Vasectomy Information for You and Your Partner

The main question a man should ask himself is: Would you like to father another child in your lifetime?
If you answer YES....keep on reading but perhaps you should not consider this procedure at this time. If you answer "NO" we are here to help you.

If you are not certain or you answer "maybe" sperm freezing or delaying the procedure should be an option for you.

Until recent years, few people questioned the long-term safety of vasectomy. A couple considering vasectomy was more likely to ask a doctor about the operation itself, its effectiveness, or how it might change their sexual relationship.

Things have changed. Men considering vasectomy and their partners now want to know about long-term side effects. Their biggest concern is hardening of the arteries or heart disease, issues raised by animal studies in the late 1970s.

Researchers speculated then that sperm antibodies, produced by many men following vasectomy, could be responsible for these and other health risks.

This concern prompted the National Institute of Child Health and Human Development (NICHD), the nation's largest supporter of research on birth control methods, to start a multimillion dollar program of vasectomy research. Fortunately for the millions of men with vasectomies and their families, the latest news about its long-term safety is good.

Almost 40,000 men took part in four studies completed in recent years under contracts with the Institute. The findings are reassuringly similar: None show an increased risk of hardening of the arteries or other forms of cardiovascular disease in men with vasectomies.

In fact, one study found that, for unknown reasons, men who have had vasectomies are healthier in some ways than those who have not.

While this is good news for men with vasectomies, those who are considering it should still give the decision serious thought, because vasectomy is generally permanent. Although new techniques for reversing vasectomies may increase the odds that fertility will return, there are no guarantees.

Realizing this, and being up-to-date on news about long-term safety, can help couples today to make informed decisions about vasectomy.

Vasectomy by Urology Consultants
Sterilization, including both vasectomy and female sterilization, is now the most popular form of birth control in the United States, chosen by four out of 10 couples who use contraception.

Vasectomy is far simpler and less expensive than sterilization for women. Yet today, fewer men than women undergo sterilization procedures. Just a short while ago, this was not the case.

In the mid-1970s, men and women had sterilizations in nearly equal numbers. Gradually, however, more and more couples opted for female sterilization, until these procedures outnumbered vasectomies by 2 to 1.

Fears about the long-term safety of vasectomy were at least partly responsible for a decline in vasectomies, experts believe, along with easier and safer sterilization operations for women.

Now, however, that trend seems to be reversing. The Association for Voluntary Sterilization (AVS) credits this increase to "evidence from scientific studies that has dispelled lingering doubts about the safety of vasectomy."

Long-term Safety: The Antibody Question
Concern over the long-term safety of vasectomy first arose many years ago when researchers discovered that many men produce antibodies to sperm following the operation. Fortunately, investigators have since found no evidence that this immune response causes health problems in men.

Antibodies are disease-fighting substances that circulate in the bloodstream. Normally they protect the body from invaders such as viruses, bacteria, and foreign cells. In the case of many vasectomized men, however, the body's immune system mistakes sperm for foreign cells and forms antibodies against them.

This happens because early in infancy, the immune system learns what is native to the body and what is foreign. Sperm cells are not produced until years later, at puberty. But at that time, they are essentially hidden from the immune system by barriers in the reproductive tract, so antibodies are not formed.

After vasectomy, however, the protective barriers can be broken. The testicles still produce sperm, which the body absorbs. In the process, antibodies often form.

One-half to two-thirds of men who have had vasectomies develop antibodies to sperm after the procedure. It is not known why some men produce more or fewer antibodies than others, and some none at all. A very small percent of men without vasectomies also develop sperm antibodies because of surgery, infection, or inborn abnormalities of the reproductive tract.

In men with vasectomies, the antibodies may persist for 10 years or more after surgery. Doctors became concerned about this immune response because they felt that, in theory, it might have adverse consequences.

The most serious side effect that was suggested by studies in monkeys is a worsening of hardening of the arteries. When these studies were reported in the late 1970s, the investigators thought the antibodies might play a part in damaging inner walls of arteries. Nevertheless, research to date has not demonstrated that these findings apply to men, according to the National Institute of Child Health and Human Development.

