Kidney Stones: Risk Factors and Preventions

The prevalence of kidney stones in the United States has increased over the last decade. As many as 1 in 10 Americans have a kidney stone at some point in their lives, and every year more than half a million Americans go to emergency rooms for kidney stone related complications.

What are kidney stones?

A kidney stone is a small, hard deposit that forms in the kidneys. Stones occur when the urine concentration of crystal-forming substances—such as calcium, oxalate and uric acid—is more than the fluid in the urine can dilute.

They begin as small crystals and grow into larger masses (stones), which then make their way through the urinary tract. Unfortunately, a stone can get stuck on its way out of the urinary system, resulting in an unbearable pain that comes in waves until the stone eventually passes.

What causes kidney stones?

Genetics is one of the risk factors. If you have family members who had kidney stones, you are at a higher risk of having them yourself. Your risk is also higher if you have had kidney stones in the past.

Dehydration is another major cause of kidney stones, which is why more kidney stones occur in the summer. In fact, kidney stone frequency is known to vary by geographic location, with warmer climates having the highest rates of stone formation.

What you eat and drink makes a huge difference. Drinking enough fluids to make over two liters of urine a day reduces the risk of stone formation. Actually, as a rule, you should always check your urine for signs of dehydration. If your urine is dark or yellow, then you are not drinking enough fluid and run the risk of having stones.

Factors that increase dehydration will contribute to kidney stone formation. For instance, excess salt or sodium in food, such as in processed or fast foods, increase dehydration as the excess salt requires a lot of fluid to excrete. So reducing the sodium in your diet will minimize your risk of stone formation.

Matthew Truesdale, MD of Largo Bardmoor, FL

How do you know that you have kidney stones?

Kidney stones cause pain by getting stuck in the urinary system. Since the kidneys continue to make urine, which in turn can’t get out due to the blockage, the urine builds up, stretches the kidneys and leads to severe pain.

You will know you have kidney stones when you have severe, excruciating pain that comes in waves. The pain typically occurs in the back and does not get better with a change in position. Patients who have had kidney stones and also delivered children report that the stones are more painful than giving birth. In addition to pain, you may have fever, nausea, and even vomiting.

Kidney stones may require a trip to the emergency room if you have severe pain, nausea, vomiting, and a fever greater than 100.3 degrees. These symptoms constitute a urological emergency because they signal both a blockage and an infection. With the blockage preventing antibiotics from getting out via urine, you can get very sick, very quickly; hence the need for emergency care.

Emergency treatment with IV fluids at a hospital may be necessary if you are having nausea and vomiting to the point of dehydration. Emergency care is also appropriate when you have pain that cannot be alleviated by over-the-counter pain medicine.

What is the treatment for kidney stones?

The treatment for kidney stones depends on the size and location of the stone, and on the clinical stability of the patient. The most common approach is medical expulsion therapy—a conservative approach for healthy patients with stones that are small enough to pass on their own and with no fever or other signs of infection.
With medical expulsion, you are encouraged to drink a lot of fluid to help the stone pass on its own. You are also given medications to control the pain and to accelerate passage. If the stone is 5 millimeters or smaller (about half of your thumbnail), there is a 50% chance it will pass on its own and you will avoid surgery.

If you have severe pain, fever, chills and an inability to drink fluids, you may not qualify for medical expulsion therapy. In that case, a surgical procedure may be needed. There are two common surgical options: (1) ureteroscopy or laser lithotripsy, and (2) extracorporeal shockwave lithotripsy.

Ureteroscopy and laser lithotripsy are fancy ways of saying you go to sleep, a camera is inserted through your urethra to the stone, and a laser is used to break the stone into smaller fragments for removal. Extracorporeal shockwave lithotripsy means you go to sleep and sound waves are sent through your skin to fracture the stone into small pieces that can pass on their own in urine.

The advantage of shockwave lithotripsy is that nothing goes into your body, making it less invasive. However, the disadvantage is that the stone fragments still have to pass on their own, a process which can be painful and uncomfortable.

How do you prevent kidney stones?

1. Increase calcium intake

There is a misconception that increasing dietary calcium increases the risk of calcium oxalate stones. This is not true. In fact, eating more calcium rich foods, such as milk or cheese, ensures the oxalate in the diet binds to calcium. When oxalate binds to calcium in the intestines, it is not absorbed in the bloodstream and ends up in stool.

