Kidney Stones: Risk, Treatment and Prevention
Most people have heard about painful kidney stones, and some liken passing them to giving birth. Is that a good analogy? Learn from Dr. Andrew Riggin, a urologist at UM Shore Regional Health, what kidney stones are, who is most at risk, how to treat them, ways to prevent them and if they are really as painful as having a baby.
Featured Speaker:
During his training, he also acquired experience using the latest minimally invasive, laparoscopic and robotic assisted techniques for the management of kidney, bladder and prostate cancer, as well as BPH. He uses the Da Vinci surgical robot to remove kidney tumors and to reconstruct kidney and ureteral abnormalities. He also performs a wide array of BPH procedures including REZUM, Greenlight Laser PVP and Trans-urethral resection of the prostate (TURP). Additionally, he offers a broad spectrum of medical and surgical treatments for erectile dysfunction.
Read more about Dr. Riggin and watch a video here.
Andrew Riggin, MD
Dr. Riggin, a urology expert at UM Shore Medical Group, has been a practicing urologist since 2017 and treats all aspects of adult urological disorders. He has a special interest in kidney stone disease and his goal is to make all of his patients 100% stone-free through a comprehensive approach, which includes surgical and medical management, as well as preventive care. He also has extensive experience performing "tubeless" percutaneous nephrolithotomy (PCNL) for the management of large and complex kidney stones.During his training, he also acquired experience using the latest minimally invasive, laparoscopic and robotic assisted techniques for the management of kidney, bladder and prostate cancer, as well as BPH. He uses the Da Vinci surgical robot to remove kidney tumors and to reconstruct kidney and ureteral abnormalities. He also performs a wide array of BPH procedures including REZUM, Greenlight Laser PVP and Trans-urethral resection of the prostate (TURP). Additionally, he offers a broad spectrum of medical and surgical treatments for erectile dysfunction.
Read more about Dr. Riggin and watch a video here.
Transcription:
Kidney Stones: Risk, Treatment and Prevention
Prakash Chandran: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This episode is sponsored by University of Maryland Shore Regional Health. Today's topic is kidney stones, risk treatment, and prevention.
My name is Prakash Chandran and my guest today is Dr. Andrew Riggin. He is currently a urologist at University of Maryland Shore Medical Group. Dr. Riggin, thanks so much for joining us today. Really appreciate your time. Let's get started with the basics. What exactly are kidney stones?
Dr. Andrew Riggin: Hi, Prakash. Thanks for having me. I kind of describe to patients kidney stones as being these hard deposits that are typically made up of either minerals or salts that form inside the kidney, and that they're just that.
Prakash Chandran: Got it. And what exactly causes them to form in the first place?
Dr. Andrew Riggin: Well, a lot of different factors can lead to the formation of kidney stones. A lot of the times it's diet, either not drinking enough fluid or eating certain things too much or too little of those things. Also, certain medical conditions can cause you to get kidney stones. Being overweight can actually increase your risk in getting kidney stones, certain medications too. But stones in general form because these deposits in your kidney become very concentrated and then they stick together and form these stones.
Prakash Chandran: Okay. And you started to touch on this, but what factors increase the risk of getting kidney stones?
Dr. Andrew Riggin: So I usually tell my patients that the most common factors for getting kidney stones are either not drinking enough fluid or eating a diet that's too high in salt. Those are probably the most two common reasons for making stones. However, there are other factors that can cause you to get stones, including diets, really high in protein, sometimes diets high in foods that contain oxalate, eating too much or too little calcium. There's also other things that can increase your risk factors for stones, such as having a first degree relative like a parent or a sibling that has stones, having certain surgeries on your bowels can cause you to get kidney stones and also problems with chronic constipation or diarrhea.
Prakash Chandran: Okay. And so in terms of preventing getting them, is it just, for example, drinking more water and reducing salt intake? Like what would you recommend to people that, you know, want to be proactive about not getting kidney stones?
Dr. Andrew Riggin: So one of the most important things I tell people, I kind of joke, I say 96 ounces of fluid a day keeps the urologist away. So I usually tell people to try to drink at least 96 to a hundred ounces of fluid a day. It doesn't have to just be water, but just some fluid to help them make more urine. Because the more urine you make, the less likely you are to make kidney stones.