As an example, one study showed that the level of sperm antibodies in a man's bloodstream does not affect his risk of developing coronary heart disease. At the Battelle Human Affairs Research Centers in Seattle, WA, a group of scientists found that high levels of sperm antibodies were equally common in men with and without heart disease. There was no evidence, moreover, that the antibody levels increase over time.

Largest Study on Vasectomy: Healthier Men
Even before the findings from the monkey studies were reported, the NICHD started a project that became the largest study on vasectomy performed to date. The study, involving more than 20,000 men in four U.S. cities, was designed to find out if the immune reaction following vasectomy could lead to any health problems.

In announcing the study, health officials stated that because it is the most comprehensive assessment ever performed on this topic, the results are especially encouraging. In almost every category of illness, the men with vasectomies were either no more prone to disease than the other men, or even less likely to become ill.

When the study began in 1976, they were mainly interested in diseases that might be related to an immune response, such as rheumatoid arthritis. But when early results from the monkey studies appeared the next year, they added a special focus on cardiovascular disease.

The study's results, reported widely in 1984, showed that men with vasectomies have no more health problems than other men -- including diseases involving the immune system, cardiovascular disease, cancer, and impotence. This held true for specific diseases that had been cited as possible complications of vasectomy, including hardening of the arteries, rheumatoid arthritis, blood clotting disorders, gout, and multiple sclerosis.

The only condition seen markedly more often in the vasectomized men was epididymitis, a local inflammation near the site of the operation. This complication, which was previously known, occurs mostly within the first year after vasectomy. Treated with heat, it usually clears up in a week.

Otherwise, men with vasectomies were just as healthy as other men, if not more so.

Besides having fewer cases of cancer and heart disease, the men with vasectomies also had one-third fewer deaths. The lower death rate was found for all causes of death except accidents and violence, which killed the same number of men with and without vasectomies. The researchers do not know why men with vasectomies had better survival rates overall.

The Risks of Vasectomy
The vasectomy operation is quick, safe, and inexpensive. Usually it is performed in a doctor's office or clinic and takes only 10 to 15 minutes.

After giving the man a local anesthetic, a doctor generally makes two small incisions, one on either side of the scrotum unless the no-scalpel method is used. We locate the two thin tubes that carry sperm, seals them off, and thats it. Usually no sutures or stitches are needed. Once leaving the office and ice pack to the scrotum should be used for about 6 hours. The cost of a vasectomy is roughly one-fifth the cost of female sterilization.

Recovery from the vasectomy operation is rapid, and serious complications are rare. Swelling, bruising, and pain -- the most common complaints -- occur in about half of men after vasectomy. The discomfort subsides within a week or two and usually responds to treatment with ice packs, mild pain killers, scrotal support and rest. Men are generally advised to avoid strenuous work or exercise for about 2 days after the operation.

A minority of men develop a small lump of inflammatory tissue called a granuloma near the incision site. Granulomas, caused by sperm leaking into surrounding tissues, usually stay so small that they don't cause symptoms. If they do cause pain, it is generally treated with bed rest and mild pain killers.

Fewer than 3 in 100 men develop complications such as infection, hematoma (bleeding under the skin), or epididymitis (inflammation of the tube that collects sperm from the testes). All can be treated, and no deaths from vasectomy have been reported in the United States, according to the Institute.

Info Please...
Before a man has a vasectomy, it is very important that he and his partner receive thorough counseling that permits them to ask questions and express any fears they may have. This forces a couple to become sure of their decision; without it, some anxieties are likely to remain. Vasectomy counselors are urged to explain all other methods of birth control, in addition to giving full details on the benefits and possible drawbacks of vasectomy.

"All Juice No Seed"...When is it Safe to Have Unprotected Sex?
Vasectomy is one of the most effective means of birth control, with a less than 1 in 100 chance of failure. It does not offer immediate protection from unwanted pregnancy, however.

