New York Urology » kidney stones

Dr.Tareen my colleague named Aol Urologic and Prostate cancer expert

Dr. Grotas — Thu, 26 Aug 2010 11:28:46 +0000

click on this to see Dr. Tareen’s 1st blog post!

I wish him well in his new career as expert blogger. Dr Tareen is one of my partner’s in the union square office. We collaborate on interesting and difficult cases involving complex cancer issues.

Urologist in ancient egypt tackled blood in urine – Dr Grotas brings modern approach 212 844 8941

Dr. Grotas — Tue, 25 May 2010 12:20:01 +0000

History buffs may already know that several ancient papyri detail the extensive medical knowledge known to the egyptians over 2500 bce.

the ebers and smith papyri are detail many specifics of the medical knowledge often attributed to 18th and 19th century doctors.

the website urologichistory.museum has some great fun facts about urology and history

in ancient egypt a major disease was Schistosomiasis and it is still a leading cause of bladder cancer in Egypt today.

It is contracted from waters infested with the parasite schistosoma haematobium, and would have been more common in the working class: farmers or fisherman .

Even in the United states, schistosomiasis is in the differential diagnosis for hematuria especially in those who are from the Mediterranean or other endemic areas.

With current technology blood in the urine should be investigated with microscopy, urine culture, cystoscopy and upper tract imaging with CT scan, Mri, or sonogram ( in some cases)

In Egypt they used herbs and spices now we uses antibiotics for schistosomiasis.

Dr. Grotas can help blood in urine – don’t ignore symptoms!

Lithotripsy availabe at Beth Israel Hospital call Dr. Grotas 212-844-8941

Dr. Grotas — Thu, 22 Apr 2010 17:02:52 +0000

We are pleased to announce that lithotripsy procedures including Medicaid, Medicare, and patients with managed care plans can now be performed at Beth Israel Medical Center, at both the Petrie Campus and the Kings Highway Division.

ESWL or extra corporeal shock wave lithotripsy is a minimally invasive treatment for kidney stones.

call or make an appointment online

prostate stones – do they need treatment? Dr.,

Dr. Grotas — Tue, 13 Apr 2010 19:01:03 +0000

prostate stones are common and not usually a problem if they are found due to symptoms of urinary discomfort or prostatitis the underlying symptoms can be address below is from http://www.prostatitis.org/stones.html

and is a helpful explanation as well. Unlikely kidney or ureteral stones which if left untreated can damage the urinary tract prostate stones often are harmless and require no active treatment

a transrectal ultrasound or CT-scan are ways to detect prostate stones

come see Dr. Grotas if you are confused about urination, prostate stones, or just want to urinate better!

