Kidney stones are a common cause of agonizing and debilitating pain in men and women. In the United States, the stones account for over one million hospital visits and more than 300,000 emergency room visits every year. When patients present with kidney stones, the treatment administered usually depends on the type, size and location of the stone and on the severity of symptoms. Apart from administering treatment, the urologist investigates the underlying cause of the stones and recommends ways of preventing a recurrence.
Spontaneous passage
Kidney stones smaller than 4 mm in diameter are often passed on their own in urine and may be treated at home. While such stones may be painful, the pain often lasts only a few days and usually disappears soon after the stone is passed. So, depending on how bad your symptoms are and how long you’ve had the symptoms, you may not be given any form of treatment and just wait for stones to pass in urine. It usually take up to six weeks to do so.
However, you should only do this if the pain is bearable, there is no sign of infection or kidney blockage and the stone is of a size that can pass on its own. As you wait for it to pass, you’ll need to drink plenty of water and take pain medication to help you manage the discomfort. If you suspect that you have a kidney stone, speak with your doctor to see if you need immediate treatment or if you can wait for it to pass spontaneously.
Medications
There are a number of medications that increase the chance of passing kidney stones. For instance, tamsulosin is commonly given to people with kidney stones to help relax the ureter and make it easier for stones to pass. Apart from medications to boost stone passage, your urologist may prescribe anti-emetic (anti-nausea) medication to reduce nausea and vomiting as you wait for the stone to pass. And if you are in severe pain, your doctor may give you 1-2 pain injections and then prescribe some painkillers and anti-emetics for you to take from home.
Surgical procedures
If the pain is so much that you can’t wait for the stone to pass in the urine, you’ll require a surgical procedure to remove it. Surgery is also necessary if the stone is too big to pass on its own or is hampering kidney function. Kidney stones may be removed surgically if they are causing repeated urinary tract infections or are blocking the normal flow of urine.
Surgical procedures to remove kidney stones include extracorporeal shock-wave lithotripsy (ESWL), ureteroscopy and percutaneous nephrolithotomy (PCNL). These procedures are usually chosen by urologists depending on the size, type and location of the stones.
1. Extracorporeal Shock-Wave Lithotripsy (ESWL)
This procedure is the most frequent way of treating stones that can’t pass spontaneously in urine. High-frequency waves (X-rays or ultrasound) are directed at the stone to break it into smaller pieces that can pass in urine. Often the tiny pieces require a few weeks to pass out in urine. While ESWL is 99 percent effective for kidney stones up to 20 mm in diameter, more than one session is usually necessary for the treatment to be successful.
2. Ureteroscopy
For kidney stones that are lodged somewhere in the kidney or ureter, ureteroscopy (also called retrograde intrarenal surgery) may be necessary. The procedure involves directing a long, thin telescope (called ureteroscope) through the urethra, into the bladder, then into the ureter or kidney where the stone is located. If the stone is stuck in the kidney or upper ureter, the urologist uses flexible telescopes for this procedure, but rigid telescopes are ideal for stones stuck in the lower parts of the ureter.
The ureteroscope helps the urologist to reach the stone without making an incision. After reaching the stone, the doctor either can use another instrument to remove it or direct laser energy on it to break it into smaller pieces that can pass naturally in urine. A stent (plastic tube) may be inserted temporarily into the bladder to drain out the stone fragments.
3. Percutaneous nephrolithotomy (PCNL)
For kidney stones that are too large (21-30 mm in diameter), percutaneous lithotripsy is the treatment of choice. During the procedure, a half-inch incision is made in the side or back, just big enough to allow passage of a telescopic instrument (called nephroscope) into the area of the kidney where the stone is located. The nephroscope is used either to pull out the stone or break it up with pneumatic energy (or laser) and suction out the pieces. In fact, it’s the ability to suction out tiny stone pieces that makes this procedure ideal for larger stones.
Kidney stones also can be removed through open surgery, laparoscopic surgery or robotic surgery. But this is only done when the less-invasive procedures fail. Routine surgical procedures for kidney stones require shorter recovery period and you can usually return home the same day after the procedure and resume normal activities in 2-3 days. If the urologist inserts a stent after a procedure, it is removed 4-10 days later. During treatment, you also may be provided with a strainer that you can use to collect stone pieces that pass in urine for laboratory testing and to enable the urologist to recommend appropriate ways of preventing stone recurrence.
At Advanced Urology Institute, we offer shockwave lithotripsy, ureteroscopy and percutaneous nephrolithotomy routinely, and perform robotic and laparoscopic procedures for kidney stones when necessary. We perform blood tests and 24-hour urine analyses for every patient to identify the cause of kidney stones in order to provide the right treatment. We also design prevention strategies tailored to each patient, including personalized dietary recommendations based on results of 24-hour urine analysis. Our aim is to always ensure that our patients properly understand why they have kidney stones and make the necessary lifestyle changes to prevent a recurrence. For more information on kidney stones and how they are managed, visit the “Advanced Urology Institute” site.