Kidney stones are solid deposits of minerals and acid salts that build up inside the kidneys. Kidney stones are relatively common, hospitalizing more than one million Americans each year. Approximately 10 percent of people in the United States will have a kidney stone at some point in their life.
In this segment, Dr.Daniel Marchalik joins the show to discuss kidney stones and how MedStar's urology specialists focus on the medical management of kidney stones for patients that require metabolic evaluations for recurring kidney stones.
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Treatment for Kidney Stones
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Learn more about Daniel Marchalik, MD
Daniel Marchalik, MD
Daniel Marchalik, MD, is Director of Ambulatory Urologic Surgery and Director of Medical Education at MedStar Washington Hospital Center. He is also an instructor at MedStar Georgetown University Hospital. As a urology specialist, he uses noninvasive, minimally invasive, and endoscopic methods to treat some of the most common conditions in urology, such as stone disease, voiding difficulty caused by prostate enlargement, and elevated PSA.Learn more about Daniel Marchalik, MD
Transcription:
Treatment for Kidney Stones
Melanie Cole (Host): Kidney stones are relatively common, hospitalizing more than 1 million Americans each year. Approximately 10% of people in the United States will have a kidney stone at some point in their life. My guest today is Dr. Daniel Marchalik. He’s the Director of Ambulatory Urologic Surgery at MedStar Washington Hospital Center. Welcome to the show, Dr. Marchalik. What is a kidney stone and how do they form?
Dr. Daniel Marchalik (Guest): Hi, thank you for having me. A kidney stone is basically a collection of some type of mineral – usually, it’s composed of calcium, but it could be other things as well. It’s something that forms in the urinary tract, in the kidney normally and then travels down and can either be found in the kidney, the ureter or ultimately, inside the bladder.
There are different reasons for formation. Some of it is inborn. Some people are genetically predisposed to forming kidney stones. Some of it is environmental -- things that we do with our diet and exposure that we have to different things that can lead to it.
Melanie: Is one gender more likely to get kidney stones over another?
Dr. Marchalik: Yes, men are more likely than women to get kidney stones. That being said, it’s extremely common in both genders. The lifetime risk for a man to have a kidney stone is about 13%, and the lifetime risk for a woman is about 7%. Even though the risk is much higher in men, it’s still very high for both genders.
Melanie: And Doctor, what are some symptoms – somebody really wouldn’t know one is forming necessarily would they? Would they get any red flags? Would there be any symptoms?
Dr. Marchalik: Yeah, and that’s one of the realities of kidney stones is that a lot of times you don’t know that you’re forming a kidney stone. Or, if a kidney stone has formed, you don’t know that it’s growing inside your kidney until that stone becomes quite large or until that stone drops down into the ureter. The ureter is the tube that connects the kidney to the bladder that the urine passes through. If the kidney stone drops down and blocks the flow of urine in the ureter, then you can develop really severe pain from the kidney becoming distended from all of that urine backing up.
Melanie: What would you notice, then? Would you feel intense pain like appendicitis when something’s really just blazing pain, or does it come on a little bit gradually?
Dr. Marchalik: No, most of the time the way that people realize that they’re having a kidney stone is with very severe, very sharp pain in their back. That pain has been evaluated, and they compare it in severity to pain from having labor. It’s very, very intense, very severe. Normally, that pain is in the back. For some people, it can also radiate to the groin, and it usually stays on one side, either the right side or the left side.
Melanie: If somebody gets that pain and they are not sure – is this an emergent situation? Do you call 9-1-1, or can you take yourself to your doctor, physician, or the Emergency Room?
Dr. Marchalik: Almost always, this is something that you can take yourself to the hospital, and it doesn’t usually require an ambulance, but this is something that the pain can be so debilitating that you want to be seen right away. Now, the time that it does become an emergency where you really want to get to the hospital as soon as possible is when you start to develop that pain, but then you also have fevers, and chills, and burning with urination. Those can be symptoms of an infection, and if an infection happens in the face of a kidney stone, that can be very, very troublesome and could be very dangerous.
