Effective Treatment of Kidney Stones For A Dollar Or Two

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Kidney stones are in the news, due to their apparent increase, and often in young people. Kidney stones were the subject of the baby food disaster in China, caused by the addition to milk of melamine to give the impression of higher protein content. One shudders to think of what those babies went through, as kidney stones may cause more pain than childbirth. Kidney stones consist of calcium or uric acid, and are assumed to be caused by their excess, and preventable with dietary modification, or drugs that reduce the concentration of uric acid. Lost in the discussion is the reason why kidney stones are trapped in the ureter, the tube that connects the kidneys with the bladder. You can pass one or many tiny kidney stones without knowing it, the problem arising should one get trapped, resulting in kidney colic.

In experiments performed at Columbia University in the nineteen twenties, a substance was found in semen that either contracted or relaxed the smooth muscle lining of the uterus. It was later extracted from semen, and labeled ”prostaglandin” because small amounts were found in the prostate. As years went by, it became apparent that every cell produces, and is- self regulated by them. A researcher at the Makerere medical college in Uganda, was intrigued by the observation that women living in rural areas, would cut the umbilical cord with a sharp stone, rather than tying a ligature, without the infant bleeding. He intuited that exposure to cooler air outside the body activates prostaglandin production, that causes the smooth muscles in the cord to constrict its blood vessels, and showed this to be true.

The innermost lining of a ureter consists of a mucous membrane, which is surrounded by smooth muscles that lack the striations of skeletal muscles, and serve a different purpose. Smooth muscles allow hollow organs such as the gall bladder, bile ducts, ureter, uterus and uterine tubes to contract. When a kidney stone reach a critical size, it irritates the mucous membrane to swell, the smooth muscles to go into overdrive; the stone is trapped, the contractions of the smooth muscles increase, and the colic begins.

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One of the earliest applications of the newly developed prostaglandin synthesis inhibitors in the nineteen seventies was the introduction of ibuprofen (Motrin) in the treatment of menstrual cramps, or colic. The value of using prostaglandin inhibiting agents such as ibuprofen and indomethacin in enabling a kidney stone to pass, was established a quarter of a century ago, and the subject of an international conference in Denmark in 1982. When in practice, I advised all patients with a history of kidney stones to have ibuprofen on hand wherever they might be.

A colleague with a history of recurrent kidney stones, came across a newspaper article concerning the acquisition by a nearby teaching hospital of a lithotripter apparatus. The patient is given a spinal anesthesia, then suspended in a tub of warm water, and positioned in such way that a sonic beam could target the stone and shatter it. There is no certainty of success, even though the cost is estimated at between $6,500 and $7,000. A few days after reading the article, he had a recurrence while at work, realized he would have to cancel his patients, but then spotted a sample bottle of Motrin in a drawer. He gulped down 1200mg, and within minutes felt relief. A young man I know called me one afternoon on his cell phone while mountaineering in Montana. In agony, he screamed and swore while telling me of a sudden, horrific pain in his penis. Fortunately, he had a bottle of ibuprofen in his truck. In less than a minute after he took 1200mg, the intensity of his bellowing started to diminish, and within 3 minutes he was fine, later passing a small stone. Why is this not standard treatment?

Compare the cost of 1200 mg of ibuprofen with that of stents, lithotripsy, surgery, and hospitalization. Then ask yourself: was the healthcare crisis inevitable?

Julian Lieb, M.D was a Yale medical school psychiatrist, before switching to the immunopharmacology of infectious disorders and cancer. He is an authority on the role of prostaglandins in depression, infectious disorders, and cancer. Dr Lieb has authored or coauthored forty five articles and nine books.

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