The reproductive tract is not clear of sperm for several weeks, and other forms of birth control must be used until a semen sample, generally checked after 15 to 20 ejaculations and it shows no sperm. The most common reason for vasectomy failure is probably unprotected intercourse before all sperm have cleared the reproductive tract.

Permanent Procedure:
While safety is a major consideration in choosing a birth control method, another important factor is convenience. Vasectomy's permanence makes it convenient; within 15 to 20 ejaculations after the operation, no other steps must be taken to prevent pregnancy.

Although this is an advantage to most men who have the operation, it is a drawback for a very small percent of them.

Approximately 2 in 1000 men who have vasectomies regret it later and wish to have the operation reversed. The main reasons for requesting a reversal are remarriage, death of a child, or an improvement in finances followed by a wish for another child. Fewer than 10 percent of men who request reversals do so because of physical or psychological problems following vasectomy.

Reversal Operations: No Guarantees
In contrast to the original operation, the vasectomy reversal is a complicated, delicate and expensive procedure that is not covered by medical insurance. The difficulty lies in trying to reconnect the sperm-carrying tube's inner canal, which is the size of a pinpoint. And although new surgical techniques are improving the chances of success, no doctor can guarantee that a reversal operation will result in both the reappearance of sperm in the semen and, ultimately, the achievement of pregnancy.

Pregnancy rates following vasectomy reversal range from 16 to 85 percent. Success depends on several factors, including the ability of the surgeon performing the reversal, the way in which the original operation was performed, and the time lapsed since vasectomy.

Some reports show that when reversal is performed within 2 years of the original operation, men can expect sperm counts eventually to return to normal. If it is done between 2 and 10 years later, they have about a 90 percent chance, and if it is more than 10 years they have only a 35 percent chance of regaining normal sperm counts.

But returning sperm counts to normal is only half the battle; the other half is achieving pregnancy. Here, the fertility of the woman must be considered as well. Another factor in question is whether men with high levels of antibodies to sperm are less likely to regain fertility following a reversal operation.

We are often asked about the possibility of storing frozen semen in sperm banks before vasectomy, as a safety measure. Few men follow up on this, however. While it is possible to bank sperm and later establish pregnancy, it can be costly. About 20% of the thawed sperm becomes non-viable. We believe that individuals who want to bank sperm probably shouldn't have a vasectomy, because they most likely have doubts about giving up their ability to father a child.

Sex After Vasectomy: No Difference
After vasectomy, a man can safely resume having sex (using another form of birth control until his semen is free of sperm) as soon as he feels comfortable. Because the sperm from the area sealed off by vasectomy make up only 5% or a fraction of the total fluid ejaculated, he should notice no difference in the amount of fluid nor in its appearance. The size of the testicles remains unchanged as well.

Two common worries about vasectomy are that it will reduce a man's sex hormone levels or take away his ability to have sex. These myths have no biological basis, however, because vasectomy only prevents the escape of sperm from the reproductive system, not the release of testosterone, the male sex hormone, into the bloodstream.

Both sperm and testosterone are produced in the testicles, but they leave by different routes. Sperm move through a series of ducts that channel through the reproductive organs to the outside of the body, while tiny veins in the testicles transport testosterone into the bloodstream.

So when vasectomy seals the tubes that carry sperm, it doesn't affect the transfer of testosterone into the bloodstream. Therefore there is no physical reason for a loss of sex drive or other sexual characteristics.

Vasectomized men and their wives usually report either no change or an improvement in marital happiness and sexual satisfaction. For most men vasectomy frees them from worries of unwanted pregnancies and the hassles of other forms of birth control.

At Urology Consultants the cost of the vasectomy includes the procedure, supplies, post vasectomy visits (if needed and up to 90 days from the procedure) and semen check (as many as needed) to ascertain that there is no sperm present. Semen check for sperm by law is performed by an independent lab at an additional expense if it is not covered by your insurance. Vasectomies are performed daily during routine office hours if you wish to schedule an appointment please contact Urology Consultants by phone or fax as listed below.

