How I treat it: kidney stones from 7 mm to 15 mm. A urologist explains

This article was translated from the original Portuguese. Português

Did you know that one in five Brazilians may be affected by kidney stones during their lifetime? And that these stones can cause intense pain and discomfort if not treated properly?

I am Dr. Bruno Benigno, urologist and director of Clínica Uro Onco in the city of São Paulo, and today I am here to tell you how I treat my patients with kidney stones from 7 mm to 15 mm.

Remember that my intention here is purely educational: you should not stop or start any treatment without a personalized evaluation, and always keep your urologist informed about your symptoms.

Well… let's get to the main topic of this video.

Kidney stones, a common condition in both the Brazilian and the global population, account for approximately 600,000 emergency medical visits every year in Brazil. Estimates indicate that about 20% of the population may be affected by this condition during their lifetime.(1,2)

When diagnosing a patient with stones between 7 mm and 15 mm in size, a crucial factor is determining whether symptoms are present.

In the absence of renal colic (a situation in which the stone migrates from the kidney and blocks the flow of urine in the ureter), the therapeutic approach should be elective and planned. This involves a detailed medical history, assessing the patient's past medical history, eating habits and family history.

Stones larger than 7 mm have less than a 30% chance of passing spontaneously, which makes treatment essential. There are two main intervention strategies:

1. *Extracorporeal Lithotripsy:* Ideal for stones located in the kidney, this technique uses high-frequency mechanical shock waves focused on the stone to break it up. The procedure does not require hospitalization, and the patient receives light sedation for greater comfort.

Even though it is minimally invasive and does not require hospitalization, there is a risk of renal colic as the fragments are expelled.

2. *Laser Intracorporeal Lithotripsy:* Recommended for larger stones. High-power lasers are now available in Brazil, minimizing complications and speeding up recovery.

The procedure is performed in the hospital under general anesthesia, takes about 1 hour, and the patient is discharged the same day.

The advantage is a higher chance of complete stone clearance and a lower risk of renal colic from the passage of stone fragments after the procedure.

Another relevant point in each patient's evaluation is stone density

Stone density, measured on CT in Hounsfield units, also guides the therapeutic approach. While stones below 500 units are porous and more easily treated, those above 1,000 units require high-power lasers.

After treatment, prevention becomes paramount, involving analysis of the stone's crystal composition, a 24-hour urine test and dietary guidance.

Patients with uric acid stones need specific monitoring and guidance and have a higher chance of dissolving the stone with medication alone, without the need for surgery. (3)

Now I will list some recommendations and foods that anyone with a history of kidney stones should avoid:

• Calcium Oxalate: If the stones are composed mainly of calcium oxalate, it may be recommended to reduce intake of oxalate-rich foods, such as:
  • Spinach
  • Beets
  • Nuts
  • Chocolate
  • Tea
  • Strawberries
  • Soy
  • Okra

• Calcium Phosphate: If the stones are calcium phosphate, avoid:
  • Avoid excessive consumption of dairy products
  • Limit foods high in phosphorus, such as processed meats, soft drinks and certain grains.
• Uric Acid: If the stones are uric acid, I recommend:
  • Reduce intake of red meat, seafood and organ meats.
  • Avoid alcoholic beverages, especially beer.
• Cystine: Cystine stones are rarer and may require a specialized diet.
• 
  
• Sodium: Reducing sodium intake can help prevent kidney stone formation, since sodium can increase the amount of calcium in the urine.
• 
  
• Protein: Excessive protein intake can increase the risk of kidney stones. Limiting animal protein intake may be recommended.
• 
  
• Water: Drinking plenty of water is essential to prevent kidney stones. Water helps dilute the minerals and salts in the urine that can form stones.
• Caffeine: Some research suggests that caffeine may increase the risk of kidney stones, although the results are mixed.

For more information on treatments and approaches, visit our website. Share this knowledge with your friends and family. Thank you for your attention, and see you soon.

If you are looking for reliable information about urological health, I invite you to explore our website and YouTube channel further. Together, let's demystify kidney stones and promote health and well-being."

"Thank you for being here with us. And remember: information is the first step toward better health. See you next time!

1. Ingimarsson JP, Krambeck AE, Pais VM. Diagnosis and Management of Nephrolithiasis. Surg Clin North Am. June 2016;96(3):517–32.

2. Ziemba JB, Matlaga BR. Epidemiology and economics of nephrolithiasis. Investig Clin Urol. 2017;58(5):299–306.

3. Abreu Júnior J de, Ferreira Filho SR. Influence of climate on the number of hospitalizations for nephrolithiasis in urban regions in Brazil. J Bras Nefrol Orgao Of Soc Bras E Lat-Am Nefrol. May 8, 2020;

🔸Don't put off until tomorrow the care that needs to be daily! ☎(11) 2769-3929 📱(11) 99590-1506 Contact us directly on WhatsApp: 📲 https://bit.ly/2HCRkgt 💻 https://www.clinicauroonco.com.br/ Book online: http://bit.ly/2WMMiCI Rua Borges Lagoa 1070, Cj 52 Vila Mariana - São Paulo - SP Dr. Bruno Benigno CRM SP 126265 | RQE 60022 Urologist at Hospital Alemão Oswaldo Cruz SP Director of Clínica Uro Onco Specialist in Uro-oncology and Robotic Surgery Instagram: @dr_benigno #urology #health #urooncology #healthyliving #uro #urology #medicine #drbrunobenigno #uroonco

Dr. Bruno Benigno
Urologist and uro-oncologic surgeon (CRM-SP 126.265 · RQE 60022). More than 1,500 robotic surgeries. Member of the AUA, EAU and SBU. Meet Dr. Bruno · In the Media

This content is educational and does not replace a medical consultation. Each case must be assessed individually, based on AUA, EAU and NCCN guidelines.