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Kidney Stones

What is the treatment for kidney stones?

The medical literature reports that treatments for kidney stones often show good results. The type of treatment your doctor will recommend depends on the size and number of stones you have as well as the location of the stones.

The good news is that kidney stones less than 4 mm in size are generally small enough to pass on their own within one to two weeks.16 80% of these patients require no intervention beyond analgesia. In this case, your doctor might recommend watchful waiting, as well as increasing your fluid intake to help flush the stones (only patients that are healthy enough), as well as taking pain medication to help manage discomfort.

However, if the stone is too large to pass on its own, or if its location is causing urinary tract infections, blocking the flow of urine, or causing other complications, it is likely to be considered an emergency situation that may include one of the treatment options described below.17

  • Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive treatment that uses shock waves to break up the kidney stones. The sound waves pass  through the body but are strong enough to break up the stone. The stone fragments are then mostly small enough to pass with the normal flow of urine.
  • Ureteroscopy is a minimally-invasive procedure in which a thin endoscope (ureteroscope) is passed up the urinary tract to the stone's location. Anesthesia is generally used. Special instruments are then passed through the endoscope to either remove the stone or break it up for easier removal. Once the stone is removed or broken up your physician may place a temporary drain called a ureteral stent. This is a small hollow tube that runs from the kidney to the bladder and may be needed to keep the ureter open to drain urine and any stone fragments. Ureteroscopy may also be required to remove larger remaining stone fragments after ESWL.
  • Percutaneous nephrolithotomy is an invasive procedure which is typically only used when patients have very large kidney stones that cannot be removed either by shock wave therapy or with an ureteroscope. It involves passing an endoscope through an incision in the skin at the back of the kidney. Special instruments are then passed through the endoscope to either remove or break up the stone or stones.
  • Open surgery is a treatment reserved for only the most complicated urinary stone cases and is highly uncommon. In open surgery, the surgeon makes an incision in the skin and another in the kidney or ureter to remove the stone directly. Open surgery usually requires several weeks of recovery time.

How can kidney stones be prevented?

If a patient has endured one kidney stone, the potential remains that other stones could form; so prevention is very important. If a kidney stone can be retained as it passes, it can be analyzed to determine its type, as are stones retrieved surgically, which may aid your health care provider in tailoring a prevention plan.

For people who have endured one or more kidney stones, in addition to remediating any of the risk factors that may have contributed to the stone formation such as diet or underlying condition, increasing fluid intake remains central to the prevention of kidney stones. Diluting urine reduces the likelihood of the formation of crystals. The amount to increase will vary from person to person.18

Questions to ask your doctor

  • What type of kidney stones or ureteral stones do I have?
  • How serious is my kidney stone problem?
  • How quickly does the problem need to be treated?
  • What will happen if my problem is not treated?
  • What treatment choices do I have?
  • What is the likelihood that I’ll be free of stones after treatment?
  • How many treatments will I need to be stone free?
  • What is the risk for complications and what types of complications are possible?
  • How much will treatments cost?
  • How many days, if any, will I be hospitalized?
  • How much pain should I expect and for how long?
  • How much time will I need to fully recover?
  • What can I do to prevent future problems or kidney stones from developing?

References

  1. Monastersky, R. (1993). Kidney Stones: Don't Curb the Calcium. Science News,143(13), 196. doi:10.2307/3977303.
  2. Margaret Sue Pearle, MD, PhD.; David S. Goldfarb, MD, et. al. Medical Management of Kidney Stones: American Urological Association (AUA) Guideline, 2014.
  3. National Kidney and Urologic Diseases Information Clearinghouse.  Kidney stones in adults. NIH Publication No. 13–2495. February 2013. p. 1.
  4. Kasper, D. L., Fauci, A. S., Hauser, S. L., & Longo, D. L. (2015). Harrison's Principles of Internal Medicine (19th ed., Vol. 1, Internal Medicine). Chapter 342: Nephrolithiasis. New York, NY: McGraw Hill.
  5. National Kidney and Urologic Diseases Information Clearinghouse.  Kidney stones in adults. NIH Publication No. 13–2495. February 2013. p. 1.
  6. Kasper, D. L., Fauci, A. S., Hauser, S. L., & Longo, D. L. (2015). Harrison's Principles of Internal Medicine (19th ed., Vol. 1, Internal Medicine). Chapter 342: Nephrolithiasis. New York, NY: McGraw Hill.
  7. Kasper, D. L., Fauci, A. S., Hauser, S. L., & Longo, D. L. (2015). Harrison's Principles of Internal Medicine (19th ed., Vol. 1, Internal Medicine). Chapter 342: Nephrolithiasis. New York, NY: McGraw Hill.
  8. Foods High in Oxalate-Topic Overview. (n.d.). Retrieved October 28, 2016, from http://www.webmd.com/kidney-stones/tc/foods-high-in-oxylate-topic-overview
  9. Vegetables High in Purines. (n.d.). Retrieved October 28, 2016, from http://healthyeating.sfgate.com/vegetables-high-purines-10306.html
  10. Kasper, D. L., Fauci, A. S., Hauser, S. L., & Longo, D. L. (2015). Harrison's Principles of Internal Medicine (19th ed., Vol. 1, Internal Medicine). Chapter 342: Nephrolithiasis. New York, NY: McGraw Hill
  11. Cysteine. (n.d.). Retrieved October 28, 2016, from http://www.newworldencyclopedia.org/entry/Cysteine
  12. National Kidney and Urologic Diseases Information Clearinghouse.  Kidney stones in adults. NIH Publication No. 13–2495. February 2013. p. 2-3.
  13. Kasper, D. L., Fauci, A. S., Hauser, S. L., & Longo, D. L. (2015). Harrison's Principles of Internal Medicine (19th ed., Vol. 1, Internal Medicine). Chapter 342: Nephrolithiasis. New York, NY: McGraw Hill
  14. Portis, A. J., Sundaram, C. P.  Diagnosis and initial management of  kidney stones.  Am Fam Physician 2001;63:1329-38.
  15. Portis, A. J., Sundaram, C. P.  Diagnosis and initial management of  kidney stones.  Am Fam Physician 2001;63:1329-38.
  16. Portis, A. J., Sundaram, C. P.  Diagnosis and initial management of  kidney stones.  Am Fam Physician 2001;63:1329-38.
  17. National Kidney and Urologic Diseases Information Clearinghouse.  Kidney stones in adults. NIH Publication No. 13–2495. February 2013. p. 6-7
  18. Kasper, D. L., Fauci, A. S., Hauser, S. L., & Longo, D. L. (2015). Harrison's Principles of Internal Medicine (19th ed., Vol. 1, Internal Medicine). Chapter 342: Nephrolithiasis. New York, NY: McGraw Hill.