Other things I try to tell people to do are try to just eat less salt in their diet. Most Americans just eat too much salt. And so, I try to tell them to try to avoid foods that are processed foods, because they generally always have salt. Other things that can help you prevent kidney stones are avoiding diets that are too high in protein or too high in oxalates. Or another problem that sometimes people do is they take too many Tums if they have acid reflux.
Prakash Chandran: So talk to us a little bit about the symptoms that you might have a kidney stone. You know, as we're talking, it reminds me of my college roommate keeled over on the couch in extreme pain. But what was he experiencing and what can people expect when they have one?
Dr. Andrew Riggin: Well, Prakash, that sounds about right. Now, that's probably the most common complaint that people have when they have a kidney stone, which is severe pain in your flank. And your flank is really this part of your back, kind of at the bottom of your rib cage, and that's where your kidneys are located on the back part of your abdomen. That's usually what happens. It's usually a very severe pain. It's intermittent, it comes and goes, or sometimes it just doesn't stop and it's kind of hard to predict.
But other symptoms you can also have when you're passing a kidney stone are nausea, vomiting blood in your urine, and sometimes people also can get infections and get fevers and chills.
Prakash Chandran: You know, I've heard some people say that passing kidney stones is similar to the pain of giving birth. Is there any truth to that?
Dr. Andrew Riggin: Usually women that have given birth say that it's worse. So there is definitely some truth to that.
Prakash Chandran: Wow. So I'm curious as to if someone is experiencing severe pain in their flank, as you're mentioning, what do they do? And how do they know when it makes sense to pass the kidney stone versus going to see someone?
Dr. Andrew Riggin: So I think usually if you're a first time kidney stone patient, and that you've never had this happen before, it's very concerning. It's very worrisome, what's happening to you. And so your first thought is, "I'm going to go to the emergency room." And usually that's not a bad idea because you can get abdominal pain for a lot of different reasons that have nothing to do with kidney stones. So it's usually good to get it checked out, especially if your pain is really severe. So people usually go to the emergency room. And there, they get a CAT scan to see what's the cause of their pain. Now, if people have had kidney stones before, they maybe have felt this pain before and kind of know what to expect, if they're that person and they've potentially passed a kidney stone before, then it's probably okay to try to potentially pass it at home.
Prakash Chandran: Okay, understood. And so when they go to the ER, the doctor is going to tell them whether or not they have a kidney stone. And if they're at the ER, are there treatments that the patient is given to help them pass it or to help dissolve the stone?
Dr. Andrew Riggin: So there is only one kind of stone that you can dissolve. And they're typically not given that treatment there in the ER, because it's kind of hard to know if they have that stone or not without having more knowledge about kidney stones. They are given medication to help with pain. They're sometimes given really strong IV versions of ibuprofen. They can be given narcotic pain medication. And if they're dehydrated, they can be given extra fluid, which can also help them pass kidney stones.
Prakash Chandran: And what about alternative ways of removing kidney stones? If, for example, they're too big to pass or people need them out sooner for whatever reason, what are some of the treatments that people should be aware of?
Dr. Andrew Riggin: So there are actually a few options for treatment of kidney stones outside of you trying to pass it at home. So say if we decide you can't pass it at home, because your kidney stone's too big or you're in too much pain, well, then you have a few options. One of the options is you can do a shockwave procedure where you would come to the hospital and we would use the shockwave machine to blow up the stone by shooting shockwaves into your body. The advantage of that is it's not invasive in terms of we don't have to put anything inside your body. Now, the downside of it is it's not perfect. But for certain people, it's a really good procedure.
If for some reason that's not a good procedure for you, another option is called ureteroscopy with laser lithotripsy. That's where we put a small camera up into the tube that connects the kidney to the bladder or the kidney itself, and we blow your stones up with a little small laser. And then, we put a stent in afterwards, okay?
Last but not least, there is a procedure for people who have really big stones or very complicated stones. And for those people, there's another procedure called a percutaneous nephrolithotomy. I know that's a mouthful. Abbreviation is just PCNL. But basically, the way it works is I go directly through your back into your kidney, through an incision about the size of a nickel. And then, I can go into your kidney with a larger camera and these larger instruments that blow up kidney stones and suck all the pieces out.
Prakash Chandran: Wow. That's pretty incredible. And one question I forgot to ask earlier is about who kidney stones affect. Are there certain ages or demographics of people that kidney stones represent themselves in more than others?
