Kidney Stone Care at Doylestown Health

Troubling Symptoms

When Felicia Kelly was sick in May, she initially thought she had food poisoning. She then developed severe nausea, fever and chills. After suffering with symptoms for several days, she went to Doylestown Hospital Emergency Department.

The team at the Doylestown Hospital Emergency Department quickly recognized that Felicia was very sick. Computerized Tomography (CT) revealed that a kidney stone was obstructing one of her ureters - thin tubes that connect the kidneys to the bladder.

Blood and urine tests showed she also had a urinary tract infection and early sepsis. Felicia was shocked to hear that she had kidney stones. "I've had kidney stones several times and the symptoms were much different. I just felt queasy, but nothing like what I experienced this time," says Felicia.

Due to the seriousness of her condition, Felicia was taken into surgery directly from the Emergency Department to remove the blockage the stone was causing in her ureter.

What are Kidney Stones?

Kidney stones are a common urologic condition. The National Kidney Stone Foundation reports over half a million people visit emergency rooms each year due to the condition.

"Kidney stones typically cause abrupt pain in the flank, but sometimes patients experience pain in the pelvis or urinary symptoms such as frequency, urgency or visible blood in the urine. It is understandable that patients can be confused about what's going on," says Kevin Fitzgerald, MD, urologist with Doylestown Health.

Kidney stones are hard objects made up of minerals that form in the kidney. They can range in size from a grain of salt to the size of a golf ball. Though most common in adult men, anyone can develop kidney stones.

The four most common types of kidney stones:

• Calcium stones: calcium oxalate is the most common type; calcium phosphate is a less common type; numerous factors can contribute to formation of calcium stones
• Cystine stones: an inherited metabolic condition called cystinuria
• Uric acid stones: develop from consuming purine-rich foods, such as organ meats, and/or having acidic urine
• Struvite stones: caused by bacterial infections

Although anyone can develop kidney stones, you might be at a higher risk if you:

• Are rapidly losing weight
• Don't drink enough fluids
• Eat an excessive amount of purine-rich foods
• Eat foods high in salt
• Had stomach or intestinal surgery
• Have a blockage in your urinary tract
• Have certain medical conditions including gout, inflammatory bowel disease, obesity, migraines or hyperparathyroidism
• Have a family history of kidney stones
• Take certain medications such as anti-seizure medications or anti-migraine medications

Recognizing Signs and Symptoms of Kidney Stones

The symptoms you experience with a kidney stone depend on its size, location and degree of obstruction of the flow of urine from the kidney through the ureter to the bladder. Stones that remain in the kidney typically do not cause any symptoms. When a stone has moved into the ureter, where it can block the passage of urine, patients typically experience symptoms.

Kidney stones can be painful. Some common symptoms you may experience include:

• Back, flank, side, abdominal or pelvic pain
• Blood in urine
• Cloudy urine
• Fever and chills
• Nausea and vomiting
• Sense of not being able to empty one's bladder
• Urinary frequency
• Urgent need to urinate
• Urinating a small amount at a time

"If you suspect you have kidney stones, you should contact your urologist or go to the emergency room. X-rays and labs can quickly determine if it's a kidney stone. If you need surgery for a stone, we are committed to evaluating you promptly, determining the right treatment plan quickly," says Dr. Fitzgerald.

Diagnosing Kidney Stones

If your healthcare provider suspects kidney stones, they may order several tests including:

• Blood tests - to check for elevated levels of calcium or decreased kidney function.
• Imaging studies (X-ray, CT) - to determine the size and location of the kidney stone.
• Urine test - to see if you have stone forming crystals, blood or an infection.

Treating Kidney Stones

In many cases, kidney stones may pass on their own without surgical intervention. It may take three to four weeks for a kidney stone to pass naturally. If you have a small kidney stone that isn't causing infection, your urologist may recommend medications that will:

• Control nausea and vomiting
• Manage pain
• Relax the urinary tract muscles to help the stone pass

If your kidney stone is too large to pass on its own or is causing an infection, your urologist may recommend surgery. Some of the procedures offered at Doylestown Health include:

• Flexible Ureteroscopy with Laser Lithotripsy and Ureteral Stent Insertion - the most common surgical approach. It has the highest success rate and lowest complication rate.
• Extracorporeal Shock Wave Lithotripsy - an alternative surgical treatment for stones within the kidney or upper portion of the ureter. This surgery is not available on an emergency basis.
• Percutaneous Nephrostolithotomy - A more invasive surgical approach typically reserved for very large stones or infection-based stones.

Dr. Fitzgerald says in most cases, kidney stone surgical procedures are performed on an out-patient basis, which means you don't have to stay overnight in the hospital.

Preventing Kidney Stones

If you have had kidney stones in the past or are considered high risk for developing kidney stones, Dr. Fitzgerald says you may want to work with your physician to create a preventive plan. "The best way to treat kidney stones is to prevent them. We can work with you to come up with a plan that fits your needs and can reduce the likelihood of kidney stones forming," he says.

Some ways you can prevent kidney stones include:

• Add citrate to your diet: lemons, limes and oranges are richest sources
• Consume salt in moderation
• Drink enough fluids to make two quarts or more of urine daily
• Eat meat in moderation
• Limit purine-rich foods

Moving Forward After Kidney Stones

Due to the sepsis, Felicia required more than a week in the hospital. According to Dr. Fitzgerald, Felicia's situation is rare. "Felicia had a very severe, life-threatening kidney stone case, however, it highlights the importance of early diagnosis and treatment," he says.

For her part, Felica is still recovering but is grateful for the care she received at Doylestown Health. "Everyone at Doylestown Hospital was so nice and reassuring during my stay. I am so thankful to have Doylestown Hospital so close," she says.

If you have been seen at another hospital and diagnosed with a kidney stone, call Doylestown Health Urology to make an urgent appointment: 215-230-0600. Bring a disk of your CT scan and any records from the Emergency Department.

Contributing Caregiver

Kevin Fitzgerald, MD is a urologist with Doylestown Health. He specializes in robotic surgery.

Find a urologist

If you are looking for a urologist - or a family medicine provider, you can search for one who is right for you in our Find a Provider directory. To learn more about urologic care at Doylestown Health, visit Urology: Conditions, Treatments, & Locations | Doylestown Health

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