Stones in the prostate are very common. They appear to be calcified proteinaceous bodies called corpora amylacea. The are thought to occur because the secretions of the prostate cannot get out of the gland because of the disarray of the architecture of the ducts due to BPH or benign prostatic hypertrophy, an almost universal growth of the prostate in men as they age. It is thought that these secretions dry out or become “inspissated” and form into a round proteinaceous body, much like a pearl in an oyster. They then become calcified.
This is not the only mechanism leading to the formation of prostate calcifications. They may appear secondary to an infection with insufficiently drained pus and detritus, eventually calcifying. Other calcifications, usually more widespread, can show up in the tissue surrounding the prostatic glandular units following an inflammatory process associated with tissue destruction or changes in the local biochemical environment (acidity, electrolyte changes). Finally, calcifications detected in the prostate can be located intraluminally inside the ejaculatory ducts, resulting from calcification of detritus in the seminal tract, eventually moving down into some narrow segment of the ejaculatory duct.
Prostatic stones are very common and generally do not cause symptoms in and of themselves but may be associated with the symptoms of BPH which men can get as they age and their BPH progresses. The stones are usually located between the BPH growth or “adenoma” and the compressed, normal prostatic tissue around the adenoma which is called the “surgical capsule” of the gland because it is the limit of resection of BPH when performed transurethrally. Stones in the urinary tract are completely different. These stones are found in the kidney where they form and can cause symptoms when the stone “passes” by moving down the ureter, the muscular tubelike structure that connects the kidney to the bladder. The presence of the stone, if it is large, in the ureter causes blockage of the ureter and “urethral colic”, a spasm type pain that is severe and is often described by my patients as the worst thing they have ever felt in their lives. Kidney stones form from the urine and are often associated with some sort of metabolic problem that predisposes the patient to forming stones but this is not always the case of some patients simply form stones for no reason that can be elucidated. Kidney stones can sit in the kidney for years and not cause symptoms but can become infected and be a persistent nexus or source of infection for years. Typically infection stones are a different type of mineral and the infection cannot be cleared without removing the stone. It is possible that prostatic stones could be the same, that is, they could serve as a source of persistent and recurring infection in prostatitis. The only thing that makes me less enthusiastic about this possibility as an explanation for the relapsing and recurrent symptoms of prostatitis is that so few patients with prostatitis have a bacterial infection documented to be present in the urine or prostatic secretions. In large series of men a bacterial infectious etiology is found in only 510% of men. Unfortunately, urologists have concentrated on this subpopulation because it represents something they can treat but still does not appear to be relevant to 90% of men with the symptoms but no infection.
Many patients have had symptoms and several courses of treatment long before a culture has been attempted. The microorganisms may have been killed, but, without removal of obstruction, the inflammatory process may continue in the affected gland. This chronic inflammation may, eventually, live its own life, either due to persistence of highly resistant clones of microorganisms in low concentration and/or inflammatory reaction to products of the immunological defense mechanism and/or inflammatory reaction to glandular secretions/pus/detritus which cannot escape. Therefore, cultures
From prostatic expressed secretion may not yield a positive result. Furthermore, even in presence of microorganisms in high = culturable concentrations, the culture may be (permanently or temporarily) negative if the process is sealed off by a stone or scar tissue.

Extracorporeal Shock Wave Lithotriptor Indicated for Fragmenting Urinary Stones in the Kidney

Dr. Grotas — Sat, 13 Mar 2010 15:36:01 +0000

more info on clinical trial for shock wave for kidney stones http://bit.ly/avYbpF
if you have a stone and need treatment contact dr. grotas today he uses all modalities to treat kidney stones: shock wave, laser lithotripsy and percutaneous nephrostolithotomy

shock wave kidney stones – avoid surgery and general anesthesia Dr. Grotas 2128448941

Dr. Grotas — Sun, 10 Jan 2010 16:15:48 +0000

Shock wave lithotripsy or ESWL is a popular treatment for kidney stones. Anesthesia with sedation is used but there is no cutting or invasive component to this technique. Only you and your doctor can decide which treatment is right for you. Ask about ESWL it may be a good option. Other options include medical therapy which works better at preventing stones than dissolving ones, ureteroscopy – a fiberoptic camera to visualize and laser/crush or remove stones, or percutaneous extraction – general anesthesia and a hospital stay (great for large stones especially to big for ESWL.

Men: Make a New Year’s resolution for health — Dr. Grotas 212-844-8941 516-239-8585

Dr. Grotas — Fri, 25 Dec 2009 19:17:07 +0000

Male health is important In 2010 don’t let these problems get ahead of you!

Dr. Grotas provides some insights! Make an appointment today!

1. prostate check up: PSA and digital exam for prostate

1. Do you have a family history of prostate cancer? Did you have I high PSA and not do anything about it? All your friends have prostate issues?

2. lower urinary track symptoms: getting up at night, weak urinary stream, frequent trips to urinate

2. stop pushing to urinate, stop being sleep deprived because your bladder/prostate wake you at night, Do you DVR everything due to frequent bathroom breaks?

3. Male sexual perfomance:

3. inadequate erections for intercourse or unreliable erections may have bothered you in 2009 but in 201o you can get help

4. Birth control Blues:

Had enough kids? Vasectomy may be the right choice for you. Come in for a fair and balanced discussion of the risks, benefits and alternatives

prior blog entries go over these in detail

Questions about kidney stones

Dr. Grotas — Fri, 23 Oct 2009 18:00:11 +0000

Can I prevent kidney stones?