2. Reduce oxalate rich foods

Foods high in oxalate, such as beets, chocolate, tea, coffee, spinach, kale, rhubarb, nuts and beer contribute to stone formation. You may have to eat smaller portions of these foods alongside calcium-rich foods or avoid them altogether.

3. Stay hydrated

Drinking plenty of water will ensure that substances in your urine are diluted and cannot form crystals. As a rule, strive to drink enough water to pass two liters of urine every day—which is drinking roughly eight standard 8-ounce cups per day. It also helps to include some citrus beverages, such as orange juice and lemonade, as the citrate in these beverages helps to block stone formation.

4. Reduce sodium intake

A high salt or sodium diet increases the amount of calcium in your urine and triggers stone formation. Excess salt also wastes the fluid you take as a lot more fluid is necessary for salt-water balance. Make sure to limit your daily sodium intake to 2300mg or less to reduce your risk of kidney stones.

5. Minimize intake of animal protein

Animal protein, such as red meat, eggs, poultry, or seafood, increases the level of uric acid in the body and may cause kidney stones. A high protein diet will also reduce your urinary citrate—the chemical in urine that prevents stones from forming. You can limit animal proteins or replace them with plant-based proteins.

At Advanced Urology Institute, we offer a range of treatments for kidney stones depending on the severity of symptoms and the type, size and location of the stones. We also run tests to find out why they form and give you advice on how to prevent them.

If you or a relative has had kidney stones, consider meeting with one of our urologists for specific ways to reduce your risk. For more information on kidney stone causes, risk factors, diagnosis, treatment and prevention, visit the Advanced Urology Institute website.

Listen to the Podcast to learn more about Kidney Stones, Click here

Penile Implants for Erection Problems – Dr. Rishi Modh

My name is Rishi Modh, I am a board-certified urologist with Advanced Urology Institute.

So I think when you go see a urologist about erectile dysfunction, you need to see a urologist who specializes in implants as well. Not all urologists perform penile implants so they may not even offer it as an option for you. A penile implant is an outpatient procedure with a small incision and a fast recovery. It’s a mechanical device that’s placed inside your body that allows you to pump fluid into the penis in order to give you a great erection. Ninety-five percent (95%) of men are extremely happy with their penile implant and ninety-five percent (95) of partners would recommend it to someone else to have a surgery done.

Kidney Stones Pain, Symptoms and Treatment – Dr. Amar Raval

Dr. Amar Raval of Palm Harbor, FLMy name is Amar J. Raval and I’m with Advanced Urology Institute.

So kidney stone disease is very prevalent in Florida because of the heat, lack of hydration being a huge factor. Patients generally present with acute onset flank pain that doesn’t resolve with oral medication [and they experience] nausea, vomiting, fever, chills, even blood in their urine then they ultimately get some sort of imaging that shows that they have a stone that may be obstructing and causing them this discomfort. Approaches are very simple and they’re very endoscopic: they don’t require any incisions whether its leaving a stent to bypass a stone or if you’re going to treat the stone, you can use shockwaves from the outside to blast it or a laser to fine-tune the stone and take a piece of it and send it as a specimen to know what kind of stone it is. So technology certainly advanced in the realm of kidney stone disease, and there’s a lot of minimally invasive approaches to be able to treat that.

The Enjoyment of Being a Urologist

Urology is a wonderful specialty, being at the same time a surgical and medical practice. It offers an interesting mix of work in both the office and the operating room.

“For many of us, we enjoy spending time in the operating room—after all, we are surgeons by trade,” says Dr. Scott B. Sellinger, FACS, a board-certified urologist at Advanced Urology Institute. “But for many of us, we also enjoy interactions with our patients in the office. I love to see my folks, especially the ones I’ve been seeing for the past 25 years. They come back every year and we can chat about all kinds of things.”

Interesting surgical techniques

While most urology patients are followed long-term with medical interventions, at least half of them are surgical patients. The subspecialty of urology offers great opportunities to practice the surgical side of the profession, which includes the hands-on application of the latest technology, such as robots and lasers. “I enjoy the surgical side of our profession, and urology offers innovative techniques and technology that makes surgical procedures even more interesting,” says Dr. Sellinger.

Long-term relationships

The opportunity to build lasting doctor-patient relationships makes urology gratifying.