Dr. Andrew Riggin: So it used to be that there was like a kidney stone season, okay? That it happened in the summer. And it was when people who worked outside, they didn't drink enough fluid and they would get kidney stones because they were dehydrated. But now, the kidney stone season last 365 days a year. And so it doesn't discriminate between men and women. It doesn't discriminate between race. I will say that some people who are overweight tend to get stones more so than people who aren't, but that would maybe be the only thing I could say for sure.
Prakash Chandran: Okay. So it's not like a young person's disease. It really occurs at all ages.
Dr. Andrew Riggin: Correct.
Prakash Chandran: Now, you kind of touched on treating a kidney stone at home. What exactly does that mean?
Dr. Andrew Riggin: So, if you go to the ER and you're diagnosed with a kidney stone, one of your options for the treatment for your kidney stone is called a trial of passage, meaning that you try to pass your stone with no surgical intervention. What that entails usually is drinking extra fluid, taking medications to help control your pain, such as Tylenol, ibuprofen or Motrin and sometimes narcotics, if you need them, and then other medications to help control the symptoms of passing a stone. We typically give people about 30 days to pass a stone, as long as they're comfortable.
Prakash Chandran: So 30 days to pass a stone. So let me take a step back here, because sometimes people may have that extreme pain in their flank. Is that something that they have to experience for 30 days? Or is it something that kind of like comes and goes as they're trying to pass it over that 30-day period?
Dr. Andrew Riggin: No, I would say that the people that usually pass their stones at home are not the person with that extreme pain. They're usually the people that are a little bit more comfortable than that. And they intermittently have some little slight twinges and things like that and their pain is generally controlled with ibuprofen and Tylenol. For people who are needing narcotics around the clock, for people who are having a lot of nausea and vomiting, or for people who actually are starting to have signs of an infection, those are called alarm symptoms. And we usually tell them to go back to the emergency room or call us because they probably need a surgery to help them pass their kidney stone.
Prakash Chandran: And just before we close here today, Dr. Riggin, I always like to ask a question about what's one thing that you know to be true with all of your experience as a urologist that you wish more people knew before they came to see you? It's basically the one golden thing that you want to leave with our audience.
Dr. Andrew Riggin: Well, one thing is kidney stones are pretty common. And you're not alone out there and having these kidney stones, a lot of people go through this, but know that when you come to see a urologist to talk about your kidney stone, we will help you figure out why it happened. We will help you treat it, and we'll give you the knowledge that you can be armed with, so hopefully you never have to go through this again.
Prakash Chandran: Well, Dr. Riggin, this has been a hugely informative conversation. Thank you so much. Is there anything else you want to leave with our listeners?
Dr. Andrew Riggin: No, I think that's it.
Prakash Chandran: All right this episode is sponsored by UM Shore Regional Health. with locations in Caroline, Dorchester, Kent, Queen Anne's and Talbot counties, UM Shore Regional Health is dedicated to bringing world class care to the communities of Maryland's Midshore region. UM Shore Regional Health, where the health of the eastern shore comes first.
Find more shows just like this one at umms.org/podcast. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.
Kidney Stones: Risk, Treatment and Prevention
Prakash Chandran: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This episode is sponsored by University of Maryland Shore Regional Health. Today's topic is kidney stones, risk treatment, and prevention.
My name is Prakash Chandran and my guest today is Dr. Andrew Riggin. He is currently a urologist at University of Maryland Shore Medical Group. Dr. Riggin, thanks so much for joining us today. Really appreciate your time. Let's get started with the basics. What exactly are kidney stones?
Dr. Andrew Riggin: Hi, Prakash. Thanks for having me. I kind of describe to patients kidney stones as being these hard deposits that are typically made up of either minerals or salts that form inside the kidney, and that they're just that.
Prakash Chandran: Got it. And what exactly causes them to form in the first place?
Dr. Andrew Riggin: Well, a lot of different factors can lead to the formation of kidney stones. A lot of the times it's diet, either not drinking enough fluid or eating certain things too much or too little of those things. Also, certain medical conditions can cause you to get kidney stones. Being overweight can actually increase your risk in getting kidney stones, certain medications too. But stones in general form because these deposits in your kidney become very concentrated and then they stick together and form these stones.
Prakash Chandran: Okay. And you started to touch on this, but what factors increase the risk of getting kidney stones?
