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Your doctor’s your best guide

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Most people have heard of kidney stones and the various methods of dealing with this sometimes very painful problem but are surprised to hear that stones can also be present in the urinary bladder.

Kidney stones most often are passed out spontaneously but in certain cases, when the stone is too big to fit through the narrow interior passageway of the ureter connecting the kidney to the bladder, urological intervention may become necessary. A stone passing down the ureter from the kidney towards the bladder may obstruct the flow of urine and the result is that the kidney, which blindly continues to produce urine, inflates itself like a balloon stretching the nerves in the tissues lining the kidney interior. Stretching of these nerves is felt as a severe pain known as “renal colic” and requires relief using appropriate medication.

If the stone should spontaneously pass through the ureter into the urinary bladder, the “renal colic” is suddenly and dramatically relieved. Usually but not always, the stone will pass out of the bladder shortly thereafter. Sometimes, especially if the patient also has an enlarged prostate, the stone may get trapped within the bladder behind an obstructing prostate, where it slowly enlarges as the urinary salts build up layer upon layer on the surface of the stone. Eventually, the stone will get so large that it becomes irritating to the bladder interior resulting in pain, worsening of the symptoms of prostate enlargement, bleeding, infection and possible development of a bladder tumor. When the stone is made primarily of calcium, it cannot be dissolved and urological intervention will be required.

When however, the kidney and/or bladder stone is made of Uric Acid, it may be dissolved by the use of certain medications. These usually consist of various combinations of potassium and sodium citrate and include Polycitra-K, Urocit-K and Bicitra. These medications, however, must be under the strict control of your doctor as there is a long list of other medications, which may interact with these drugs and cause far more harm than good. So always ask your doctor to check out drug compatibility not only for what he prescribes for you but also for what other of your doctors may have prescribed for entirely unrelated conditions and for over the counter medications you may have obtained on your own.

Another drug, which works in a different manner to actually reduce the production of uric acid, may also play a role in the treatment of uric acid stones. This drug is allopurinol and it also must be under your doctor’s strict control with periodic blood tests checking for possible toxicity to liver, kidney and bone marrow, because like all medications and treatments, it can be a double-edged sword; it can help but it can also cause harm. Your doctor will know what is best and guide you appropriately.

Have a question? Call Dr. Okun at 718-241-6767

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