“As a urologist, you get to care for the entire spectrum of age groups of patients, such as children with congenital problems and patients in their declining years, when a lot of urologic problems tend to set in.” says Dr. Sellinger. “I like the fact that I see different patients every day, delve into their emotional problems, and with empathy, provide the support and solutions they need. I also enjoy speaking with the patients I see every year for several years since every time they come in they have something great to share,” he adds.

Tackling embarrassing problems

Urology brings relief to patients with personal and sometimes embarrassing medical problems. Through surgery, medications or both, urologists resolve these issues and improve the quality of life of their patients, which is quite appealing.

“As a urologist, not only do I treat life-threatening conditions like cancer, I also improve the quality of life of patients by freeing them from sexual dysfunction or incontinence,” says Dr. Sellinger.

Great outcomes

Unlike some other specialties, the treatments offered by urologists often provide quick relief and good outcomes. In fact, most patients treated by urologists do well and get better.

“Nowadays, urology is quite advanced, and we have at our disposal medicines, surgery, and the combination of both treatments that render our patients improved soon after they interact with us,” says Dr. Sellinger. “So we feel satisfied and secure in the knowledge that we can solve most, if not all, of the urologic problems,” he adds.

Because of consistently great results, urologists are held in high regard by their patients, who are usually grateful for the care. In turn, this gives a kind of satisfaction to urologists.

“I am happy that I chose urology. I’m always filled with joy every time patients come back to thank me for what I’ve achieved for them,” says Dr. Sellinger. “If I were to start all over again, I would still choose to become a urologist.”

Personalized, compassionate care

Want to have your urological problem treated by an effective urologist? AUI is a medical group with a long history of providing comprehensive, high-quality care. The urologists at AUI find it a joy to work in an environment that brings out the best of their knowledge and experience for the benefit of their patients.

Whether you have kidney, urinary tract, prostate, pelvic or other urological needs, at AUI you will find a urologist who can deliver the right treatment for you. For more information on the diagnosis and treatment of urological conditions, visit the Advanced Urology Institute website.

How Often Should Women See A Urologist

Female Urinary Incontinence: Lauren Masters, ARNPMy name is Lauren Masters with Advanced Urology Institute.

When we’re looking at urinary incontinence, for example, most women are having some degree of incontinence; whether it be soaking through one (1) pad a day or wearing depends all day long. Usually we can get someone at a minimum to a 50% improvement. It varies based on your history, your basic demographic and whatever else is going on in your body, but a lot of times we can get you to a good 50% and there are many women we can get to 80-90 [percent] and even a complete resolution of their issues.

Why Southerners Have a Higher Risk of Kidney Stone

I am Ketan Kapadia. I’m with Advanced Urology Institute and a board certified urologist.

Dr. Ketan Kapadia of St Petersburg, FLObviously the heat is going to play a major role, a lot of it has to do with our diet unfortunately as well. [As with] an American diet, we just don’t eat very well, we’re all a little heavier and that also increases the risk of kidney stones as well.

The interesting thing here in Florida, which isn’t talked about very much and this is sort of the holistic treatment of the patient in urology, which is we get a lot of men who have prostate problems who start cutting back on their fluids because they don’t want to get up at night; And when you start cutting back on fluids and not getting up at night, now you’re at more risk of [getting] stones. We see a lot of older guys who come in with kidney stones for the very first time because they got a prostate problem as well and that hasn’t really been addressed.

Same with women who have overactive bladder. First thing most people do is they start cutting back their fluid so they’re not having to run to the bathroom all the time. Again, you cut back your fluid and now you’re living in Florida in the heat, you’re going to get kidney stones. So a lot of doctors will be more than happy to just get rid of your stone and have the surgery [but] I’m also interested in preventing that next stone. Part of that is getting twenty-four (24) hour urines, seeing why you’re making stones, addressing all the overactive bladder problems and prostate problems because I don’t want you to end up having more stones. I’m happy to operate and take out stones, that’s fun, but it’s my obligation to help prevent [it from happening agan].

Diagnostic Tools and Urodynamic Testing for Urinary Problems

Donna Irving, APRN of Naples, FLHi, my name is Donna Irving and I am a Nurse Practitioner with Advanced Urology Institute.

