00:00 – When we’re talking about the urinary tract you can have kidney stones,
00:03 – you can also have bladder stones but bladder stones tend to form for a different set of reasons.
00:22 – Melissa: Dr Kymora Scotland is a US-based urologist
00:25 – who specializes in endoeurology and stone disease and she’s also been collaborating with our team
00:30 – on patient-centered Research.
00:32 – Thank you so much for sharing your expertise with us today.
00:35 – Doctor scotland: Thank you so much for having me here!
00:37 – Melissa: Can you share a little bit more about your background
00:39 – and how you came to be interested in recurrent and chronic UTI?
00:43 – Doctor Scotland: Well I’m a urologist, and during residency I…
00:49 – really started becoming interested in kidney stones,
00:52 – and so that is my primary area of interest.
00:57 – But one of the things that I noticed once I became an actual urologist,
01:02 – is a lot of my patients were coming in with recurrent UTIs,
01:06 – sometimes they were sent in to me because they had kidney stones,
01:10 – and as I’m sure we’ll talk about a little bit later
01:12 – there can sometimes be a connection between the two.
01:15 – But you know towards the end of my first few years working as a urologist
01:23 – I started to notice that lots of patients, even without kidney stones, were coming to me with recurrent UTIs
01:29 – and so it’s really become an area of interest for me as well
01:33 – Melissa: Well that’s good for us because there does seem to be quite a bit of crossover
01:36 – between kidney stones and UTIs in our community so we got a lot of questions.
01:40 – But I wanted to start with some basics to get an overview.
01:44 – And the first one of course is what is a kidney stone?
01:46 – Doctor Scotland: All right so a kidney stone is really what I try to call a collection of material.
01:54 – What tends to happen in all of our bodies is that
01:58 – our kidneys make urine and that urine will have minerals and crystals.
02:04 – For people who form stones what ends up happening is that
02:07 – those crystals will deposit out of the urine into the kidney and then as time goes on
02:15 – more and more crystals will sort of pile up on each other and form a stone.
02:19 – Melissa: Right. Are there different types of stones?
02:22 – There are. So there are five main types of stones.
02:27 – There are calcium-based stones, calcium oxide and calcium phosphate.
02:31 – There are uric acid stones there are cysteine stones,
02:36 – struvite stones and then there are another mix of stones,
02:42 – which is sort of my my fifth type.
02:44 – And those tend to be much more rare and they can be caused by certain medications
02:49 – or certain drugs that you might be taking.
02:51 – Melissa: What does the kidney stone look like?
02:54 – Doctor Scotland: Well it really looks like a stone that you would see on the street.
02:58 – And that’s why it’s called a kidney stone:
03:01 – They can be just as hard as a rock or a pebble that you see on the street as well.
03:06 – Melissa: Sounds very uncomfortable. But how do each of those types that you mentioned form,
03:11 – are they formed in different ways?
03:13 – Doctor Scotland: They are. And I should mention that most people
03:16 – will form calcium-based stones.
03:19 – So you know if you are a stone former
03:22 – and you go online a lot of the information that you’re going to see
03:25 – has to do with people who have calcium type stones but I’ll start with the others first because
03:31 – they are a little bit less addressed online and in literature.
03:39 – So for instance you’ve got uric acid stones, which tend to form for a variety of reasons
03:45 – and I should say that that’s the case for all stores but for uric acid stones
03:49 – they sometimes form because of certain illnesses that people have.
03:53 – And they can sometimes form because of the types of food that you eat.
03:58 – So I’ll tell people that with uric acid stones for instance you tend to see a lot of folks
04:06 – with diabetes folks with obesity might have uric acid stones
04:11 – folks who eat lots of meat, I don’t just mean red meat, I mean any type of meat product
04:16 – can sometimes have uric acid stones.
04:20 – That’s not exclusive but those are some of the more common things that we see.
04:25 – For instance with cysteine stones those are genetic and so really with people
04:32 – with existing stones they form them as kids there’s nothing that you have done
04:37 – or you know can do necessarily to avoid cysteine stones and
04:41 – they’re the type of stones that we really have to work with patients and
04:44 – you’ll tend to find lots of family members with those stones.
