Stones (calculi) are hard masses that form in the urinary tract and may cause pain, bleeding, or an infection or block of the flow of urine.
Urinary tract stones begin to form in a kidney and may enlarge in a ureter or the bladder.
Depending on where a stone is located, it may be called a kidney stone, ureteral stone, or bladder stone.
Urologic cancers include cancers of the bladder, kidney, prostate and testicles, all relatively common.
The treatment of urologic cancers, including bladder cancer, is rapidly evolving.
Here, urologic oncologic surgeon and kidney stone specialist Donald Hannoun, M.D., an assistant clinical professor in the Division of Urology and Urologic Oncology at City of Hope | Antelope Valley, explains the changes in his field, and explains what urinary stones are and what do patients need to know about them?
Selected Podcast
Urologic Cancer and Urinary Stones
Featured Speaker:
Dr. Hannoun is an active member in several professional organizations including the American Urological Association and the Los Angeles Urological Society. He has presented several abstracts for the Proceedings of the Western Section of the American Urological Association and has written several articles, abstracts and book chapters.
Learn more about Dr. Hannoun
Donald Hannoun, MD
Dr. Hannoun attended medical school and completed both an internship and residency at the Keck School of Medicine, University of Southern California, where he was elected to membership in the Alpha Omega Alpha Honorary Medical Society. He is the recipient of multiple awards and honors including the Dean’s Recognition Award from Keck and was recognized as Intern of the Year, by Keck’s Department of General Surgery. In addition, he was awarded Resident Teacher of the Year from Keck’s Department of Urology in 2009.Dr. Hannoun is an active member in several professional organizations including the American Urological Association and the Los Angeles Urological Society. He has presented several abstracts for the Proceedings of the Western Section of the American Urological Association and has written several articles, abstracts and book chapters.
Learn more about Dr. Hannoun
Transcription:
Urologic Cancer and Urinary Stones
Melanie Cole (Host): At City of Hope, our physicians are leading experts in treating patients with all type of urologic cancers. Just as no two patients are alike, cancer requires a unique treatment plan tailored to each individual to attain the best possible outcomes. My guest today is Dr. Donald Hannoun. He’s a urologist at City of Hope. Welcome to the show, Dr. Hannoun. Tell us what constitutes urologic cancers.
Dr. Donald Hannoun (Guest): Yes. So, urologic cancers are cancers that take place anywhere along the tract of the urinary system. This starts at the level of the kidneys, and there’s these long tubes that connect the kidneys down to the bladder called the ureters. And then obviously, urine is stored in the urinary bladder until it’s a safe and appropriate time to empty the bladder, and then the urine goes down through the prostate in males down out the urethra, or in females, right out the urethra. So a urologic cancer is a cancer that arises anywhere along that flow of urine.
Melanie: There are some other conditions besides cancer, such as urinary stones. What are they, and who is at risk for them?
Dr. Hannoun: Urinary stones are precipitations or substances that are oversaturated in the urine and then can precipitate out of solution into a solid substance. For example, if calcium is present in really high concentrations in the urine, especially in somebody who is relatively dehydrated, these calcifications can form with other substances to make solid substances within the urine, and this can then grow. And this is what forms urinary stones. While there are multiple, multiple risk factors for kidney stones, the number one risk factor really is dehydration. And then the other risk factors are underlying predispositions based on how a patient’s kidney handles calcium and other substances, and these can also lead to precipitations or urinary stones.
Melanie: What’s the difference between urinary stones and kidney stones?
Dr. Hannoun: You know, they’re really same things. It’s just based on the locations. Just like how we mentioned urologic cancer is a cancer that can take place anywhere in the urinary system, stones are very similar. Stones will form in the kidney usually, and then if they’re in the kidney, they’re called kidney stones. If they try to make their way down those long tubes that we discussed, sometimes they can get stuck along the way, then they’re considered urethral stones. If they make their way into the bladder, then they would be considered bladder stones. So a urinary stone is a very nondescript term for a stone that could be anywhere along the urinary system. A kidney stone, you’re typically describing a stone that’s still in the kidney itself.
Melanie: So after they’ve developed, how would you know? Because we’ve heard that kidney stones, for example, can be quite painful to pass. How would you even know that you have them?
Dr. Hannoun: That’s an excellent question. What’s scary is that sometimes, if you have a kidney stone that had not made its way down yet, it can actually be completely silent, and you will never know you have one unless you had an imaging study done for another reason, or let’s say you saw some blood in your urine, this would often prompt a physician to order some radiologic studies, and this could find the stone. Otherwise, if you begin to experience symptoms, it would typically be on either the left or right side, depending on where the kidney stone is. And if it makes its way down, typically, you would feel pain on that one side and what we call the flank or the side or the upper back area—not in the middle of your back, but really more on the side. And then as that stone makes its way down closer to the bladder, that pain can actually do what we call radiate. It can actually move down towards the groin area, and then once it gets into the bladder, if it does make its way into the bladder, you can begin to experience more urinary symptoms, so maybe not so much pain but rather urinary frequency and urgency or feeling like when you need to go to the bathroom, you need to go to the bathroom much quicker.
