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Scott Webb: Hello and welcome to Checkup Chat with Evergreen Health. I'm Scott Webb and we're here today with Dr. Jessica Dai from Evergreen Health Urology Care to discuss kidney stones, a common condition that affects over a half million people per year. Dr. Dai, welcome. Thank you for joining us on Checkup Chat.

Dr. Jessica Dai: Thank you. It's wonderful to be here.

Scott Webb: Yeah, so as I mentioned in my intro, kidney stones are a common condition. Seems like I hear about them a lot. I don't know if it media, social media. You just see people seem to talk about kidney stones. So could you explain what exactly kidney stones are and how common are they?

Dr. Jessica Dai: Kidneys are actually very common. . They affect about one in 11 people in the United States, and that number's been growing over the last decade or so these are calcifications typically that form in the kidney. And some of them stay up in the kidney and don't cause many problems, and some of them start to move or try to drop down out of the kidney, down the uterine tube that carries urine into the bladder. And that's typically when most of us tend to find it. , they can present with symptoms or some of them can be as we called asymptomatic. And, these are very common things that we see.

Scott Webb: Yeah. It seems that they are. It seems like everybody of a certain age anyway has kind of been through this, but are there some specific risk factors that increase someone's chances of developing kidney stones?

Dr. Jessica Dai: There's a couple different types of kidney stones and some of the risk factors kind of depend on the type of stone. They also depend on our personal medical histories. Just to kind of briefly describe there are types of stones. Most common type is calcium oxalate, your run-of-the-mill stone. Most people who have kidney stones do have calcium-based stones, but there are other less common types of stones that we do see uric acid stones, for example, or struvite stones, or even cystine stones.

And I mentioned those because uric acid stones, for example, in particular, are associated, or folks who are diabetic tend to have a higher , Likelihood of having uric acid stones, and that's the rare stone that actually can be dissolved over time with the medication. Folks who have recurrent urinary tract infections, particularly folks who have spinal cord injuries, or just recurrent infections in general, tend to be at higher risk for stite infections and eradication of the infections for those type of stones. In addition to treating the actual stone or really the cornerstone of preventing the stones from coming back.

And then lastly, cystine stones. Those are stones that actually are formed from a genetic predisposition. It's a mutation in one of the transporters in the kidney, in terms of how they transport amino acids. And so that's a stone that is treatable, but they're hard stones and they tend to recur very frequently. And these are people that can form stones from a young age.

Scott Webb: Yeah. I mentioned people of a certain age, but as you mentioned, that type obviously, can affect younger folks as well. So what are some of the symptoms? I hear a range of things, but never pleasant , no one ever says, You know, it wasn't so bad having a kidney stone, but let's talk about the symptoms. What would folks be experiencing?

Dr. Jessica Dai: Yeah, so the symptoms typically happen when the stones start to try to move or drop down the ureter. You know, some people with asymptomatic stones, meaning the ones that kind of sit up in the kidney and don't do much, may sometimes have blood in the urine or what we call hematuria. Whether that's blood that they see or blood that's picked up on a dipstick in the clinic. When the stone does try to move and they start having symptoms really commonly, Flank pain oftentimes is associated with nausea, and the pain can radiate, and it can be felt in other places. Sometimes it wraps around the back towards the lower abdomen. Some particularly men may feel it in the groin or the testicle.

And it kind of depends on the size of the stone, where the stone is and how much it's blocking the kidney. Sometimes you might feel other symptoms, nausea, vomiting, in particular the ones that I worry about the are people who have these symptoms and also have fevers or chills or signs of, a systemic infection. Those are our emergencies actually.

Scott Webb: Yeah, that would be a time for urgent care or the ED, something like that.

Dr. Jessica Dai: Mm-hmm. Definitely.

Scott Webb: Yeah. So let's talk about diagnosis, right? I'm assuming when you meet with a patient, you go through patient history, you know what they're experiencing and so on. So I'm not sure if there's any tests per se, but how do you diagnose kidney stones?

Dr. Jessica Dai: Yeah, kidney stones, there are all these clinical signs and symptoms that we just talked about that kind of raise our suspicion that you might have a kidney stone. But really the cornerstone of diagnosis is imaging, and that could be any number of things, a CAT scan or a CT scan, or even just a plain x-ray or an ultrasound.

Those all give us indications and can sho w whether there are stones present. Other tests that can be helpful in terms of making the diagnosis and helping us to decide what to do. Include blood tests, , looking at your white counts, looking at your kidney function and urine testing also to make sure that you don't have an active ongoing infection.

Scott Webb: Yeah. Infections. When you think about conceptions and mainly misconceptions, one of them about kidney stones is that it needs to be passed naturally to be treated. Is that always the case? And either way, what are the treatment options?

Dr. Jessica Dai: Yeah, that's a great question. I would say the vast majority of kidney stone. Often do pass on their own. And I certainly being a urologist, tend to see the ones that don't. How likely they are to pass is often dependent on where they are in the urinary system, whether they're up in the kidney, up in the top part of the Utera or down at the bottom part. And also how big they are and how long they've been trying to pass. There are some stones that kind of get stuck in the utera, so to speak. And the more they get stuck, the more they create some inflammation and then it becomes harder for them to pass.

The stones that do pass oftentimes are symptomatic, meaning that most people feel them, they're, they don't kind of pass unnoticed. And the ones that don't pass, typically we talk about then doing treatment or surgery for, and those are the ones that typically we've kinda given at the old college. Try about four to six weeks of letting you try to pass it on your own. And at that point, if it hasn't passed, it's fairly unlikely to pass. There are a couple different treatment options for kidney stones and you'd have to talk to your doctor in terms of the specifics, because they are very tailored in terms of the size of the stone, where the stone is located, what your body habitus looks like, how the stone looks on the x-ray, for example.