Melanie: Doctor, what are some available treatments for kidney stones?
Dr. Marchalik: That depends entirely on the location and the size of the kidney stone. Some stones, which don’t cause symptoms and which are small or in certain areas of the kidney, can just be watched. Some stones are pretty small, and they might cause symptoms, but we can observe them hoping that they will pass on their own because depending on the size of the kidney stones, many will pass on their own. Some stones are large enough so that they really don’t have a good chance of passing on their own. If that’s the case, they would require some type of surgical intervention. There are different types of surgical interventions that we can take to take care of a kidney stone.
Melanie: Before we talk about a few of those, what’s it like to pass a kidney stone? What happens?
Dr. Marchalik: It’s very painful. Patients describe this as this nagging pain that comes in waves, and usually, it starts out in the back, and as the kidney stone makes its way down the ureter, the pain tends to migrate along with it. Initially would be a back pain, then it might become a stomach pain and a groin pain. The pain would come in waves, so it gets worse, then it gets better, then it gets worse, then it gets better.
The reality of passing a kidney stone is that kidney stones can take up to four weeks to pass. Even though you’re making progress – even though the stone is on its way out, it’s just taking a long time, and that can be a difficult thing for a lot of patients understandably.
Melanie: Speak about some of the treatments that you might do, and based on the location of the stone itself, are these treatments that you do right then and there? Or, are they scheduled -- something that can wait a day or two? Just speak about some of these procedures.
Dr. Marchalik: Of course, that depends entirely on the clinical scenario. If someone has a kidney stone and they have an infection, that’s an emergency. In that case, what we normally do is we don’t treat the stone as much as we treat the blockage that the stone is causing. In those cases, we put a stent – which is a tiny little plastic tube that can go from the kidney to the bladder inside the ureter. That little tube allows for the urine to flow through it. And then we treat the patient with antibiotics and wait for him to recover. That’s the only kidney stone surgery that we have to do truly emergently. For everything else, those stones are normally something that we can watch for a few days, or even a few weeks depending on what the likelihood of passage is, and to schedule this as an outpatient surgery at a time that’s convenient for everyone.
Melanie: What about prevention? Is there any way to prevent a kidney stone? And Doctor, is there a certain time of year that you’re seeing more of these that they might be more common?
Dr. Marchalik: Absolutely. Those two are very much connected. Kidney stones are more common in the summer for an understandable reason. The number one risk factor for forming a kidney stone is dehydration. I think a lot of us are guilty of not drinking enough water, and we’re especially guilty of that in the summer when it’s hot out. People start to exercise a lot more, but then they don’t increase their water intake to account for the amount of sweating that they are doing and the amount of exercise that they are doing.
One of the big things that people can do to prevent themselves from getting a kidney stone is making sure that they hydrate well. For the most part, that means not only are you having water when you’re having your meals, but then you’re also having a bottle of water between meals. You’re making sure that you are staying hydrated the entire time.
The other thing which we are also guilty of for the most part is we eat too much salt. The amount of salt that you have in your diet is probably one of the other big risk factors for forming stones. Between those two things, I think a lot could be done to prevent kidney stones.
Melanie: Wrap it up for us, with your best advice, if somebody maybe has a family history of this, or if they’re just – this is something that they are concerned about – what would you like them to know about preventing kidney stones, and what to know if they’re recognizing that there might possibly be one?
Dr. Marchalik: My advice would be this: Kidney stones are incredibly common. If 10% of the population is going to end up getting a kidney stone and you have a family history, you’re probably even more likely. If you're one of those patients for whom kidney stones are a real risk, you need to be very vigilant. You need to make sure that you hydrate very well. You need to make sure that you limit the amount of salt that you have in your diet, the amount of protein that you have in your diet. You need to make sure that you hydrate especially well during times where you’re likely to be dehydrated, like the summer, or times when you do intense exercising.
