Ureteroscopy: Background and Current Controversies

MINIMALLY INVASIVE STONE SURGERY (Ureteroscopy) (Images of surgical equipment featured in this article are for patient education only. They are not intended for promotional use or a reflection of personal preference. We accept no fees or other benefits from vendors or their agents.) Evolution of Technique The fascinating history of urology with its captivating depictions, texts and stories rivals any other field in medicine. In particular, the ancient past of lithotomy (treatment and removal of urinary stones) dates back to Mesopotamia (3200 BC), and descriptions and treatments for urinary stone disease have been identified from ancient cultures including Hindu, Greek, and Egyptian. The treatment of stones, which at the time most commonly occurred in the bladder, was very dangerous, often lethal.  As such, it led to the development of one of the first … Continued


The pretty picture shows uric acid crystals in urine magnified 400x under polarized light to bring out their shapes with special clarity. Here is what to look for and what to do if your stones have uric acid in them or are entirely uric acid. A caution: Occasional stones are not uric acid but a salt of uric acid: Sodium hydrogen urate or ammonium hydrogen urate. This article is not for them, They occur in unusual situations, not as yet covered here or anywhere else on this site. Urine pH Uric acid is a large carbon based molecule. Water ‘dissolves’ molecules because of charge attraction. But there is not a lot of charge on this kind of molecule. In fact there … Continued


Jeff, a reader of this site, suggested this topic and I realized it was one that I should have written long ago. You can make sense of all those numbers in the 24 hour kidney stone reports. You can use those numbers to understand how things stand with you. Reading the numbers can help you achieve your best possible chance at stone prevention – which is the only reason all those lab tests were done in the first place. This article deals with calcium stones. A second one will cover uric acid stones. Be Sure You Have Been Screened For Systemic Diseases Your physician does this part. But even for systemic diseases stone risk is gauged in the urine so you can read along … Continued


Thiazide Type Diuretics Reduce Stone Formation The common thiazide type drugs in use today are hydrochlorothiazide, chlorthalidone, and indapamide. All three have been used in stone prevention trials and shown to have beneficial effects. A nice recent review is also the source for the drug structures pictured above. I have obtained and studied nine trials. In all nine trials, there was a comparison – untreated – group. This spreadsheet contains links to the trial documents, but you will find it not easy to obtain the original publications unless you have access to a university library system. For this reason I have copied out the key data. Briefly, there were 330 controls, of which 149 relapsed (45%), and 314 treated subjects of whom 72 relapsed (23%), … Continued


At the end of it all, the science, the medical visits, the surgeries, what we really want is to prevent new stones. That is the main goal. Modern surgery is a blessing for those with stones. But no surgery is far better than even the most skilled and effective surgery. Prevention of stones is orderly and occurs only over time. Here is how to do it. This article is designed to go with my other one which tells how to organize your medical visits so as to achieve these steps.  What is the Science of the Five Steps? Stones are made of crystals. Supersaturation drives crystal formation and growth – this is a physical law that must always apply. Supersaturation … Continued

How To Eat A Low Oxalate Diet

LISTS – AND LISTS I know you are all looking for THE list. Here is one from a reliable source. We have downloaded one version on their site to a separate document so it opens with one click a useful table of oxalate foods. Get yourself acquainted with it. It will tell you much of what you need to know. A lot of it will even surprise you. You are not as restricted as you think you are or as you have been told. A more dramatic list is the 180 high oxalate foods distilled out of the big list. Here are culprits! Not on this list? Probably not very high in oxalate so far as we know – with perhaps a few exceptions. Note that … Continued

How To Eat a Low Sodium Diet

One of the most common things I hear throughout the day when I talk about eating a low sodium diet is ‘I don’t use the salt shaker.’ Using salt shakers is the least of our problems. The message is: Salt is in everything we eat, from cereal to soda. Salt is sodium chloride. When we talk about salt intake we will be talking about sodium because that is what is on all the labels. But the word ‘salt’ is what most of us say, so I use both sodium and salt. Why Should You Care How Much Sodium You Eat? First, the more salt you eat the higher the level of calcium you will find in your urine. When you have more calcium … Continued

Does Too Much Protein Increase Stones or Damage Bones?

Certainly, we all need protein in our diet. Some of us overdo things with shakes and powders, some with 2 pound steaks. Others who love sweets too much may not eat much protein. Like all the diet factors in stone and bone disease, protein intake is complex. Experts debate the best course, and patients wonder what to do. Abraham van Beijeren was, according to this public biography, little recognized in his day but not considered a major painter of ‘luxuries’ like this standing roast. I chose this, as opposed to others in the public domain because it looks more modern – I have seen something like this on my own dining room table. How Much Protein Do We Need? Lets begin with … Continued

Control Your Salt for Fewer Stones and Stronger Bones

Here is my ‘bottom line’ on salt: The more you eat, the higher will be your urine calcium and – from what trial data I can find – the higher your risk of forming stones and losing bone mineral. The big articles, on salt and on idiopathic hypercalciuria have put into place the structure I need to make this simple generalization acceptable. That is part of the reason I wrote them – to be a structure I can rely on and work off of. The large image is from a recent publication about the bone disease of idiopathic hypercalciuria. The full report is available and I recommend it.  So here is a new kind of article, from me to you, … Continued


Being chronic in many cases, stones need to be prevented not just removed. That accomplishment, prevention, needs the skills, efforts, and cooperation of two people. I am writing this for the one who makes the stones, and my purpose is to promote success: No more stones. I have never known physicians who do not want successful treatment for their patients. It is the ultimate satisfaction. But they are time pressured, as are we all in this hectic world, and you can help by doing before and after a visit all that you can do to make the visit time count – to waste as little as possible, and put to use as much as you can get by way of treatment. I … Continued