04:48 – Struvite stones which I’m sure we’ll talk about a lot more later,
04:52 – are also known as infectious stones,
04:55 – and those stones are formed from bacteria.
04:58 – Then you’ve got the calcium-based stones as I mentioned.
05:01 – Those can be formed for any number of reasons.
05:05 – Sometimes we can find reasons associated with diet for instance
05:11 – whether or not you’re drinking enough water. And I should mention here that with almost any stone
05:18 – that you can form, if you stay hydrated that’s gonna get you a long way
05:25 – towards preventing stones because hydration is one of the things that we
05:29 – found is really associated with stone formation.
05:32 – Melissa: Okay. How big can kidney stones get?
05:37 – Doctor scotland: So they can be anywhere from a small pebble
05:41 – or you know a what you call a pontate stone, so for those people who’ve had stones,
05:47 – if you get ultrasounds that are CAT scans done and you know,
05:51 – the physician tells you the report result you might see that you have a
05:55 – punctate stone and that just means it’s a pinpoint.
05:58 – and it can go anywhere from that size to you know filling the entire kidney.
06:03 – So you’re talking five six centimeters,
06:05 – which again doesn’t sound like much, but your kidney is not that large
06:08 – Melissa: When the stones form, do they stay in the kidney or can they move elsewhere in the urinary tract?
06:13 – So they can do both. I have lots of patients who have had kidney stones for years,
06:18 – so lots of folks will have just one stone
06:21 – and you know they’ve had it it hasn’t gotten any larger it’s been 10 15 years,
06:25 – and it just sort of stays in the kidney.
06:27 – but every now and then and for some people more often than that,
06:31 – kidney stones will decide to fall out of the kidney.
06:34 – And what happens in that case is then they get stuck in the ureter.
06:38 – The ureter is the tube that the kidney drains urine out of and it connects into the bladder.
06:44 – So a lot of times when people will tell you they have a kidney stone pain
06:46 – or they’re passing a kidney stone, that stone has already left the kidney.
06:51 – It’s stuck in the ureter and that’s what’s causing all the pain
06:55 – Melissa: In that case, does it often pass on its own or some kind of intervention needed?
06:59 – Doctor Scotland: It really depends on the size.
07:01 – So what I tell my patients is that most stones
07:05 – that are about five millimeters or less will pass.
07:09 – Once you get past that size, the chances of them passing on their own really starts to decrease.
07:15 – Then, even when you know you have smaller stones it’s not always a guarantee that you’ll pass it.
07:21 – I’ve had lots of patients with two millimeter and three millimeter stones
07:25 – which don’t pass.
07:27 – So it really sometimes is hard to predict,
07:30 – but generally speaking the smaller the stone the you know more of a chance that it will pass.
07:35 – Melissa: Okay, and when you do form kidney stones, do they tend to form in
07:38 – both kidneys at the same time or just one or the other?
07:41 – Doctor Scotland: You know that’s not necessarily the case, I have lots of patients who
07:45 – will only have stones in one kidney who are not quite sure why that happens.
07:50 – We think it’s something to do with, because you know each kidney is a little bit different,
07:55 – and so we think it’s something to do with you know how much crystal is
07:59 – forming in one kidney versus the other but we’re not quite sure.
08:02 – I have lots of patients who have what we call bilateral stones, so stones on both sides,
08:06 – and it’s hard to predict what will happen.
08:09 – Melissa: Right. Do stones form anywhere else
08:11 – in the urinary tract or do they always originate in the kidneys?
08:15 – Doctor Scotland: So there are different types of stones and when we’re talking about the urinary tract,
08:19 – you can have kidney stones you can also have bladder stones.
08:22 – But bladder stones tend to form for a different set of reasons.
08:27 – Generally speaking bladder stones will form if there’s something obstructing the bladder.
08:32 – So what I tell most of my patients is “your bladder is kind of a ball of muscle.
08:38 – Think of it like a balloon it fills up and then it will or it should
08:43 – push the urine out once it’s full enough.
08:46 – If you’ve got something blocking the bladder
08:48 – or if you’ve got something that’s causing the bladder not to be
08:52 – able to contract as well as it should,
08:54 – sometimes urine starts building up.
08:56 – When urine builds up you have sediment building up it causes bladder stones.
09:00 – So that’s really very different from kidney stones.