And then, if you do end up having these symptoms, like a severe, sudden pain in the back, or severe, sudden pain that’s coming in waves that’s radiating down to your groin, then come to the Emergency Room and make sure that you get seen right away. This is especially true if you develop fevers, chills, or symptoms of a urinary tract infection because that could be a truly dangerous situation.
Melanie: Thank you, so much, for being with us today. This is Medical Intel with MedStar Washington Hospital Center. For more information, you can go to MedStarWashington.org, that’s MedStarWashington.org. This is Melanie Cole. Thanks, so much, for listening.
Treatment for Kidney Stones
Melanie Cole (Host): Kidney stones are relatively common, hospitalizing more than 1 million Americans each year. Approximately 10% of people in the United States will have a kidney stone at some point in their life. My guest today is Dr. Daniel Marchalik. He’s the Director of Ambulatory Urologic Surgery at MedStar Washington Hospital Center. Welcome to the show, Dr. Marchalik. What is a kidney stone and how do they form?
Dr. Daniel Marchalik (Guest): Hi, thank you for having me. A kidney stone is basically a collection of some type of mineral – usually, it’s composed of calcium, but it could be other things as well. It’s something that forms in the urinary tract, in the kidney normally and then travels down and can either be found in the kidney, the ureter or ultimately, inside the bladder.
There are different reasons for formation. Some of it is inborn. Some people are genetically predisposed to forming kidney stones. Some of it is environmental -- things that we do with our diet and exposure that we have to different things that can lead to it.
Melanie: Is one gender more likely to get kidney stones over another?
Dr. Marchalik: Yes, men are more likely than women to get kidney stones. That being said, it’s extremely common in both genders. The lifetime risk for a man to have a kidney stone is about 13%, and the lifetime risk for a woman is about 7%. Even though the risk is much higher in men, it’s still very high for both genders.
Melanie: And Doctor, what are some symptoms – somebody really wouldn’t know one is forming necessarily would they? Would they get any red flags? Would there be any symptoms?
Dr. Marchalik: Yeah, and that’s one of the realities of kidney stones is that a lot of times you don’t know that you’re forming a kidney stone. Or, if a kidney stone has formed, you don’t know that it’s growing inside your kidney until that stone becomes quite large or until that stone drops down into the ureter. The ureter is the tube that connects the kidney to the bladder that the urine passes through. If the kidney stone drops down and blocks the flow of urine in the ureter, then you can develop really severe pain from the kidney becoming distended from all of that urine backing up.
Melanie: What would you notice, then? Would you feel intense pain like appendicitis when something’s really just blazing pain, or does it come on a little bit gradually?
Dr. Marchalik: No, most of the time the way that people realize that they’re having a kidney stone is with very severe, very sharp pain in their back. That pain has been evaluated, and they compare it in severity to pain from having labor. It’s very, very intense, very severe. Normally, that pain is in the back. For some people, it can also radiate to the groin, and it usually stays on one side, either the right side or the left side.
Melanie: If somebody gets that pain and they are not sure – is this an emergent situation? Do you call 9-1-1, or can you take yourself to your doctor, physician, or the Emergency Room?
Dr. Marchalik: Almost always, this is something that you can take yourself to the hospital, and it doesn’t usually require an ambulance, but this is something that the pain can be so debilitating that you want to be seen right away. Now, the time that it does become an emergency where you really want to get to the hospital as soon as possible is when you start to develop that pain, but then you also have fevers, and chills, and burning with urination. Those can be symptoms of an infection, and if an infection happens in the face of a kidney stone, that can be very, very troublesome and could be very dangerous.
Melanie: Doctor, what are some available treatments for kidney stones?
Dr. Marchalik: That depends entirely on the location and the size of the kidney stone. Some stones, which don’t cause symptoms and which are small or in certain areas of the kidney, can just be watched. Some stones are pretty small, and they might cause symptoms, but we can observe them hoping that they will pass on their own because depending on the size of the kidney stones, many will pass on their own. Some stones are large enough so that they really don’t have a good chance of passing on their own. If that’s the case, they would require some type of surgical intervention. There are different types of surgical interventions that we can take to take care of a kidney stone.