Impotence

Understanding male impotence, a condition that affects an estimated 10 to 20 million men in the United States. The internet provides Urology Consultants with the forum to discuss and explore impotence in a very private matter.

Impotence as defined in the medical community is erectile dysfunction, the consistent inability to attain and maintain an erection satisfactory for intercourse. With the approval of Caverject^® by the FDA a few years ago the treatment of impotence via penile injections has acquired renewed interest and respect by the medical communities and the concerns and fears of administering to a patient a non FDA approved drug, as it was the case prior to the introduction of Caverject^®, its now practically a mute subject.

Caverject contains a synthesized version of alprostadil, a naturally occurring form of prostaglandin E1 (PGE1), which is found in human tissues and fluids and plays a role in the mechanism producing a natural erection. Available by prescription, Caverject works by relaxing smooth muscle tissue, which enhances blood flow to the penis creating an erection.

In clinical studies, the most common side effect of Caverject was penile pain, which was reported in 37 percent of patients in clinical trials. Other less common side effects include minor bleeding at the injection site (5 percent), prolonged erection of four to six hours (4 percent) and fibrosis (3 percent, with one, 18-month study recording a rate of 7.8 percent). The incidence of priapism, an erection that lasts more than six hours, was 0.4 percent.

• Pharmacologic Erection Program
  
  
• Impotence Questionnaire

Kidney Stones

Overview
Kidney stones are one of the most painful disorders to afflict humans. This ancient health problem has tormented people throughout history. Scientists have even found evidence of kidney stones in an Egyptian mummy estimated to be more than 7,000 years old.

Kidney stones are one of the most common disorders of the urinary tract More than 1 million cases of kidney stones were diagnosed in 1985. It is estimated that 10 percent of all people in the United States will have a kidney stone at some point in time. Men tend to be affected more frequently than women.

Most kidney stones pass out of the body without any intervention by a physician. Cases that cause lasting symptoms or other complications may be treated by various techniques, most of which do not involve major surgery. Research advances also have led to a better understanding of the many factors that promote stone formation.

An Introduction to the Urinary Tract
The urinary tract, or system, consists of the kidneys, ureters, bladder, and urethra. The kidneys are two bean-shaped organs located below the ribs toward the middle of the back. The kidneys remove extra water and wastes from the blood, converting it to urine. They also keep a stable balance of salts and other substances in the blood. The kidneys produce hormones that help build strong bones and help form red blood cells.

Narrow tubes called ureters carry urine from the kidneys to the bladder, a triangle-shaped chamber in the lower abdomen. Like a balloon, the bladder's elastic walls stretch and expand to store urine. They flatten together when urine is emptied through the urethra to outside the body.

What Is a Kidney Stone?
A kidney stone develops from crystals that separate from urine and build up on the inner surfaces of the kidney. Normally, urine contains chemicals that prevent or inhibit the crystals from forming. These inhibitors do not seem to work for everyone, however, and some people form stones. If the crystals remain tiny enough, they will travel through the urinary tract and pass out of the body in the urine without even being noticed.

Kidney stones may contain various combinations of chemicals. The most common type of stone contains calcium in combination with either oxalate or phosphate. These chemicals are part of a person's normal diet and make up important parts of the body, such as bones and muscles.

A less common type of stone is caused by infection in the urinary tract. This type of stone is called a struvite or infection stone. Much less common are the uric acid stone and the rare cystine stone.

Urolithiasis is the medical term used to describe stones occurring in the urinary tract. Other frequently used terms are urinary tract stone disease and nephrolithiasis. Doctors also use terms that describe the location of the stone in the urinary tract. For example, a ureteral stone (or ureterolithiasis) is a kidney stone found in the ureter. To keep things simple, the term "kidney stones" is used throughout this text.

Gallstones and kidney stones are not related. They form in different areas of the body. If a person has a gallstone, he or she is not necessarily more likely to develop kidney stones.