09:04 – But one of the things that we’ve noticed is that
09:06 – people who do have bladder stones those can get infected as well
09:10 – because if you’ve got sediment you know piling up in the bladder
09:13 – you can also have bacteria sitting in the bladder.
09:16 – and sometimes those stones can be infected and cause UTIs.
09:20 – Melissa: Okay, so how common are kidney stones? What percentage
09:23 – of people do you think have kidney stones?
09:26 – Doctor Scotland: Well they’re quite common and
09:28 – what we found is that globally about 12 percent of people
09:32 – form kidney stones. If you think about it that’s millions and millions…
09:35 – Melissa: yeah, that’s a lot.
09:37 – So I guess it’s not surprising there’s so many people in our community that say
09:42 – they have kidney stones as well then.
09:44 – So given there are different types of kidney stones,
09:47 – are there common causes? You mentioned dehydration is a common cause.
09:51 – are there other things that can lead to any type of stone?
09:54 – Doctor scotland: There can be. So like I said
09:56 – there are some genetic issues that can cause stones like cysteine stones
09:58 – and there are some calcium-based stones that can be caused because of genetics as well.
10:04 – But then there are certain things like diseases like I said
10:08 – diabetes, you know some folks have bowel disorders like Crohn’s and IBD.
10:16 – What those things can do is really pull fluid away from you.
10:22 – Dehydration is really one of the reasons why we think these types of stones form.
10:27 – So even if you’ve got these diseases it’s not really the disease that’s the problem
10:30 – it’s the lack of water and the lack of being able to hold on to water.
10:34 – There are some things that we think can also cause kidney stones.
10:39 – Like I said, eating excessive amounts of meat. But it can be also as simple as eating foods
10:45 – that are really good for you that happen to have oxalate,
10:49 – and oxalate is something that unfortunately is found in quite healthy foods
10:53 – like spinach and nuts and berries.
10:56 – and so sometimes people are you know doing the best that they can.
11:00 – Trying to eat healthy foods and you know they’re causing calcium oxalate stones for instance.
11:04 – So there are a variety of reasons and what we will do is you know
11:08 – work with the individual patient to try to figure out what might be causing
11:12 – their their specific stones.
11:15 – Melissa: Is it a predisposition to oxalate issue,
11:18 – so not everybody needs to avoid any spinach,
11:21 – or is this something that everybody should think about?
11:24 – Doctor Scotland: No it really isn’t because again like I said
11:26 – oxalate is found in really healthy foods and these are things we want folks to eat.
11:30 – And even some patients who have calcium oxalate stones
11:34 – may not be forming them because they’re eating excess oxalates.
11:38 – and so that’s one of the things that I want people to learn from this because I think if you’ve got
11:42 – kidney stones and you go online there’s a lot of focus on oxalate.
11:46 – But I should mention one, like I said, that just because you’re eating oxalate heavy foods
11:50 – doesn’t necessarily mean that that’s what’s causing your stones.
11:54 – And even with people who have oxalate you know,
11:57 – all of your oxalate doesn’t necessarily come from your diet.
12:00 – Your body makes oxalate as well.
12:03 – And so you know even in those cases where you’re trying to cut back on your oxalate it may still be an issue.
12:08 – So what I would say is you know talk to your doctor try to figure out
12:12 – why you’re forming stones there are different things that we can do to help you figure that out
12:16 – and then you you know work on stone prevention based on that .
12:21 – Melissa: Okay. That’s good to know because there is a lot of discussion
12:24 – about oxalates in our community as well and whether they should be avoided for
12:27 – everybody that has a UTI problem but it sounds like that’s not the answer.
12:31 – We got a lot of questions about risk factors for kidney stones
12:36 – and you’ve covered some of them.
12:37 – Is there a difference between male and female biological sex in risk for kidney stones?
12:43 – Doctor Scotland: So there had been huh,
12:45 – you know up until the last couple of decades,
12:48 – it really was very skewed towards males.
12:52 – And what we’ve noticed though in the last couple of decades as I said,
12:56 – is that that’s getting closer to 50 percent.
12:59 – Melissa: Okay.
12:59 – Dr. Scotland: Especially in the U.S.
13:01 – And so I suspect that you know in the next decade or two,
13:04 – we will notice a lot of parity.
