters or less in size, we consider it a small stone. These are the stones that have a very good chance of passing on their own. So, if we see a small stone and the patient is not septic, not running a fever or chills, usually we'll just tell them to drink lots of fluids, try and pass the stone on their own in the urine, and give them pain medication as needed. If they are larger stones, then they can block the kidney, cause a lot of pain, and they sometimes will need treatment. 

How do you treat large kidney stones?

If there's a large stone that does not pass on its own, the treatment depends on where the stone is located. If it's in the ureter—which is a tube between the kidney and the bladder—and closer to the bladder, it's easier to take it out with a scope. So, under anesthesia, I pass the scope through the opening to the urinary tract, get into the bladder, and then pass the scope into the tube on the side that the stone is located. If it's a small stone, I can take it out intact using an instrument called a stone basket. If it's too large to take out intact, I can break it up with a laser machine and then take the small pieces out. 
 
Now, if the stone is located in the kidney, sometimes I'll break it up using what is called a shock-wave machine. It's called ESWR which stands for extracorporeal shock-wave lithotripsy. This is a machine that generates shocks from outside the body. I position the patient using x-rays in such a way that the shock-waves meet at the stone. The shock-waves break up the stone and it's fine gravel. Then, they pass the gravel in the urine. 

What is recovery like after surgery?
 
After the kidney stone surgery, they are usually in the recovery room and under observation. Usually within a few hours of the procedure they're able to go home. Usually, we leave a stent in there, and this is to let that area heal up from the procedure. For about a week after the procedure, they should not be doing any heavy lifting or straining. After a week, I take the stent out, usually in the clinic under local anesthesia.

Would you recommend Brookings Health System?
 
Oh, absolutely. We have the equipment that's needed and the expertise to do it, so I definitely recommend doing it here.