Who Gets Kidney Stones?
For some unknown reason, the number of persons in the United States with kidney stones has been increasing over the past 20 years. White people are more prone to kidney stones than are black people. Although stones occur more frequendy in men, the number of women who get kidney stones has been increasing over the past 10 years, causing the ratio to change. Kidney stones strike most people between the ages of 20 and 40. Once a person gets more than one stone, he or she is more likely to develop others.

What Causes Kidney Stones?
Doctors do not always know what causes a stone to form. While certain foods may promote stone formation in people who are susceptible, scientists do not believe that eating any specific food causes stones to form in people who are not susceptible.

A person with a family history of kidney stones may be more likely to develop stones. Urinary tract infections, kidney disorders such as cystic kidney diseases, and metabolic disorders such as hyperparathyroidism are also linked to stone formation.

In addition, more than 70 percent of patients with a rare hereditary disease called renal tubular acidosis develop kidney stones.

Cystinuria and hyperoxaluria are two other rare inherited metabolic disorders that often cause kidney stones. In cystinuria, the kidneys produce too much of the amino acid cystine. Cystine does not dissolve in urine and can build up to form stones. With hyperoxaluria, the body produces too much of the salt, oxalate. When there is more oxalate than can be dissolved in the urine, the crystals settle out and form stones.

Absorptive hypercalciuria occurs when the body absorbs too much calcium from food and empties the extra calcium into the urine. This high level of calcium in the urine causes crystals of calcium oxalate or calcium phosphate to form in the kidneys or urinary tract. Other causes of kidney stones are hyperuricosuria (a disorder of uric acid metabolism), gout, excess intake of vitamin D, and blockage of the urinary tract. Certain diuretics (water pills) or calcium-based antacids may increase the risk of forming kidney stones by increasing the amount of calcium in the urine. Calcium oxalate stones may also form in people who have a chronic inflammation of the bowel or who have had an intestinal bypass operation, or ostomy surgery. As mentioned above, struvite stones can form in people who have had a urinary tract infection.

What Are the Symptoms?
Usually, the first symptom of a kidney stone is extreme pain. The pain often begins suddenly when a stone moves in the urinary tract, causing irritation or blockage. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur with this pain. Later, the pain may spread to the groin. If the stone is too large to pass easily, the pain continues as the muscles in the wall of the tiny ureter try to squeeze the stone along into the bladder. As a stone grows or moves, blood may be found in the urine. As the stone moves down the ureter closer to the bladder, a person may feel the need to urinate more often or feel a burning sensation during urination. If fever and chills accompany any of these symptoms, an infection may be present. In this case, a doctor should be contacted immediately.

How Are Kidney Stones Diagnosed?
Sometimes "silent" stones - those that do not cause symptoms are found on x-rays taken during a general health exam. These stones would likely pass unnoticed.

More often, kidney stones are found on an x-ray or sonogram taken on someone who complains of blood in the urine or sudden pain. These diagnostic images give the doctor valuable information about the stone's size and location. Blood and urine tests help detect any abnormal substance that might promote stone formation.

The doctor may decide to scan the urinary system using a special x-ray test called an IVP (intravenous pyelogram). Together, the results from these tests help determine the proper treatment.

How Are Kidney Stones Treated?
Fortunately, most stones can be treated without surgery. Most kidney stones can pass through the urinary system with plenty of water (2 to 3 quarts a day) to help move the stone along. In most cases, a person can stay home during this process, taking pain medicine as needed. The doctor usually asks the patient to save the passed stone(s) for testing.

The First Step: Prevention
People who have had more than one kidney stone are likely to form another. Therefore, prevention is very important. To prevent stones from forming, their cause must be determined. The urologist will order laboratory tests, including urine and blood tests. He or she will also ask about the patient's medical history, occupation, and dietary habits. If a stone has been removed, or if the patient has passed a stone and saved it, the lab can analyze the stone to determine its composition.

A patient may be asked to collect his or her urine for 24 hours after a stone has passed or been removed. The sample is used to measure urine volume and levels of acidity, calcium, sodium, uric acid, oxalate, citrate, and creatinine (a byproduct of protein metabolism). The doctor will use this information to determine the cause of the stone. A second 2nd hour urine collection may be needed to determine if the prescribed treatment is working.