I think [with] the tool sets that we use, we have good ways to evaluate just with blood withdrawal, looking at the PSAs [etc.]. Then we have what’s called urodynamic studies, where we can put catheters in people’s bladder and we can actually tell them how well their bladder is working because we have men that will come in and we’ll say “We’re not sure if its your prostate or is it actually your bladder that’s not working”. [With Urodynamic Testing] we can actually measure both of them or we can do the cystoscopies, look up inside their bladder and tell them how big of a prostate that they have, how much is it impinging on their urethra and we can also measure their bladder so that we can tell them if they have a little bit of both, [and] so we’ll know how to treat them afterwards.

Types of Prostate Cancer: What You Need to Know

Prostate cancer is a complex disease. It is not easy to predict how any particular prostate tumor will grow, or how rapidly it will spread to areas outside the prostate. After a prostate cancer diagnosis, your urologist will assess various factors to determine the level of risk associated with the disease. Understanding the risk level—low, intermediate or high—will help you and your doctor make decisions to achieve the best survival rate and quality of life.

Types of prostate cancer

While there are many types of prostate cancers, urologists first divide them into two categories—aggressive and indolent—to begin determining the best treatment.

1. Aggressive prostate cancer

Dr. Scott Sellinger of Tallahassee, FLAggressive prostate cancer is the type that grows rapidly, spreads fairly early, quickly and widely, and causes massive body damage. Since it spreads swiftly via secondary deposits, it quickly becomes advanced stage cancer and is very difficult to treat, particularly during the later stages.

For aggressive high-risk prostate cancer, treatment is most effective when it begins while the tumor is still in its early stages. Without early treatment, the cells of the tumor remain highly active, multiplying rapidly. The tumor grows swiftly, spreads rapidly and causes widespread damage.

2. Indolent prostate cancer

Indolent prostate cancer is the type that grows very slowly and is unlikely to spread to areas outside the prostate. Therefore, it is a low-risk, low-volume tumor that can exist in the prostate for several years without causing significant problems. Even if left untreated, it is unlikely to spread outside the prostate; and if it spreads, it only does so slowly and locally.

How are high-risk and low-risk prostate tumors identified?

If you are diagnosed with prostate cancer, your doctor will monitor the disease periodically to see if it is growing and spreading. The primary way for monitoring the growth and spread of the tumor is the prostate-specific antigen (PSA) level in blood. PSA is produced by the prostate and reaches the bloodstream; but larger amounts of PSA in the bloodstream are usually a signal that the prostate is enlarged, infected or malignant.

For instance, the PSA doubling time—the time it takes for a patient’s PSA level to double—predicts how aggressive the cancer is. The faster the PSA level doubles, the more aggressive is the cancer. Likewise, the PSA velocity helps to predict the aggressiveness of a tumor. If the PSA level increases sharply, then the cancer is likely aggressive.

Urologists also use the Gleason score to detect how fast the cancer is growing and spreading. This score is obtained by grading cells in the tumor on the basis of how abnormal or normal the cells look under the microscope. The two most abnormal areas of the tumor are evaluated, each given a score from 1-5, and then the two numbers are added. The higher the score (typically 6 or more), the more aggressive the tumor.

While immediate treatment is called for with aggressive, high-risk tumors, a patient can live with an indolent, low-risk tumor for 20-30 years without the cancer causing any serious effects. For the slow growing tumor, we may recommend observation or a watchful waiting called active surveillance, where we monitor the growth and spread of the tumor without medical intervention.

At Advanced Urology Institute, we offer a wide range of treatment options for prostate cancer, including chemotherapy, hormone therapy, radiotherapy, and surgery. But before we can recommend any treatment, we try to determine the risk of advanced disease. For more information on the diagnosis and treatment of prostate cancer, visit the Advanced Urology Institute website.

Women have many treatment options for urinary incontinence

Female Urinary Incontinence: Lauren Masters, ARNPMy name is Lauren Masters with Advanced Urology Institute. When we’re looking at urinary incontinence, for example, most women are having some degree of incontinence; whether it be soaking through one (1) pad a day or wearing depends all day long.

Usually we can get someone at a minimum to a 50% improvement. It varies based on your history, your basic demographic and whatever else is going on in your body, but a lot of times we can get you to a good 50% and there are many women we can get to 80-90 [percent] and even a complete resolution of their issues.

Do You Treat People With ED

Well, yes—every day. At Advanced Urology Institute, we treat men with erectile dysfunction (ED) and achieve great results for our patients. Erectile dysfunction is a big issue for men today, regardless of their age. Up to half of all men experience some form of ED in their lifetime, with roughly 10% of men over 40 suffering severe forms of impotence.

