Several factors may increase your risk of stones including higher calcium or oxalate in the urine, recurrent urinary tract infections, uric acid in the urine (often related to a high protein intake) or family history of kidney stones. Dehydration and certain dietary choices may also play a role.

NON-SURGICAL TREATMENT

There are a few ways to decrease stone formation, they include:

• Adjusting beverage choices:

• Fluid intake is extremely important with goal urine output of 2.5 liters/day
• Crystal Light® may be useful to increase citrate levels in the urine, a protective mineral that decreases stone risk
• Avoid dark soft drinks (i.e. colas, root beer)
• Data on lemonade and orange juice is inconclusive

• Dietary changes:

• The best diet for most stone formers is the DASH diet – high in fruits/vegetables, low in sodium (less than 2300mg/day) and low in animal protein (less than 1g of protein per Kg of body weight per day)
• Maintaining a moderate amount of dietary calcium intake is important (2-3 servings/day – 1000-1200mg/day)
• If on a calcium supplement, take at the time of meals to decrease stone formation risk
• Men and Pre-menopausal women: 1000mg/day
• Men over 70 and post-menopausal women: 1200mg/day

• If on Vitamin D supplementation, ok to continue as long as normal calcium in your 24 hour urine (please discuss with your provider)
• Consider a lower oxalate diet by decreasing spinach, beets, leafy vegetables, chocolate, peanuts, tea, and soybeans from your diet.

SURGICAL TREATMENT

• Trial of passage: This is useful for patients with sufficient pain control, adequate kidney function, no fevers/chills, and for stones less than 1 cm in size. The size and location of the stone significantly impacts success rates of passage (please review with your provider). Of note it may take up to 4-6 weeks for a stone to pass.
• Tamsulosin (Flomax) may be used to assist in stone passage
• Ibuprofen may be used for pain control and to assist in stone passage
• ESWL (Shockwave Lithotripsy): A non-invasive treatment that breaks up stones through sound waves on the outside of the skin.
• Ureteroscopy: A minimally invasive procedure where upon a scope is inserted into the bladder and ureter and the stone is lasered (typically) and the fragments are removed.
• PCNL (Percutaneous stone removal): Involves a small incision in the back and the insertion of a scope directly into the kidney with fragmentation and stone removal. This is utilized for stones larger than 2 cm typically.

What is a ureteral stent? A small tube that is inserted into the ureter during your procedure that allows urine to bypass an obstructing stone or allows the ureter to heal after ureteroscopy.