Lifestyle Changes
A simple and most important lifestyle change to prevent stones is to drink more liquids - water is best. A recurrent stone former should try to drink enough liquids throughout the day to produce at least 2 quarts of urine in every 2 hour period. Patients with too much calcium or oxalate in the urine may need to eat fewer foods containing calcium and oxalate. Not everyone will benefit from a low-calcium diet, however. Some patients who have high levels of oxalate in their urine may benefit from extra calcium in their diet. Patients may be told to avoid foods with added vitamin D and certain types of antacids that have a calcium base.

Patients who have a very acid urine may need to eat less meat, fish, and poultry. These foods increase the amount of acid in the urine.

To prevent cystine stones, patients should drink enough water each day to reduce the amount of cystine that escapes into the urine. This is difficult because more than a gallon of water may be needed every 24 hours, a third of which must be drunk during the night.

Medical Therapy
The doctor may prescribe certain medications to prevent calcium and uric acid stones. These drugs control the amount of acid or alkali in the urine, key factors in crystal formation. The drug allopurinol may also be useful in some cases of hypercalciuria and hyperuricosuria.

Another way a doctor may try to control hypercalciuria, and thus prevent calcium stones, is by prescribing certain diuretics, such as hydrochlorothiazide. These drugs decrease the amount of calcium released by the kidneys into the urine.

Some patients with absorptive hypercalciuria may be given the drug sodium cellulose phosphate. This drug binds calcium in the intestine and prevents it from leaking into the urine.

If cystine stones cannot be controlled by drinking more fluids, the doctor may prescribe the drug Thiola^®. This medication helps reduce the amount of cystine in the urine.

For struvite stones that have been totally removed, the first line of prevention is to keep the urine free of bacteria that can cause infection. The patient's urine will be tested on a regular basis to be sure that bacteria are not present.

If struvite stones cannot be removed, the doctor may prescribe a new drug called acetohydroamic acid (ALIA). AHA is used along with long-term antibiotic drugs to prevent the infection that leads to stone growth.

To prevent calcium stones that form in hyperparathyroid patients, a surgeon may remove part or all of the parathyroid glands (located in the neck). This is usually the treatment for hyperparathyroidism as well. In most cases, only one of the glands is enlarged. Removing the gland ends the patient's problem with kidney stones.

Surgical Treatment
Some type of surgery may be needed to remove a kidney stone if the stone:

• does not pass after a reasonable period of time and causes constant pain,
• is too large to pass on its own,
• blocks the urine flow,
• causes ongoing urinary tract infection,
• damages the kidney tissue or causes constant bleeding, or has grown larger (as seen on followup xray studies).

Until recently, surgery to remove a stone was very painful and required a lengthy recovery time (4 to 6 weeks). Today, treatment for these stones is greatly improved. Many options exist that do not require major surgery.

Extracorporeal Shockwave Lithotripsy
Extracorporeal shockwave lithotripsy (ESWL) is the most frequently used surgical procedure for the treatment of kidney stones. ESWL uses shockwaves that are created outside of the body to travel through the skin and body tissues until the waves hit the dense stones. The stones become sand like and are easily passed through the urinary tract in the urine.

There are several types of ESWL devices. One device positions the patient in a water-bath while the shockwaves are transmitted. Other devices have a soft cushion or membrane on which the patient lies. Most devices use either x-rays or ultrasound to help the surgeon pinpoint the stone during treatment. For most types of ESWL procedures, some type of anesthesia is needed. In some cases, ESWL may be done on an outpatient basis. Recovery time is short, and most people can resume normal activities in a few days.

Complications may occur with ESWL. Most patients have blood in the urine for a few days after treatment. Bruising and minor discomfort on the back or abdomen due to the shockwaves are also common. To reduce the chances of complications, doctors usually tell patients to avoid taking aspirin and other drugs that affect blood clotting for several weeks before treatment. In addition, the shattered stone fragments may cause discomfort as they pass through the urinary tract in the urine. In some cases, the doctor will insert a small tube called a stent through the bladder into the ureter to help the fragments pass. Sometimes the stone is not completely shattered with one treatment and additional treatments may be required.