But broadly speaking, for kind of most stones treatment options include shockwave lithotripsy, or urethroscopy. Shockwave lithotripsy is a noninvasive way to treat stones, where we basically put a probe to avac and we deliver shockwave energy directly through the kidney, through the back, and to the stone. We have to be able to see the stone on an x-ray typically to target this well. And then the stone breaks up and we rely on your body's natural urine flow to kind of pass the stone fragments. It's the least invasive way. Certainly it's not a good option if you are, have an active infection, if you're pregnant or if you're blood thinners because there are risks in terms of bleeding and infection from that perspective.

Urethroscopy is the other way that we very commonly treat stones, that is a little bit more invasive in that it entails driving up in through the bladder and up the utera tube directly to the stone with a small telescope. And the advantage of that approach is that I could see the stone directly and I can see exactly the size of the fragments that I'm generating and what I've cleared out. The stone is broken up with a little laser fiber. Any big pieces are pulled out and there may be just fine sand or gravel that passes on its own afterwards.

And typically after that procedure, I leave a stent, which is a temporary. Plastic greenage tube, not like the kind of stent that goes in your heart, that's a permanent piece of metal. But this is something that's soft, pliable comes out typically in about a week to two weeks. And the purpose of the stent is to keep the utera open sometimes just from the stone being there or from me driving up the utera, it can cause some swelling and inflammation that rarely is enough s swallow a kidney shut and make you feel like you've got a kidneys done all over again.

So that stent is temporary. It comes out in about a week to two weeks. And then lastly, the third treatment option typically is reserved for larger stones. That's something called percutaneous nephro lithotomy or pcnl. I know it's a big, a big mouthful.

Scott Webb: That's a lot of letters there.

Dr. Jessica Dai: Exactly, but that entails going through the back again , in the same approach as the shock with, but I actually make a hole through the back, through the kidney and to the stone, and it's a bigger entry into the kidney and lets me treat the stone more directly. So it's a better option for bigger stones. It also a better option for some infection based stones as well. I actually treat the stones and the pieces get sucked out through this lithotriter device that has a combination of a suction, and then there's a couple different energy modes that can be used ultrasonic and pneumatic, lithotripsy.

But the long and short of it is that the stone gets broken up, the pieces get sucked out, and it's a much more efficient way to treat a big kidney stone. If we try to treat it with any of the other ways, for example, might require multiple trips to the operating room, whereas this might be able to take care of it with one procedure. And then there's a variation on that pcnl, something called a mini pcnl where I use a smaller channel and I make a smaller hole. So there's slightly smaller risks to that procedure. And it lets me clear out the stones a little bit more effectively than I might be able to through some of the other methods, if they're larger stones.

Scott Webb: Well, you know, obviously kidney stones are not fun for anybody, especially patients. But good to hear that there's lots of options depending on the size and location, magic words to my ears. Shock waves and lasers. You know, once you're 15, doctor, you're always 15. So I hear laser and I think, Well, that's cool.

Dr. Jessica Dai: Yeah, exactly.

Scott Webb: I was gonna ask you if Stones recur for people, but I think how I wanna phrase this is once folks have stones, if they are sort of the kind of person who has kidney stones or who develops kidney stones, does that become a common theme in their life? Do they tend to come back more For folks who've had them previously?

Dr. Jessica Dai: Yeah, that's a great question. And we were talking earlier about risk factors. There are some things just in our lifestyle, for example, or in how our body processes, certain chemicals, calcium, for example,, or even family history, kind of increases our risk of stones. And some of these are things are within our control and some of them are not. Folks who do have kidney stones tend to be at higher risk for having recurrent stones. And so what I typically do with my patients, Particularly for folks who've had multiple stone episodes. But even for folks where it's your first time you've had stones, I take a fairly aggressive approach to stone prevention.

There are some general things we can do to prevent kidney stones from coming back. Staying very well hydrated. Avoiding high salt or high animal proteins in our diet. And actually, having a moderate amount of calcium is actually protective, particularly for calcium based stones. Some people think, we gotta cut out calcium because they've got a calcium based stone, and that's simply not true. But there are other things we do. I often will do 24-hour urine testing, which is a metabolic evaluation to look at your individual specific risk factors. And that helps us pinpoint and develop an individualized plan for you in terms of what modifications we might need to make.

It might be drinking more fluid to combat dehydration. It might be altering your diet to decrease your protein intake. It might also include medications to help regulate th e pH of your urine or the calcium levels in your urine. So, I think for me, In my approach to how to prevent the stone, it's very personalized. And I think the goal is trying to not have them recur for you.

Scott Webb: Yeah, it does seem that prevention is key, but obviously there are a lot of options, shockwaves and lasers and things with big words. And thank goodness we have you and your expertise to help us through things like this. Help us take care of these stones, laser them, or vacuum them, or whatever it might be. So this has been really educational today. Doctor. Thanks so much for your time.

Dr. Jessica Dai: Absolutely. It's been a pleasure.

Scott Webb: Evergreen Health Urology Care provides expert evaluation and treatment for urinary tract and pelvic health issues to help you improve your quality of life. To schedule an appointment, please visit the Evergreen Health Urology Care website at evergreenhealth.com/urology-care, or call 425-899-5800 . Please remember to subscribe, rate and review this podcast and all the other EvergreenHealth podcasts. For more health tips and updates, follow us on your social channels.