Urology - Services

The Urology Clinic provides:

• Highly specialized clinical care for diseases and conditions including, but not limited to, urinary dysfunction and incontinence, erectile dysfunction, prostate cancer and kidney stones 
• Education and support
• Coordination of care, from diagnosis through surgery
• Information about and referrals to community resources
• Follow up

About Urology and the Metabolic Stone Clinic

About 50 per cent of individuals who develop stones will have more than one, which can indicate more serious health problems. To treat patients with recurring stones, the multidisciplinary team at St. Joseph’s have established a kidney stone prevention clinic, the first of its kind in Canada. Through the clinic, patients are assessed in a single appointment by a nephrologist (a specialist with expertise in medical conditions that affect the kidneys), ​a urologist for surgical and treatment consultation and a registered dietitian.

Most kidney stones can be prevented through a combination of medication, diet, fluid intake and other lifestyle changes. Prevention and treatment plans are determined based on the cause and type of stones. Patients are also evaluated on their medical and diet history, blood tests, and urine samples taken over a 24-hour period. If medication can play a role in prevention for a patient, a nephrologist selects the best option and monitors its effectiveness.

St. Joseph’s has a long history of innovative advances in the treatment and diagnosis of kidney stones. In 1990 St. Joseph’s became the second hospital in Ontario to offer shock wave lithotripsy, a noninvasive way to break up kidney stones. In 1993, St. Joseph’s urologists were the first to treat a human for kidney stones using a holmium laser, a treatment now used around the world.

Our Mission and Philosophy

St. Joseph’s Metabolic Stone Clinic’s mission is to provide a multidisciplinary setting for the educational, consultative and therapeutic requirements of patients with recurrent urinary tract stones.

The Metabolic Stone Clinic’s main focus is the prevention of future stone reoccurrences using a patient-centered approach that emphasizes the importance of dietary and environmental modifications where appropriate. 

Our multidisciplinary approach: urology dietitians

During your appointment at the clinic you will meet several members of our team.  The initial assessment and management of your condition will be supervised by one of our staff urologists.  Assisting the urologist in the education and treatment of your condition will be specially trained nursing staff and a dietitian.

The basis of most preventative regimens, regardless of the type of stone, is increasing fluid intake and attention to dietary practices.  Our team will provide you with specific recommendations. Should medication or other therapies be prescribed, these interventions will be tailored to your individual needs. 

Defining your condition

The development of urinary stones is a common occurrence worldwide. In North America, approximately 10% of men and 3% of women may be affected during their lifetime. Of  more importance, 50% of these patients will develop another stone within 10 years of the first occurrence.  

Various factors may predict who is at risk of forming additional stones including genetic predisposition, inadequate fluid intake, chronic metabolic, kidney and bowel conditions to name just a few examples.

Research

Refinements in the care of patients with urinary stones can only be achieved through further research.  From time to time our clinic may be involved in research projects. You may be asked by your urologist if you would be interested in participating.  Your involvement is voluntary. 

Types of urinary stones

There are five main types of urinary stones and several are more likely to re-form than others.

Calcium oxalate 

This is the most common type of kidney stone, accounting for at least 75% or more of all stones formed. The most common reasons for recurrent stones of this type are low fluid intake, consumption of foods high in oxalate, excess salt intake, higher than normal calcium absorption from the intestine and overactive parathyroid glands.

Calcium phosphate

This type of stone is rare but occurs in patients with a type of kidney problem which promotes the development of very alkaline urine or as a result of the use of certain medications.

Cystine 

This type of stone accounts for approximately 1% of all kidney stones.  Patients with this type of stone have inherited an abnormal gene promoting stone development.  

Most patients have a strong family history of stones and often have their first stone as children or teenagers. 

Struvite

This type of stone occurs more commonly in women. The main risk factors include chronic urinary tract infections and the presence of foreign bodies (e.g. urinary catheter) in contact with the urine over long periods of time. 

Uric acid

This is another common type of kidney stone occurring in about 10 – 15% of patients. Patients who suffer from gout (painful joint swelling often involving the big toe) are prone to this type of stone.  

Risk factors for developing this type of stone include low fluid intake, excess intake of foods rich in purines (animal protein, alcohol) and metabolic conditions which cause the urine to be too acidic.

The Prostate Diagnostic Assessment Program (PDAP) at St. Joseph's Hospital streamlines testing for patients suspected of having prostate cancer.

A nurse navigator and urologist work together with each patient to ensure the patient is involved with, and understands, their care plan.

Diagnostic Assessment Programs help to ensure patients receive timely and coordinated access to high quality diagnostic services and appropriate treatment. The overall goal is to improve the patient experience and enhance a patient's quality of life during this phase of the medical journey. 

This program is in collaboration with the South West Regional Cancer Program.

View the Frequently Asked Questions about the PDAP