13:07 – We’re seeing more and more women coming in with kidney stones.
13:10 – Melissa: Do you have any theories about why that’s changed?
13:13 – Dr scotland: We think some of it has to do with changes in diets.
13:17 – And you know potentially some of it has to do with the fact that you know,
13:23 – we do see that it’s getting a little bit warmer we’re seeing lots more dehydration,
13:28 – people are drinking less water than they used.
13:31 – People are drinking a lot more sodas
13:33 – and things with lots of sugar and that are not helping with your hydration.
13:38 – Melissa: Okay. So a lot of it comes back to hydration, it seems like.
13:43 – Dr Scotland: It really does. I’ll be using that word a lot.
13:46 – Melissa: Yeah! Well some of the other potential risk factors people raise,
13:50 – so whether perimenopause or menopause
13:52 – or HRT might have an impact on kidney stone formation.
13:56 – Dr Scotland: We haven’t really seen that. Melissa: Okay.
14:00 – And what about other hormones in the body?
14:02 – People mentioned stress hormones like cortisol.
14:05 – Dr Scotland: Again there’s not really very much data to support that.
14:08 – You know, there are lots of folks, including myself,
14:10 – actively doing research trying to figure out how kidney stones form
14:13 – and why they form.
14:15 – But there’s not been any real strong data
14:18 – in support of any hormonal changes necessarily causing stones.
14:23 – Melissa: Okay, and the the last ones on that topic were whether you’re urine pH might
14:29 – impact the formation of stones or whether there’s this is related,
14:32 – supplements that are designed to alkalize the urine,
14:35 – whether that also could be an issue.
14:37 – Dr Scotland: So I will say that there can be a connection
14:40 – with your pH and stones.
14:42 – But what we see so for instance with folks who have uric acid stones,
14:47 – what we see is that they tend to have much more acidic urine.
14:51 – And in fact, I should mention uric acid stones are the only type of stones
14:55 – that you can dissolve with medication.
14:58 – That’s primarily because if you try to alkalize your urine,
15:02 – then those stones will dissolve. Melissa: Okay.
15:05 – Dr Scotland: With respect to other types of stones,
15:09 – there are some types of diseases and disorders
15:13 – that are associated with changes in PH
15:15 – and it can form certain types of stones.
15:18 – So for instance calcium phosphate stones
15:21 – can sometimes be seen in a specific type of disease
15:24 – that’s associated with a higher pH so more alkaline pH.
15:29 – So it really depends on the type of stone you’ve got.
15:32 – what are some of the issues going on with you specifically health-wise
15:36 – that can cause stones.
15:39 – The other question that you really asked
15:41 – was about alkalinizing your urine.
15:44 – And I know there’s lots of of talk about alkaline water these days,
15:48 – Melissa: Yeah. I think Dr Scotland: What is important is drinking water.
15:52 – Melissa: Okay. Dr Scotland: Alkaline water hasn’t really been shown
15:55 – to make a difference for most people with kidney stones.
16:00 – Again because there are different reasons why stones can form.
16:02 – And there’s not really any data to show that the alkaline water doesn’t
16:06 – just you know neutralize in the stomach which is acidic right so um my my advice
16:09 – Melissa: Right. Dr Scotland: So my advice is just drink lots of water.
16:14 – I don’t care what kind of water you drink, as long as you’re drinking water.
16:18 – Melissa: Got it! The other question on possible risk factors
16:21 – was around long-term antibiotics or long-term Hiprex
16:24 – and whether either of those things might be associated with kidney stones?
16:29 – Dr Scotland: So there’s not really any data about Hiprex.
16:32 – But I should say that there’s some immersion data about antibiotics.
16:37 – There are a couple of papers that have been published in the last few years
16:41 – now showing a connection between previous antibiotic use and kidney stone formation.
16:48 – One paper in particular was done in the UK
16:51 – because you know you’ve got the NHS and you’ve got all this data thankfully.
16:55 – And huh, these scientists were able to show
16:59 – that in pediatric patients, so in kids who were given antibiotics,
17:05 – within months to a year afterwards there was an increase
17:10 – in the rate of kidney stone formation.
17:12 – Now again, like I said this is emerging data,
17:15 – and as of right now it’s just an association,
17:18 – we haven’t had anybody yet prove
17:21 – that there’s a through line from antibiotics to stones.