A good first step for prevention is to drink more liquids ? water is the best. If you tend to form stones, you should try to drink enough liquids throughout the day to produce at least two liters of urine in every 24-hour period. People who form calcium stones used to be told to avoid dairy products and other foods with high calcium content. However, recent studies have shown that restricting calcium may actually increase stone risk secondary to increased absorption of oxalate, a component of stones. Megadoses of calcium, Vitamin D, or Vitamin C may increase the risk of developing stones, especially in people with a family history of stones. These people need to be careful and should calcium supplementation be needed, calcium citrate is best. If you are at risk for developing stones, your doctor may perform certain blood and urine tests to determine which factors can best be altered to reduce the risk. Some people can decrease their risk with dietary changes while others will need medicines to prevent stones from forming.

Other general recommendations for stone formers other than remaining well hydrated, and and ingesting recommended daily allowance of calcium, are a low sodium and low animal protein diet.

My stone has not passed, do I need surgery?

In general, you are facing surgery if your stones are large enough to obstruct urine flow, if they are potentially harmful to your kidneys or if they are causing symptoms for which medication does not help.

Will my children get kidney stones because I have them?

Any person with a family history of kidney stones may be at higher risk for calculi. Stone disease in a first degree relative, such as a parent or sibling, can dramatically increase the probability for you. In addition, more than 70 percent of people with certain rare hereditary disorders are prone to the problem. Those conditions include cystinuria, an excess of the amino acid, cystine that does not dissolve in urine and instead forms stones of cystine; and primary hyperoxaluria, an excess production of the compound oxalate, which also does not dissolve in urine, forming stones of oxalate and calcium.

Are gallstones and kidney stones related?

No. There is no known link between gallstones and kidney stones. They are formed in different areas of the body. Also, if you have a gallstone, you are not necessarily more likely to develop kidney stones.

What is a staghorn stone?

Resembling the horns of a stag, or deer, these stones get their name from the shape they form by filling the pelvis or drainage system of the kidney (at the top of the ureter). Staghorn stones are linked to urinary tract infections. Despite the fact that they can grow large, they are often overlooked by patients because they cause minimal or even no pain. But a staghorn stone can lead to deterioration of kidney function, even without blocking the passage of urine.

Treating this condition can be challenging. In the past, urologists relied on conventional open surgery to remove the offending stone. But today they employ a combination of shock wave lithotripsy and percutaneous surgical procedures, even though patients may still need a traditional operation. ESWL alone is not effective. In any case, it is essential that once the stone is removed, you work diligently to prevent further ones from forming by preventing urinary tract infection. Luckily, new drugs and the growing field of lithotripsy have greatly improved the treatment of all kidney calculi, including staghorn stones.

Where can I get more information?

Exercise at young age may decrease prostate cancer risk.

Dr. Grotas — Wed, 03 Jun 2009 12:26:42 +0000

Medscape(6/1, Foster) reported, “Moderate to vigorous physical activity during young adulthood may help offset the increased risk for prostate cancer in black men,” according to a study that included 160,000 white men and 3,671 black men. After analyzing questionnaire responses, investigators found that while “physical activity was not significantly associated with prostate cancer risk in the white men,” black men “who reported at least four hours of physical activity per week between the ages of 19 and 29 years were 35 percent less likely to develop prostate cancer.” An earlier study revealed that the “apparent protective effect of physical activity may be related to race-specific differences in tumor immunobiology.” Similarly, the lead investigator of the current study, Steven C. Moore, PhD, of the National Cancer Institute, also pointed out that “tumors seem to be different in black men,” adding that “physical activity influences both immune function and inflammation, which play a larger role in the tumors of black men.”

This research report is consistent with dietary and physical wellness recommendations that most doctors recommend to patients. Eat healthy and exercise are typical things we say. This study is interesting because it found that good health at a young age prevents prostate cancer later on in life. Black men are at a higher risk so this is a useful thing to counsel young men who usually come in for circumcision, testicle pain, vasectomy or kidney stones.

I guess a treadmill a day keeps the doctor away!

What is a kidney stone?

Dr. Grotas — Fri, 29 May 2009 09:20:13 +0000

kidney stones can come from dehydration, excessive intake of foods such as calcium supplements, red meat, chocolate, coffee, other metabolic conditions, gastric bypass surgery etc.

they are crystals of calcium combined with other minerals or just made up of uric acid

once a stone has passed or from information derived from X-rays done by your doctor the composition of the stone can be found out.

A urologist or nephrologist can then recommend medical therapy to prevent stones in the future.

As a urologist this is one of the most common problems I see in my clinical practice. There are options about how to treat stones.