L+M Urology covers the whole kidney stone journey

Women have equated the pain to childbirth. Men have described it as the worst pain of their life. Kidney stones.

Formed by the crystallization of minerals in the urine, kidney stones may block the flow of urine and back it up into the kidney and ureter (tube connecting the kidney and bladder). Passing one can be excruciating, according to urologist Timothy Tran, MD.

Ranging in size from a grain of sand to a ping pong ball, kidney stones can cause severe pain on either side of the lower back, abdomen or groin; blood in the urine; nausea, or vomiting. Diagnosis is through a urine test, blood test, X-ray, ultrasound or low-dose CT scan. If tests show a stone is small, pain medicine and drinking plenty of fluids may be enough to flush it out through the urinary tract. Tiny granules may pass without a patient even noticing.

The Kidney Stone Program at Lawrence + Memorial Hospital offers a comprehensive pathway back to urinary health that takes patients from diagnosis through treatment and prevention. Care includes procedures to remove existing stones, nutritional counseling to reduce the risk of developing new ones and behavior change designed to prevent recurrence.

“Our clinic covers the whole process for a patient suffering from kidney stones,” said Dr. Tran, pointing out that ultrasound, nutritional counseling and medical treatments are provided in his office at the hospital. “In our region, we offer the only comprehensive kidney stone program in one location.”

“We provide personalized treatment that begins with sending a stone to the lab for analysis to begin to understand the cause and best treatment,” said Dr. Tran, because there are many types of stones and every patient’s situation is unique.

For special circumstances, such as patients who are also being treated for conditions which may have dietary restrictions, such as heart disease, there is a nephrologist (kidney disease specialist) on staff for medical consultation. A dietitian will help identify foods that may trigger stone formation.

L+M offers the full range of treatment options, including:

• Shock-wave lithotripsy – non-invasive procedure using high-energy sound waves to blast the stones into fragments that can then pass out through the urine.
• Ureteroscopy – involves inserting a tiny endoscope into the ureter to retrieve or break up stones using a laser. The outpatient procedure is used for medium-to-large stones.
• Percutaneous stone removal – a minimally invasive surgery for very large stones. The surgeon makes a thumbnail-sized incision in the back, inserts a tube and removes the stone using either laser or ultrasonic energy. It can require hospitalization for one or two days.

People who have had a kidney stone are at risk of developing another. Recurrence is 25 percent within the first three years and up to 50 percent after five years, Dr. Tran notes. Depending on the individual and type of stones, preventive treatment may include cutting down on red meat, organ meats and shellfish, and following a diet rich in certain vegetables, fruits and whole grains. Dr. Tran recommends limiting sugar-sweetened foods and drinks. Drinking water infused with fresh-squeezed lemon or lime juice or eating oranges will help decrease urine acidity and reduce the chance for stone formation.

“The best way to treat kidney stones is to avoid getting them,” said Dr. Tran. “The easiest way to do that is to drink plenty of water.”

Not all kidney stones are alike.

• Calcium stones, the most common, are usually made of calcium and oxalate, a natural chemical found in many foods including spinach, peas, chocolate and nuts.
• Uric acid stones form when the urine is too acidic, generally in the setting of medical conditions such as diabetes or obesity.
• Struvite stones are associated with urinary tract infections in which bacteria make ammonia that builds up and rapidly creates stones.
• Cystine stones are rare and only happen to those with an inherited condition that causes cystine (a sulfur-containing amino acid) to leak from the kidneys into the urine.

Expert urologists offer comprehensive care in New London

Lawrence + Memorial Hospital is home to some of the best urologists in the state. The Yale Urology team on staff at L+M includes Joseph Brito; Joseph F. Renzulli, MD; and Timothy Tran, MD, all faculty at Yale School of Medicine.

Our urology specialists diagnose and treat a variety of urological problems – from the common to the most complex, such as:

• Kidney stones
• Bladder cancer, the fourth most common cancer in men and ninth most common in women
• For men: Conditions that affect the prostate and sexual function, such as low testosterone, erectile dysfunction, fertility issues, Peyronie’s disease
• For women: Urinary incontinence and other pelvic floor disorders
• Urologic cancers, in collaboration with Smilow Cancer Hospital Care Center in Waterford

Because L+M Hospital is part of Yale New Haven Health system, patients benefit from the affiliation with Yale School of Medicine where physician specialists actively investigate new approaches to treat conditions such as urinary incontinence, pelvic organ prolapse and kidney stone disease. This collaboration enables Yale Medicine specialists to provide exceptional patient care based on cutting-edge research and clinical experience. When needed, patients have access to specialized care at Yale New Haven Hospital when needed.

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