Melanie: So what’s the treatment for these? Are they something that you just have to wait until they go away, or is there something that can speed the process along a little bit?
Dr. Hannoun: Yes, that’s a very good question. And that really depends on multiple factors. The biggest factor that dictates the treatment of a stone is the size of the stone. Smaller stones obviously have a much higher chance of passing on their own; larger stones do not. Sometimes, getting an idea, if the patient has previously passed stones, this will tempt you one way or another whether or not these stones can be observed and allowed to pass on its own. For example, a patient who has previously passed stones, they can pass the stones on their own. Patients that have never passed a stone before may have a tougher time, so it really depends on the size, the patient’s history, its location. Stones that are located closer to the kidney have a harder time passing. Stones that present closer to the bladder, meaning they’re further down in the urinary system, have a much higher chance of passing on their own. So that’s another thing. And then also time. Typically, if a stone has been stuck there for anywhere from two to four weeks and has not moved, then in that case, typically, you need to act on it. There are some medications that can help stones pass, some medications that are similar to Flomax, which we give for older men with prostate problems. These can help the stones pass. But typically, if either of those treatment plans fail, then typically you’ll have to move to surgery.
Melanie: Is this more common in men or women? Do men seem to come up with kidney stones or urologic stones more often than women? And do urinary tract infections, which women seem to come up with, do they contribute to this at all?
Dr. Hannoun: That’s another very good question. If you went back about 15 years ago and prior to that, the incidence of kidney stones in men outnumbered women about 8:1. Now, if you look at those numbers, that gap has narrowed, and it’s narrowed down to about 3:2—meaning now, for every three men that develop kidney stones, about two women will develop kidney stones. And the reason for that change has been because of the epidemic of obesity in our country. So obesity turns out it’s actually a risk factor for certain types of kidney stones. Now, as far as your second question, whether or not women who have a higher risk of urinary tract infections, can they get more kidney stones? Urinary tract infections can contribute to kidney stone formation, but it has to be from a specific bacteria that causes the infection, and the infection has to be in the kidney. In those patients, yes, urinary tract infection can be a predisposition for certain types of kidney stones.
Melanie: You mentioned at the beginning dehydration. Are there any other sort of behavioral modifications, lifestyle, things you’d like to recommend to the listeners for prevention?
Dr. Hannoun: Yes. For patients that are known kidney stone formers, the general recommendations for the best diet to try to prevent future kidney stones development or the growth of a present kidney stone is to maintain a low-sodium diet, which is typically less than two grams. There’s been a lot published in the literature whether patients who develop kidney stones, should they cut out calcium from their diet or do they not need to, and it turns out it’s actually neither. They neither should take calcium nor should they cut out calcium. But rather, they should continue taking the normal recommended daily elemental calcium intake, which is anywhere from 800 to 1,200 mg of calcium a day, and then the last recommendation is to try to not overconsume a lot of animal protein. So this is overconsumption of chicken, red meat, fish, not overconsuming these substances because these can also contribute to kidney stones. To summarize, low sodium, low animal protein but to continue the normal recommended calcium intake.
Melanie: That’s great information. Thank you so much, Dr. Hannoun. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org, that’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Urologic Cancer and Urinary Stones
Melanie Cole (Host): At City of Hope, our physicians are leading experts in treating patients with all type of urologic cancers. Just as no two patients are alike, cancer requires a unique treatment plan tailored to each individual to attain the best possible outcomes. My guest today is Dr. Donald Hannoun. He’s a urologist at City of Hope. Welcome to the show, Dr. Hannoun. Tell us what constitutes urologic cancers.
Dr. Donald Hannoun (Guest): Yes. So, urologic cancers are cancers that take place anywhere along the tract of the urinary system. This starts at the level of the kidneys, and there’s these long tubes that connect the kidneys down to the bladder called the ureters. And then obviously, urine is stored in the urinary bladder until it’s a safe and appropriate time to empty the bladder, and then the urine goes down through the prostate in males down out the urethra, or in females, right out the urethra. So a urologic cancer is a cancer that arises anywhere along that flow of urine.
Melanie: There are some other conditions besides cancer, such as urinary stones. What are they, and who is at risk for them?
Dr. Hannoun: Urinary stones are precipitations or substances that are oversaturated in the urine and then can precipitate out of solution into a solid substance. For example, if calcium is present in really high concentrations in the urine, especially in somebody who is relatively dehydrated, these calcifications can form with other substances to make solid substances within the urine, and this can then grow. And this is what forms urinary stones. While there are multiple, multiple risk factors for kidney stones, the number one risk factor really is dehydration. And then the other risk factors are underlying predispositions based on how a patient’s kidney handles calcium and other substances, and these can also lead to precipitations or urinary stones.