17:23 – But certainly more and more data is showing that there might be some connection there.
17:27 – Melissa: Okay. That’s interesting. You mentioned earlier a type of story that is caused by bacteria.
17:32 – Does that mean that long-term UTI also might increase the risk of kidney stones?
17:38 – Dr Scotland: So it’s sort of the other way around.
17:42 – And that stone is a called a struvite stone.
17:44 – Those stones are really formed by the activity of specific types of bacteria.
17:50 – I won’t go into too much detail.
17:52 – But there are certain types of bacteria that can release a particular enzyme.
17:57 – And what that does is it causes these stones to really form on very quickly.
18:04 – So you have that deposition that I was talking about earlier where you have sediment forming,
18:08 – you can have that happen very quickly because of the activity of those bacteria.
18:13 – So they form stones. Because those stones now incorporate bacteria,
18:18 – all right, into themselves they can be a source of infection.
18:23 – So they can be a source of recurrent UTIs for patients.
18:27 – And so I do have a small percentage of my patients coming into me
18:32 – because they have this history of struviced zones,
18:36 – and then the treatment in that case is you’ve got to get rid of the stones.
18:39 – What you tend to find is once you get rid of the stones and you try to treat those patients
18:43 – for a certain amount of time with antibiotics,
18:46 – you can really help them in terms of the recurrent UTIs and their symptoms.
18:51 – there are some patients who do not have struvite stones,
18:55 – who have other types of stones calcium-based stones,
18:58 – that we may also find to be associated with bacteria.
19:02 – Melissa: Okay. Dr Scotland: And in those cases what you tend to find
19:06 – is those patients will come in with recurrent UTIs.
19:09 – and as their physicians try to work them up to figure out
19:12 – why they’re forming these infections, you may have some Imaging done,
19:16 – ultrasounds or cascads and find the stones then.
19:19 – That’s where you know I started seeing most of my patients
19:22 – because those patients would then be sent to me,
19:25 – and sometimes what will happen is when we treat the stone,
19:28 – we will actually culture the stones to see if there’s bacteria incorporated into it.
19:34 – and once you see that you know again we think that potentially
19:37 – what’s happening here is that this bacteria is really the source of infection.
19:41 – So some of those patients when we clear their stones, their UTIs go away.
19:47 – So the way that we tend to diagnose kidney stones primarily is with imaging.
19:52 – Either with an ultrasound or with a CT scan or CAT scan.
19:57 – I should mention here that the gold standard is the CAT scan.
20:01 – And I say that because you know sometimes,
20:06 – ultrasounds don’t necessarily tell the truth about kidney stones.
20:11 – And what I mean by that is this ultrasounds are excellent type of Imaging,
20:16 – but they’re not the best at picking up kidney stones
20:19 – and so sometimes they’ll miss stones,
20:21 – and sometimes they will call stones that aren’t really there.
20:24 – Restoration is CT scans but that’s primarily what we will do.
20:29 – Now you can do urinalysis and you can do some blood tests
20:34 – that might help you to get a sense of what’s going on with the stones,
20:37 – but really it’s Imaging that will tell you
20:39 – unless of course the patient has already passed the stone then you know they have a history.
20:43 – Melissa: Right. Are there symptoms of kidney stones that people can look out
20:47 – for are early warning things that they might be beginning to form?
20:50 – Dr Scotland: Absolutely. So you know as I mentioned earlier,
20:55 – there are folks who have kidney stones and they just sit there they don’t do anything.
20:59 – Lots of people are walking around with kidney stones and have no idea.
21:04 – So generally people will know they have kidney stones,
21:07 – unfortunately when they start to cause pain.
21:14 – In a very small percentage of people you may have them passing stones
21:16 – that are not painful. so say for instance you’ve got a two millimeter stone,
21:17 – which is quite small, and you’re able to pass it.
21:20 – You might see it when you urinate, “Oh, what is that?”.
21:23 – And then you realize that’s a stone or you know huh,
21:26 – that is very very rare.
21:28 – Most people unfortunately will find out they have kidney stones
21:31 – when a stone has fallen into the ureter.
