Kidney Stones

[Jor-el]

Hopefully I have a success story to post. After finding I had kidney stones during a pre op physical for knee replacement, I had the worst one removed via lithotripsy.

That one was about 8 mm and partially blocking the urterer. After becoming dissatisfied with the first urologist I consulted a second I liked better. We set up a date within a few days of seeing him. I was given an anesthetic and put under and woke up very groggy. He told me it would not or should not effect BP or diabetes because that might happen with heavy treatments that leave leave scarring in areas where this litho would not touch.

My back hurt the first couple of days but the reward is to see the sand or tiny gravel filtered out of my urine. So something happened and it was at least partially destroyed. See him again in a couple weeks for another look with xray. He said it sometimes takes a while for the fractured stone to disentegrate, partially or completely.

I have had very little pain urinating. So far so good.

Jor-el

[cathrine001]

Jor-el

Lithotripsy can damage the tissues and the central nervous system. This information is documented in the Urology Journal 2006 and Mayo Clinic

Print out the information and bring it to your new urologist and ask if he has read it. Based on the answer he gave you, my guess is that he has not read it. If he did not counsel you regarding the risks, prior to your procedure, he is going against suggested protocol.

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Please read the following articel from Mayo Clinic.
Article Link: http://www.mayoclinic.org/news2006-rst/3338.html


Shock Wave Therapy for Kidney Stones Linked to Increased Risk of Diabetes, Hypertension

Monday, April 10, 2006

ROCHESTER, Minn. — Mayo Clinic researchers are sounding an alert about side effects of shock wave lithotripsy: in a research study, they found this common treatment for kidney stones to significantly increase the risk for diabetes and hypertension later in life. Risk for diabetes was related to the intensity of the treatment and quantity of the shock waves administered; hypertension was related to treatment of stones in both kidneys.

Shock wave lithotripsy uses shock waves to break up an impassable kidney stone into smaller, sandlike pieces which can be passed spontaneously, usually within a month. The patient and the lithotriptor that emits the shock waves are placed in a water bath. Water allows easier conduction of the shock waves through the patient's tissue and precise focus on the kidney stone.

"This is a completely new finding," says Amy Krambeck, M.D., Mayo Clinic urology resident and lead study investigator. "This opens the eyes of the world of urology to the fact that hypertension and diabetes are potential side effects. We can't say with 100 percent certainty that the shock wave treatment for the kidney stones caused diabetes and hypertension, but the association was very strong. The risk of developing diabetes after shock wave lithotripsy is almost four times the risk of people with kidney stones treated with medicine, and the risk of developing hypertension is one and one-half times, which is a significant risk increase."

The study, which is the first examination of the effects of shock wave lithotripsy over the long term, involved reviewing charts of 630 patients treated with shock wave lithotripsy in 1985 at Mayo Clinic. The researchers sent those still alive a questionnaire; almost 60 percent responded. The researchers matched the patients treated with lithotripsy to patients similar in age, gender and initial time of seeing a urologist for kidney stones who received a different treatment, medicine. Nineteen years post-treatment, those treated with lithotripsy had 3.75 times the risk of having diabetes as those given the other kidney stone treatment. The degree of increased risk rose with greater number and intensity of shocks administered. Those treated with lithotripsy also had 1.47 times the risk of having hypertension — high blood pressure — than those who received the other kidney stone treatment; risk was highest for those who had both kidneys treated.

The researchers hypothesize that the increase in risk for diabetes associated with shock wave therapy for kidney stones relates to damage inflicted to the pancreas, a previously known risk of lithotripsy, which may affect the islet cells in the pancreas that make insulin. They believe the increased risk for hypertension may relate to scarring, which the treatment may cause to the kidneys and could alter the secretion of hormones centered in the kidneys like renin, which influence blood pressure.

Drs. Krambeck and Joseph Segura, M.D., Mayo Clinic urologist and study investigator, say that they continue to use shock wave treatment, among other alternative treatments for kidney stones.

"Despite the risks, shock wave therapy still can save the day for patients, and it would be a mistake to put it on the shelf," says Dr. Segura.

The researchers indicate that they now counsel patients about the potential risk for diabetes and hypertension prior to shock wave treatment.

Dr. Segura stresses the need for kidney stone patients and their physicians to weigh the pros and cons of shock wave treatment according to individual situations. "It's a trade-off about whether the risks are worth taking," he says. "We're assuming doing nothing is not the right thing to do for patients. You have to look at it in terms of treatment alternatives — percutaneous stone removal [removing a kidney stone through a small incision in the patient's back using an instrument called a nephroscope] or ureteroscopy [snaring a stone with a small instrument passed into the ureter through the bladder and then breaking up the stone with ultrasound or laser energy] — each of which has its own set of risks."

The Mayo Clinic researchers examined the long-term effects of lithotripsy for patients treated with a 1985 lithotriptor, one of the early models, in this study. Drs. Krambeck and Segura say additional research studies, including research on newer machines and different models, are needed on shock wave therapy and risk for diabetes and hypertension later in life.

Prior to age 70, approximately 10 percent of men and 5 percent of women will experience a kidney stone, according to the National Institutes of Health. About 1 million people in the United States have had shock wave lithotripsy, says Dr. Segura.

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About Mayo Clinic

Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. Doctors from every medical specialty work together to care for patients, joined by common systems and a philosophy of "the needs of the patient come first." More than 3,300 physicians, scientists and researchers and 46,000 allied health staff work at Mayo Clinic, which has sites in Rochester, Minn., Jacksonville, Fla., and Scottsdale/Phoenix, Ariz. Collectively, the three locations treat more than half a million people each year. To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. For information about research and education visit www.mayo.edu. MayoClinic.com is available as a resource for your health stories.

Contact Information
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[Jor-el]

Yes, the second doctor did counsel me on the risks of Litho whereas the first doctor did not. Part of the rational for change. I am not a researcher in this realm, perhaps one is reading, but the information I have come accorss is that damage to the pancrease, that is scarring due to lithotripsy, is the cause of high BP and diabetes later.

According to my doc, this study was done with patients who got Litho in 85 and they used a different type of machine then. One that explodes rather than implodes the stone. So he thought that might be part of it. Also, there was a follow up study I read that contradicted the Mayo findings. If I can find it again I will post it.

All in all it is wise to do your research and always remember you are in control. Saying NO is as easy and cutting a piece of ribbon with shears. The doctor is NOT in charge nor will he or she suffer the possible lifetime of consequenses of a wrong choice - except in the most remote, comfortable way. That helps me to know that I can always say NO right up to the last second.

I am not trying to tell you to be afraid and live in fear. All decisions have consequences and we are not GOD so we do not always make the best decsions but the quality of decision making is directly related to the quantitiy and quality of information you have before the decsion. So do due dillegence. Of course some take that to extremes and use endless research as an excuse for not making a decision. I personally believe that a part of every important decision is prayer. Not a substitute for doing the work but in addition to doing the work because after you have all the info you, "still gotta decide."

Y'all have fun out there, ya here?

Jor-el