Percutaneous Nephrolithotomy
Sometimes a procedure called percutaneous nephrolithotomy is recommended to remove a stone. This treatment is often used when the stone is quite large or in a location that does not allow effective use of ESWL. In this procedure, the surgeon makes a tiny incision in the back and creates a tunnel directly into the kidney. Using an instrument called a nephroscope, the stone is located and removed. For large stones, some type of energy probe (ultrasonic or electrohydraulic) may be needed to break the stone into small pieces. Generally, patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the healing process.

One advantage of percutaneous nephrolithotomy over ESWL is that the surgeon removes the stone fragments instead of relying on their natural passage from the kidney.

Ureteroscopic Stone Removal
Although some ureteral stones can be treated with ESWL, ureteroscopy may be needed for mid and lower ureteral stones. No incision is made in this procedure. Instead, the surgeon passes a small fiberoptic instrument called a ureter scope through the urethra and bladder into the ureter. The surgeon then locates the stone and either removes it with a cage-like device or shatters it with a special instrument that produces a form of shockwave. A small tube or stent may be left in the ureter for a.few days after treatment to help the lining of the ureter heal.

Is There Any Current Research on Kidney Stones?

The Division of Kidney, Urologic, and Hematologic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) funds research on the causes, treatments, and prevention of kidney stones. The NIDDK is part of the Federal Government's National Institutes of Health in Bethesda, Maryland.

New drugs and the growing field of lithotripsy have greatly improved the treatment of kidney stones. Still, NIDDK researchers and grantees seek to answer questions such as:

• Why do some people continue to have painful stones?
• How can doctors predict, or screen, who is at risk for getting stones?
• What are the longterm effects of lithotripsy?
• Do genes play a role in stone formation?
• What is the natural substance(s) found in urine that blocks stone formation?

Researchers are also working to develop new drugs with fewer side effects.

Prevention Points to Remember

• People who have a family history of stones or who have had more than one stone are likely to develop another.
• A good first step to prevent any type of stone is to drink of plenty of liquid - water is best.
• If a person is at risk for developing stones, the doctor may perform certain blood and urine tests. These tests will determine which factors can be best altered to reduce that risk.
• Some patients will need medicines to prevent stones from forming.
• People with chronic urinary tract infections and stones will often need the stone removed if the doctor determines that the infection results from the stone's presence. Patients must receive careful followup to be sure that the infection has cleared.

Foods and Drinks Containing Calcium and Oxalate

Persons prone to forming calcium oxalate stones may be asked by their doctor to cut back on certain foods on this list.

apples, asparagus, beer, beets, various berries (e.g., cranberries, strawberries), black pepper, broccoli, cheese, chocolate, cocoa, coffee, cola drinks, collards, figs, grapes, ice cream, milk, oranges, parsley, peanut butter, pineapples, spinach, Swiss chard, rhubarb, tea, turnips, vitamin C, yogurt.

Persons should not give up or avoid eating these types of foods without talking to their doctor first. In most cases, these foods can be eaten in limited amounts.

Conditions

Our practice treats many urological conditions, including the following:

• Adrenal cancer
• Benign prostatic hyperplasia (BPH; enlarged prostate)
• Bladder cancer
• Bladder control problems
• Female sexual dysfunction
• Hematuria
• Interstitial cystitis
• Kidney cancer
• Male infertility
• Pediatric urology
• Peyronie's disease
• Prostate cancer
• Prostatitis
• Sexually transmitted diseases (STDs)
• Testicular cancer
• Testosterone deficiency
• Upper tract tumors
• Urethral/penile cancer
• Urinary incontinence
• Urinary tract infection
• Vaginal prolapse
• Varicocele

Do you have a personal health story that you would like to share with others?

Many people, especially when newly diagnosed, find comfort in knowing that others are having similar experiences. This is also helpful for loved ones of those dealing with health-related issues.

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