Melanie: What’s the difference between urinary stones and kidney stones?
Dr. Hannoun: You know, they’re really same things. It’s just based on the locations. Just like how we mentioned urologic cancer is a cancer that can take place anywhere in the urinary system, stones are very similar. Stones will form in the kidney usually, and then if they’re in the kidney, they’re called kidney stones. If they try to make their way down those long tubes that we discussed, sometimes they can get stuck along the way, then they’re considered urethral stones. If they make their way into the bladder, then they would be considered bladder stones. So a urinary stone is a very nondescript term for a stone that could be anywhere along the urinary system. A kidney stone, you’re typically describing a stone that’s still in the kidney itself.
Melanie: So after they’ve developed, how would you know? Because we’ve heard that kidney stones, for example, can be quite painful to pass. How would you even know that you have them?
Dr. Hannoun: That’s an excellent question. What’s scary is that sometimes, if you have a kidney stone that had not made its way down yet, it can actually be completely silent, and you will never know you have one unless you had an imaging study done for another reason, or let’s say you saw some blood in your urine, this would often prompt a physician to order some radiologic studies, and this could find the stone. Otherwise, if you begin to experience symptoms, it would typically be on either the left or right side, depending on where the kidney stone is. And if it makes its way down, typically, you would feel pain on that one side and what we call the flank or the side or the upper back area—not in the middle of your back, but really more on the side. And then as that stone makes its way down closer to the bladder, that pain can actually do what we call radiate. It can actually move down towards the groin area, and then once it gets into the bladder, if it does make its way into the bladder, you can begin to experience more urinary symptoms, so maybe not so much pain but rather urinary frequency and urgency or feeling like when you need to go to the bathroom, you need to go to the bathroom much quicker.
Melanie: So what’s the treatment for these? Are they something that you just have to wait until they go away, or is there something that can speed the process along a little bit?
Dr. Hannoun: Yes, that’s a very good question. And that really depends on multiple factors. The biggest factor that dictates the treatment of a stone is the size of the stone. Smaller stones obviously have a much higher chance of passing on their own; larger stones do not. Sometimes, getting an idea, if the patient has previously passed stones, this will tempt you one way or another whether or not these stones can be observed and allowed to pass on its own. For example, a patient who has previously passed stones, they can pass the stones on their own. Patients that have never passed a stone before may have a tougher time, so it really depends on the size, the patient’s history, its location. Stones that are located closer to the kidney have a harder time passing. Stones that present closer to the bladder, meaning they’re further down in the urinary system, have a much higher chance of passing on their own. So that’s another thing. And then also time. Typically, if a stone has been stuck there for anywhere from two to four weeks and has not moved, then in that case, typically, you need to act on it. There are some medications that can help stones pass, some medications that are similar to Flomax, which we give for older men with prostate problems. These can help the stones pass. But typically, if either of those treatment plans fail, then typically you’ll have to move to surgery.
Melanie: Is this more common in men or women? Do men seem to come up with kidney stones or urologic stones more often than women? And do urinary tract infections, which women seem to come up with, do they contribute to this at all?
Dr. Hannoun: That’s another very good question. If you went back about 15 years ago and prior to that, the incidence of kidney stones in men outnumbered women about 8:1. Now, if you look at those numbers, that gap has narrowed, and it’s narrowed down to about 3:2—meaning now, for every three men that develop kidney stones, about two women will develop kidney stones. And the reason for that change has been because of the epidemic of obesity in our country. So obesity turns out it’s actually a risk factor for certain types of kidney stones. Now, as far as your second question, whether or not women who have a higher risk of urinary tract infections, can they get more kidney stones? Urinary tract infections can contribute to kidney stone formation, but it has to be from a specific bacteria that causes the infection, and the infection has to be in the kidney. In those patients, yes, urinary tract infection can be a predisposition for certain types of kidney stones.
Melanie: You mentioned at the beginning dehydration. Are there any other sort of behavioral modifications, lifestyle, things you’d like to recommend to the listeners for prevention?
Dr. Hannoun: Yes. For patients that are known kidney stone formers, the general recommendations for the best diet to try to prevent future kidney stones development or the growth of a present kidney stone is to maintain a low-sodium diet, which is typically less than two grams. There’s been a lot published in the literature whether patients who develop kidney stones, should they cut out calcium from their diet or do they not need to, and it turns out it’s actually neither. They neither should take calcium nor should they cut out calcium. But rather, they should continue taking the normal recommended daily elemental calcium intake, which is anywhere from 800 to 1,200 mg of calcium a day, and then the last recommendation is to try to not overconsume a lot of animal protein. So this is overconsumption of chicken, red meat, fish, not overconsuming these substances because these can also contribute to kidney stones. To summarize, low sodium, low animal protein but to continue the normal recommended calcium intake.
Melanie: That’s great information. Thank you so much, Dr. Hannoun. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org, that’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.