Dr. Andrew Riggin: So I usually tell my patients that the most common factors for getting kidney stones are either not drinking enough fluid or eating a diet that's too high in salt. Those are probably the most two common reasons for making stones. However, there are other factors that can cause you to get stones, including diets, really high in protein, sometimes diets high in foods that contain oxalate, eating too much or too little calcium. There's also other things that can increase your risk factors for stones, such as having a first degree relative like a parent or a sibling that has stones, having certain surgeries on your bowels can cause you to get kidney stones and also problems with chronic constipation or diarrhea.
Prakash Chandran: Okay. And so in terms of preventing getting them, is it just, for example, drinking more water and reducing salt intake? Like what would you recommend to people that, you know, want to be proactive about not getting kidney stones?
Dr. Andrew Riggin: So one of the most important things I tell people, I kind of joke, I say 96 ounces of fluid a day keeps the urologist away. So I usually tell people to try to drink at least 96 to a hundred ounces of fluid a day. It doesn't have to just be water, but just some fluid to help them make more urine. Because the more urine you make, the less likely you are to make kidney stones.
Other things I try to tell people to do are try to just eat less salt in their diet. Most Americans just eat too much salt. And so, I try to tell them to try to avoid foods that are processed foods, because they generally always have salt. Other things that can help you prevent kidney stones are avoiding diets that are too high in protein or too high in oxalates. Or another problem that sometimes people do is they take too many Tums if they have acid reflux.
Prakash Chandran: So talk to us a little bit about the symptoms that you might have a kidney stone. You know, as we're talking, it reminds me of my college roommate keeled over on the couch in extreme pain. But what was he experiencing and what can people expect when they have one?
Dr. Andrew Riggin: Well, Prakash, that sounds about right. Now, that's probably the most common complaint that people have when they have a kidney stone, which is severe pain in your flank. And your flank is really this part of your back, kind of at the bottom of your rib cage, and that's where your kidneys are located on the back part of your abdomen. That's usually what happens. It's usually a very severe pain. It's intermittent, it comes and goes, or sometimes it just doesn't stop and it's kind of hard to predict.
But other symptoms you can also have when you're passing a kidney stone are nausea, vomiting blood in your urine, and sometimes people also can get infections and get fevers and chills.
Prakash Chandran: You know, I've heard some people say that passing kidney stones is similar to the pain of giving birth. Is there any truth to that?
Dr. Andrew Riggin: Usually women that have given birth say that it's worse. So there is definitely some truth to that.
Prakash Chandran: Wow. So I'm curious as to if someone is experiencing severe pain in their flank, as you're mentioning, what do they do? And how do they know when it makes sense to pass the kidney stone versus going to see someone?
Dr. Andrew Riggin: So I think usually if you're a first time kidney stone patient, and that you've never had this happen before, it's very concerning. It's very worrisome, what's happening to you. And so your first thought is, "I'm going to go to the emergency room." And usually that's not a bad idea because you can get abdominal pain for a lot of different reasons that have nothing to do with kidney stones. So it's usually good to get it checked out, especially if your pain is really severe. So people usually go to the emergency room. And there, they get a CAT scan to see what's the cause of their pain. Now, if people have had kidney stones before, they maybe have felt this pain before and kind of know what to expect, if they're that person and they've potentially passed a kidney stone before, then it's probably okay to try to potentially pass it at home.
Prakash Chandran: Okay, understood. And so when they go to the ER, the doctor is going to tell them whether or not they have a kidney stone. And if they're at the ER, are there treatments that the patient is given to help them pass it or to help dissolve the stone?
Dr. Andrew Riggin: So there is only one kind of stone that you can dissolve. And they're typically not given that treatment there in the ER, because it's kind of hard to know if they have that stone or not without having more knowledge about kidney stones. They are given medication to help with pain. They're sometimes given really strong IV versions of ibuprofen. They can be given narcotic pain medication. And if they're dehydrated, they can be given extra fluid, which can also help them pass kidney stones.
Prakash Chandran: And what about alternative ways of removing kidney stones? If, for example, they're too big to pass or people need them out sooner for whatever reason, what are some of the treatments that people should be aware of?