What is erectile dysfunction?

Also called impotence, erectile dysfunction is the inability to regularly get or maintain an erection for satisfying sex. In general, an occasional problem should not be a cause for concern. In fact, it is normal to have trouble getting or keeping an erection for up to 20% of sexual encounters. But frequent trouble getting an erection indicates a medical problem. With ED, successful erections either become the exception more than the rule or they never happen.

Treating People with Erectile DysfunctionSome of the causes of ED include:

  • Alcohol use, illicit drug use, or smoking
  • Medications, such as for high blood pressure
  • Diabetes
  • High cholesterol
  • Heart disease
  • Obesity
  • Blocked blood vessels
  • Scar tissue inside the penis
  • Sleep disorders
  • Metabolic syndrome
  • Anxiety, stress, or depression
  • Emotional or relationship issues

Risk factors for erectile dysfunction include advanced age, diabetes, obesity, depression, cardiovascular disease, high blood pressure, low testosterone, high cholesterol and smoking.

What does treatment for ED involve?

Erectile dysfunction is a treatable condition. At Advanced Urology Institute, we offer several treatment options, generally beginning with the least invasive approach. We also give lifestyle advice that may help with overcoming the condition.

For instance, if your ED is due to inactivity, obesity, metabolic syndrome, high blood pressure or cardiovascular disease, we may recommend you engage in regular aerobic exercise to help reduce the symptoms. We may also recommend you quit smoking, minimize your alcohol intake and follow a healthy diet.

Treatments for ED include:

1. Phosphodiesterase type-5 (PDE5) inhibitors

PDE-5 medications are typically the first line of treatment we recommend for men with ED. They include Stendra (avanafil), Viagra (sildenafil), Cialis (tadalafil), and Levitra or Staxyn (vardenafil).

These oral medications work in a similar manner to boost the level of cGMP—a natural chemical in the body that promotes the widening of blood vessels following sexual arousal. In turn, more blood reaches the penis.

At the same time, these medicines enhance the relaxation of muscles of the penis in response to stimulation, hence increasing blood flow to the penis and allowing an erection.

2. Creams and injections

Sometimes we prescribe a topical Alprostadil cream as an alternative to the oral medications. The cream comes with a plunger and is applied to the tip of the penis and the surrounding skin 5-30 minutes before having sex.

At other times, we may prescribe penile injections as a treatment for ED. That is, we teach you how to inject a medicine at the base of your penis 5-20 minutes before sexual intercourse. After the injection, there will be increased blood flow to your penis and an erection will develop within 15 minutes.

3. Penis pumps (vacuum devices)

A penis pump (vacuum erection pump) is a tube that fits over the penis. A plastic container is placed over the penis and the pump draws air from the container to create a vacuum. The change in air pressure when the device is used causes blood to be drawn into the penis and triggers an erection.

Once the vacuum creates an erection, the retaining band is slid down the lower end of the penis and the pump is removed. An erection will typically last long enough for intercourse but the penis may be cold to the touch, and the rubber band may restrict ejaculation.

4. Penile implant (surgery)

We generally recommend surgery only when all other treatment options are not successful or not well tolerated. If that is the case, a penile implant (prosthesis) may help in achieving erections.

A penile implant is a medical device surgically placed into a penis to mimic the look and performance of a natural erection. The prosthesis involves an inflatable rod inserted in the middle of the penis, with a pump hidden in the scrotum. The pump is used to inflate the rod, which in turn causes an erection.

Penis pumps are custom-fit to your anatomy in a procedure that is performed carefully to ensure that the sensitivity of the penis and your ability to ejaculate are not adversely affected, allowing you to have a normal orgasm and great sexual encounters.

At Advanced Urology Institute, we recognize that erectile dysfunction is a common but very sensitive issue. That is why we provide a compassionate, patient-friendly approach to ED treatment to help men tackle it as soon as it starts. And because ED may also be a sign of a more serious medical condition, we encourage you to speak with a urologist as soon as possible to help you address the underlying condition and find the best treatment option.

Remember, the sooner you speak with your doctor about ED, the sooner you can go back to enjoying physical intimacy with your significant other. For more information about the diagnosis and treatment of erectile dysfunction, visit the Advanced Urology Institute website.