21:33 – and it really does cause excruciating pain,
21:35 – Lots of patients who have kidney stones will tell you
21:39 – it’s the worst pain they’ve had. And so when you start to have pain,
21:42 – that’s sort of in the back in the area where we call the flank
21:46 – and that’s the area sort of right underneath the ribs.
21:49 – Sometimes radiating around to the side and coming towards the front of the abdomen.
21:54 – uh you know people will tell you
21:56 – that they have this you know horrible pain, it could be a cramping pain
22:00 – or what we call colic.
22:01 – And that is the type of pain that’s associated with kidney stones.
22:05 – But unfortunately, they can also present a little bit lower down in the abdomen as well
22:11 – And that all depends on where the stone is in the ureter.
22:15 – So if you’ve got a stone that’s stuck closer to the kidney
22:18 – you might have pain up near the back like I mentioned.
22:20 – But if you’ve got a stone that’s stuck right before you hit the bladder,
22:24 – you might have pain in the lower portion of your abdomen.
22:27 – And so it can sometimes be really tough to tell
22:30 – if that pain is a kidney stone or something else.
22:32 – Melissa: Okay. As the stone passes through the urinary tract
22:35 – can it cause damage along the way?
22:37 – Dr Scotland: It can cause a little bit of irritation, and so that’s why sometimes people who
22:42 – have kidney stones will see blood in their urine.
22:45 – Because the stones can scratch the ureter, scratch thekidney, scratch the bladder
22:50 – when they fall in and so you can see a little bit of blood in your urine.
22:53 – Generally speaking after a patient has passed a stone at least some weeks to months later
22:58 – I will have an ultrasound done, just because I want to make sure that all is well.
23:04 – Because the other thing that stones can do when they are stuck in the ureter,
23:08 – is they can cause something called hydronephrosis.
23:12 – Hydronephrosis is a swelling of the kidney.
23:15 – If you think about it, as I mentioned earlier, the kidneys form urine.
23:20 – And then they train that urine down the ureter to the bladder.
23:23 – If the ureter is stuck then the kidney is still making urine.
23:27 – So eventually what happens is that urine hits the stone, can’t get past it,
23:31 – and so it backs up into the kidney it causes it to swell,
23:34 – and that swelling we can see on ultrasounds and CATs and it’s called hydronephrosis.
23:40 – By the way I should mention that that’s part of the reason why people have that pain in their back.
23:45 – It’s because the kidney is so swollen that it starts to stretch
23:49 – and that stretching is what causes the pain. Melissa: Right okay, and you mentioned earlier
23:55 – that urine pH is not necessarily associated with kidney stone formation
23:59 – but do kidney stones themselves change the pH of the urine?
24:03 – Dr Scotland: So they can again. Like I mentioned with struvite stones, they can change the urine pH,
24:11 – uric acid stones are associated with low PH but they’re not necessarily
24:15 – changing the pH of the urine they are able to form because your urine is that acidic.
24:21 – Melissa: Right. That makes sense. So you’ve talked about
24:25 – the symptoms that you might have as you’re passing a stone
24:28 – or as one is lodged somewhere in the urinary tract.
24:30 – Could a kidney stone just cause symptoms that feel like a normal UTI?
24:36 – Dr Scotland: They sometimes can and so what can happen,
24:40 – oh I should mention as well that some of the other symptoms
24:43 – that people will have with kidney stones are, in addition to pain, nausea, vomiting,
24:48 – you can sometimes have chills, and in the case of an infected stone
24:54 – you can also have fevers. And if that’s the case, you’ve got to go to the ER.
24:58 – Because that could be a sign that you have something called sepsis,
25:02 – and sepsis is an emergency. So if you know you have kidney stones you’re
25:06 – you’re passing a kidney stone but you’re starting to have fever and chills,
25:09 – you’ve got to contact your doctor or go to the emergency room.
25:12 – Melissa: Okay. Dr Scotland: That being said, to answer your question
25:16 – which was again whether kidney stones can cause symptoms similar to UTIs.
25:21 – They can. I mentioned that kidney stones
25:24 – they’re moving from the kidney down the ureter which is quite long.
25:28 – So sometimes when you’ve got a stone that’s stuck closer to the bladder you can have
25:32 – you can have the symptoms of a UTI, you can have urgency, you can have frequency,
25:37 – you can even have burning with urination.
