patient-education

Kidney Stone Disease: Myths and facts

Kidney stone disease is extremely common in this part of the country which constitutes part of the “stone belt” of the world. Since this is so common, every other person either suffers from kidney stones or has a relative who does. Unfortunately, there are so many myths and commonly held misbeliefs about kidney stones that the common man easily gets mislead into a confusion of different kinds of advice he gets from friends, relatives, unqualified quacks and even qualified doctors.

Myths about food articles which may cause stone disease

Intake of tomatoes can cause stones

Fact: It has been proven beyond doubt that tomatoes eaten in the usual quantities, bhindi and other seeded vegetables have no role to play in causing renal stones. On the other hand, all kinds of beans, foods like apples and apple juice, saag and leafy vegetables like spinach should be consumed in restricted quantities – there is NOTHING banned!!

Milk is prohibited in kidney stones

Fact: Milk and Calcium containing medicines have been shown to have NO effect whatsoever on the formation of kidney stones. Excess of protein rich foods like meat, chicken and fish should, however, be avoided.

Myths about fluid intake

One should take plenty of all kinds of fluids to get rid of stones

Fact: The best fluid guaranteed to prevent and treat renal stones is plenty of water to which some lemon juice is added, without sugar or salt. Salt, in particular, is very harmful in stone disease. All other fluids like tea, coffee, sodas and soft drinks and juices etc., should be taken in moderation!! All of these fluids do cause increased flow of urine but only by causing loss of the body’s own fluids! As a rough guide, each cup of tea causes the body to lose at least two glasses of water!! If one likes to drink any of these dehydrating fluids, one must drink more water.

Intake of Beer is useful in kidney stone disease

Fact: Beer causes kidney stones: In addition to causing large scale loss of precious body fluids, beer contains several chemicals which can cause kidney stones!!

If one stays in an air conditioned atmosphere all the time, one doesn’t need to drink more water

Fact: One of the functions of air conditioning is to remove moisture from the environment. So, if one lives and works in an air conditioned atmosphere all day long, one must necessarily drink more water. People earning their livelihood thru manual labour obviously need many times more.

Myths about diagnosis of stone disease

Ultrasound is always right in diagnosing kidney stones

Fact: Ultrasound Examination may diagnose stones where there are none, and conversely, miss stones when they are present. There is a portion of the ureter in which a stone can be missed quite easily. To make a firm diagnosis of renal stone, a urologist usually considers the patient’s history and then conducts a thorough clinical examination of the patient. Following this clinical examination, he may then advise several investigations including urine microscopic exam, Ultrasound, and imaging studies of the Urinary tract including Intravenous Urography and/or CT scan / Isotope scan. Using a combination of these techniques, he then advises appropriate treatment. He may also advise biochemical tests including stone analysis to guide the patient on how best to prevent stone recurrence.

Myths about treatment of Renal Stone

Any doctor can treat stone disease

Fact: Although every qualified M.B.,B.S. doctor is supposed to have some working knowledge about some aspects of kidney stone disease, many of them do not keep themselves updated, and so , are unable to provide the correct and current advice . Non-MBBS doctors, are obviously unqualified to prescribe allopathic treatment

Desi medicines can help get rid of stones

Fact: There is no evidence that “desi” or indigenous medicines help in treating or preventing kidney stones. Many of these “desi” medicines, in fact, contain allopathic pain relieving medicines. The patient becomes free of pain and assumes that the stone has passed! After some time, the kidney becomes non-functional or “dead”. Ayurvedic/ homeopathic medicines may have some efficacy but do not have enough studies to support their use.

Any surgeon can treat stone disease

Fact: Many surgeons who are interested in kidney stone disease and keep their knowledge updated can usually render appropriate advice regarding kidney stone management. The best consultant to manage a patient of kidney stones is a urologist. A urologist is a surgeon who has been trained in urology for 2-3 years after acquiring the degree of M.S.(Surgery). A urologist may hold the degree of M.Ch. or DNB in Urology. Unfortunately, there are only about 2000 qualified urologists in the whole of India, and most practise in larger cities. In Punjab, for example, this number may be less than 20. Thus, anybody and everybody manages kidney stone disease.

There is no medical treatment of kidney stone disease

Fact: There are specific guidelines for management of every type of kidney stone disease including medical management – most urologists are aware of these guidelines and follow them. As a general rule, if there are stones in both kidneys, at least one should be kept free of stone as soon as possible. Similarly, in case a stone is causing severe pain or fever or is likely to damage the kidney being affected, it usually needs urgent admission and management. Mere absence of pain does not mean that the kidney is safe.

Absence of pain means that the stone has been passed

Fact: The fact that a stone which was earlier causing pain is not painful anymore does not necessarily indicate that it has been passed. In fact, many times, pain disappears merely because the kidney has stopped to function! Even the absence of stone on ultrasound may not confirm that it has passed out. Passage of stone in the urine is the only proof-positive of stone passage, unless additional tests confirm it

Intravenous Fluids can help get rid of stones

Fact: Intravenous fluids are used only to manage an episode of severe pain, not to “get rid of” stones. Pain caused by stones may be so severe as to require intravenous medication for pain relief. In addition, there may be vomiting and abdominal distension during severe pain which may limit intake of oral fluids by the patient, and this is why an intravenous drip may become necessary.

“Flushing”/“Lasix Therapy” or “Forced Diuresis” can get rid of kidney stones

Fact: There is NO medical evidence that Lasix therapy / Forced diuresis helps to get rid of stones. However, despite this fact, this form of “treatment” continues to be the most commonly abused. If the stone is in the kidney, increasing urine flow will never affect it. If the stone is in the ureter or obstructing the system, “flushing” can be so dangerous that it can actually kill the patient! All urologists have seen patients brought in as an emergency in severe septicaemia because some doctor tried this ridiculous means of treatment.

Open stone surgery is the only sure method to get rid of all the stones

Fact: Open surgery for stone disease has been given up as a method of choice for more than 98% of kidney stones treated all over the world. The reasons are very obvious: 1.Endoscopic surgery requires very tiny or no incision compared to open surgery which requires very large and muscle-damaging incisions; 2. There is hardly any pain during and after endoscopic surgery; 3. No rest is required after endoscopic surgery; which can be repeated if and when the stone occurs again (recurrence). Open stone operation on the other hand, becomes more and more difficult with every repeated attempt, and may even lead to removal of the kidney finally. Apart from the trauma and pain, open surgical incisions for kidney surgery are very prone to form hernias. However, endoscopic surgery for stone disease is rather expensive in terms of proper equipment and adequate training of urologists, so open surgery is quite common in India and the developing world.

Surgical Removal of Stones is useless because stones may form again

Fact: Surgical removal can never be a cause of new stone formation! Urologists usually give detailed dietary and medical advice to ensure that stones do not form again. It then becomes the duty of both, the patient and the doctor to ensure that the advice is followed religiously.

Endoscopic surgery can cause recurrence (re-occurrence) of stones

Fact: Endoscopic Surgery can never be a cause of stone recurrence. What can happen is that stones or stone fragments are left behind during surgery and they grow later. This may happen in patients who have multiple kidney stones. For this very reason, most urologists make sure that patients leave the hospital free of stones after endoscopic surgery . Several techniques including XRays are used to ensure that the patient is absolutely stone-free after the operative procedure. This is something which is almost never done after open surgery!