Melanie: Before we talk about a few of those, what’s it like to pass a kidney stone? What happens?
Dr. Marchalik: It’s very painful. Patients describe this as this nagging pain that comes in waves, and usually, it starts out in the back, and as the kidney stone makes its way down the ureter, the pain tends to migrate along with it. Initially would be a back pain, then it might become a stomach pain and a groin pain. The pain would come in waves, so it gets worse, then it gets better, then it gets worse, then it gets better.
The reality of passing a kidney stone is that kidney stones can take up to four weeks to pass. Even though you’re making progress – even though the stone is on its way out, it’s just taking a long time, and that can be a difficult thing for a lot of patients understandably.
Melanie: Speak about some of the treatments that you might do, and based on the location of the stone itself, are these treatments that you do right then and there? Or, are they scheduled -- something that can wait a day or two? Just speak about some of these procedures.
Dr. Marchalik: Of course, that depends entirely on the clinical scenario. If someone has a kidney stone and they have an infection, that’s an emergency. In that case, what we normally do is we don’t treat the stone as much as we treat the blockage that the stone is causing. In those cases, we put a stent – which is a tiny little plastic tube that can go from the kidney to the bladder inside the ureter. That little tube allows for the urine to flow through it. And then we treat the patient with antibiotics and wait for him to recover. That’s the only kidney stone surgery that we have to do truly emergently. For everything else, those stones are normally something that we can watch for a few days, or even a few weeks depending on what the likelihood of passage is, and to schedule this as an outpatient surgery at a time that’s convenient for everyone.
Melanie: What about prevention? Is there any way to prevent a kidney stone? And Doctor, is there a certain time of year that you’re seeing more of these that they might be more common?
Dr. Marchalik: Absolutely. Those two are very much connected. Kidney stones are more common in the summer for an understandable reason. The number one risk factor for forming a kidney stone is dehydration. I think a lot of us are guilty of not drinking enough water, and we’re especially guilty of that in the summer when it’s hot out. People start to exercise a lot more, but then they don’t increase their water intake to account for the amount of sweating that they are doing and the amount of exercise that they are doing.
One of the big things that people can do to prevent themselves from getting a kidney stone is making sure that they hydrate well. For the most part, that means not only are you having water when you’re having your meals, but then you’re also having a bottle of water between meals. You’re making sure that you are staying hydrated the entire time.
The other thing which we are also guilty of for the most part is we eat too much salt. The amount of salt that you have in your diet is probably one of the other big risk factors for forming stones. Between those two things, I think a lot could be done to prevent kidney stones.
Melanie: Wrap it up for us, with your best advice, if somebody maybe has a family history of this, or if they’re just – this is something that they are concerned about – what would you like them to know about preventing kidney stones, and what to know if they’re recognizing that there might possibly be one?
Dr. Marchalik: My advice would be this: Kidney stones are incredibly common. If 10% of the population is going to end up getting a kidney stone and you have a family history, you’re probably even more likely. If you're one of those patients for whom kidney stones are a real risk, you need to be very vigilant. You need to make sure that you hydrate very well. You need to make sure that you limit the amount of salt that you have in your diet, the amount of protein that you have in your diet. You need to make sure that you hydrate especially well during times where you’re likely to be dehydrated, like the summer, or times when you do intense exercising.
And then, if you do end up having these symptoms, like a severe, sudden pain in the back, or severe, sudden pain that’s coming in waves that’s radiating down to your groin, then come to the Emergency Room and make sure that you get seen right away. This is especially true if you develop fevers, chills, or symptoms of a urinary tract infection because that could be a truly dangerous situation.
Melanie: Thank you, so much, for being with us today. This is Medical Intel with MedStar Washington Hospital Center. For more information, you can go to MedStarWashington.org, that’s MedStarWashington.org. This is Melanie Cole. Thanks, so much, for listening.