25:40 – And you know some people, for men you can have
25:43 – pain at the tip of the penis sometimes all of this happens because
25:46 – the nerves in that area are you know sort of connected and it’s really hard
25:53 – for your brain to tell exactly what’s happening.
25:56 – So you have a stone that’s stuck in the ureter
25:59 – close to the bladder, it’s irritating the bladder
26:02 – and your bladder doesn’t know why it’s irritated, it just knows it’s irritated
26:07 – So you can have a lot of the same symptoms that you would have with a UTI,
26:12 – but it’s just because there’s a stone stuck there and it’s causing discomfort.
26:17 – Melissa: Okay in that case, does it make sense for people with ongoing UTI issues
26:22 – to be checked for kidney stones?
26:24 – Dr Scotland: Absolutely. I think most physicians if they’re um taking care of
26:29 – a person who has recurrent UTIs will at some point do at least an ultrasound
26:34 – to see what’s going on.
26:35 – Melissa: And you mentioned that CT scans of the gold standard,
26:39 – is it possible that stones could still be missed using that?
26:42 – Dr scotland: It’s really unlikely. There are very very rare stones
26:47 – that are a result of the specific drugs that people take,
26:53 – specific medications that people take.
26:56 – and they cause kidney stones that cannot be picked up on CAT scans.
27:00 – Those medications are not used by many people.
27:04 – And in fact you know their sort of being used
27:08 – even less and less by the folks who have that indication.
27:12 – So hopefully it won’t be an issue for very much longer.
27:16 – But yes they’re very rare cases in which that would be something to think about.
27:21 – And if you’re taking those medications or you have those issues,
27:25 – it’s something that your urologist would be thinking about.
27:29 – Melissa: Okay are there currently any urine tests
27:31 – that can detect the presence of kidney stones or is Imaging always required?
27:37 – Dr Scotland: There are urinary tests that can help you figure out
27:43 – what kind of stone you have to a very small degree. So again I’ll go back to
27:49 – this pH and uric acid stones issue or you know struvite and pH.
27:55 – There are no urine tests right now that are on the market that can help you
28:01 – to figure this out. There is some work being done by some of my colleagues,
28:05 – with a specific test that is a point of care urine test that can help,
28:10 – that can potentially I should say, help with that in years to come.
28:15 – They’re moving towards you know making this a commercial venture, so you know we’ll see.
28:19 – fingers crossed on that. But what we do use uranalysis for
28:24 – and and urine tests for is to help to figure out why people form stones.
28:30 – So in the case that you do form stones especially if you’re a recurrent stone former
28:35 – you may talk to your doctor about doing something called a 24-hour urine,
28:39 – which is exactly what it sounds like. You’re going to be collecting your urine
28:43 – for a full 24 hours and the reason for that is because uh we need that much
28:49 – information to help us to figure out why you specifically might be forming your stones.
28:53 – So it doesn’t necessarily help diagnose the stones but it can help
28:57 – in some patients to give us a better sense of what are the things we really need to be
29:02 – attacking in terms of preventing more stones.
29:05 – Melissa: Okay you also mentioned earlier
29:07 – that you’ll test the stones to see if there’s bacteria associated with them.
29:11 – Is that always done and is it also done to see what type of stone has passed?
29:16 – Dr Scotland: So it’s not always done. I personally will routinely do stone cultures
29:22 – because of, just anecdotally for me and for some of my colleagues,
29:26 – we’ve seen positive stones even in patients that we weren’t expecting to see them.
29:31 – So I try to do it routinely, but most people
29:35 – I think will not necessarily do that unless there is uh
29:38 – some evidence of recurrent UTIs with stones then they’ll check.
29:42 – But most people will primarily do what’s called a stone analysis.
29:47 – So if you either pass a stone or you have surgery and we go in and take the stone out,
29:53 – we’ll send that stone off to analyze it
29:56 – so that we can get a sense of what kind of stone you form.
29:59 – Because like I mentioned there’s different types of stones and it’s hard
30:02 – to tell sometimes what kind of stone you have.
30:05 – So my advice to anybody is if you’re passing stones if you’ve passed a kidney stone,
30:09 – try to capture it, and then bring it in, so that your doctor can get it analyzed.