Dr. Andrew Riggin: So there are actually a few options for treatment of kidney stones outside of you trying to pass it at home. So say if we decide you can't pass it at home, because your kidney stone's too big or you're in too much pain, well, then you have a few options. One of the options is you can do a shockwave procedure where you would come to the hospital and we would use the shockwave machine to blow up the stone by shooting shockwaves into your body. The advantage of that is it's not invasive in terms of we don't have to put anything inside your body. Now, the downside of it is it's not perfect. But for certain people, it's a really good procedure.
If for some reason that's not a good procedure for you, another option is called ureteroscopy with laser lithotripsy. That's where we put a small camera up into the tube that connects the kidney to the bladder or the kidney itself, and we blow your stones up with a little small laser. And then, we put a stent in afterwards, okay?
Last but not least, there is a procedure for people who have really big stones or very complicated stones. And for those people, there's another procedure called a percutaneous nephrolithotomy. I know that's a mouthful. Abbreviation is just PCNL. But basically, the way it works is I go directly through your back into your kidney, through an incision about the size of a nickel. And then, I can go into your kidney with a larger camera and these larger instruments that blow up kidney stones and suck all the pieces out.
Prakash Chandran: Wow. That's pretty incredible. And one question I forgot to ask earlier is about who kidney stones affect. Are there certain ages or demographics of people that kidney stones represent themselves in more than others?
Dr. Andrew Riggin: So it used to be that there was like a kidney stone season, okay? That it happened in the summer. And it was when people who worked outside, they didn't drink enough fluid and they would get kidney stones because they were dehydrated. But now, the kidney stone season last 365 days a year. And so it doesn't discriminate between men and women. It doesn't discriminate between race. I will say that some people who are overweight tend to get stones more so than people who aren't, but that would maybe be the only thing I could say for sure.
Prakash Chandran: Okay. So it's not like a young person's disease. It really occurs at all ages.
Dr. Andrew Riggin: Correct.
Prakash Chandran: Now, you kind of touched on treating a kidney stone at home. What exactly does that mean?
Dr. Andrew Riggin: So, if you go to the ER and you're diagnosed with a kidney stone, one of your options for the treatment for your kidney stone is called a trial of passage, meaning that you try to pass your stone with no surgical intervention. What that entails usually is drinking extra fluid, taking medications to help control your pain, such as Tylenol, ibuprofen or Motrin and sometimes narcotics, if you need them, and then other medications to help control the symptoms of passing a stone. We typically give people about 30 days to pass a stone, as long as they're comfortable.
Prakash Chandran: So 30 days to pass a stone. So let me take a step back here, because sometimes people may have that extreme pain in their flank. Is that something that they have to experience for 30 days? Or is it something that kind of like comes and goes as they're trying to pass it over that 30-day period?
Dr. Andrew Riggin: No, I would say that the people that usually pass their stones at home are not the person with that extreme pain. They're usually the people that are a little bit more comfortable than that. And they intermittently have some little slight twinges and things like that and their pain is generally controlled with ibuprofen and Tylenol. For people who are needing narcotics around the clock, for people who are having a lot of nausea and vomiting, or for people who actually are starting to have signs of an infection, those are called alarm symptoms. And we usually tell them to go back to the emergency room or call us because they probably need a surgery to help them pass their kidney stone.
Prakash Chandran: And just before we close here today, Dr. Riggin, I always like to ask a question about what's one thing that you know to be true with all of your experience as a urologist that you wish more people knew before they came to see you? It's basically the one golden thing that you want to leave with our audience.
Dr. Andrew Riggin: Well, one thing is kidney stones are pretty common. And you're not alone out there and having these kidney stones, a lot of people go through this, but know that when you come to see a urologist to talk about your kidney stone, we will help you figure out why it happened. We will help you treat it, and we'll give you the knowledge that you can be armed with, so hopefully you never have to go through this again.
Prakash Chandran: Well, Dr. Riggin, this has been a hugely informative conversation. Thank you so much. Is there anything else you want to leave with our listeners?
Dr. Andrew Riggin: No, I think that's it.
Prakash Chandran: All right this episode is sponsored by UM Shore Regional Health. with locations in Caroline, Dorchester, Kent, Queen Anne's and Talbot counties, UM Shore Regional Health is dedicated to bringing world class care to the communities of Maryland's Midshore region. UM Shore Regional Health, where the health of the eastern shore comes first.
Find more shows just like this one at umms.org/podcast. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.