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Kidney stones (Treatment)

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How kidney stone is treated?

The kidney stone treatment depends upon the size, location, and associated symptoms.

1. Small to medium-sized stone treatment:

Small stone of size less 5mm located in mid and lower ureter are likely to pass on their own.

Small stones with symptoms and medium-sized are generally put on conservative treatment with:

• Pain killers: generally NSAIDs are given. In severe pain, opioid derivatives are given.

• Increased water intake: drinking a minimum of 2 to 3 liters a day may help to pass out stone through urine.

• Alpha-blockers (medicine): these medicines help by relaxing the muscles of ureter causing its dilatation. These are found to be efficient in promoting passage of the stones in the ureter that are smaller than 10mm in size. Generally, used when the size of the stone is between 5-10mm.

– Tamsulosin capsule, 0.4 mg at bedtime may be given in adults with lower ureteral stones of size up to 10 mm for 28 days or until the passage of the stone.

– Silodosin capsule, 8 mg may be given in adults one time in a day. It is considered to have greater efficacy than tamsulosin for distal ureteral calculi. However, its safety in children is not established until now.

• IV fluids or hydration therapy may be given to restore hydration and increase urine output which may help to pass out stones. It becomes important for people with chronic underlying kidney disease.

• Antibiotics: are given in case of infected stones (struvite stones) or if there’s associated infection with the stones.

antibiotics-medicines

2. Large stones and stone causing significant symptoms and complications:

Some of the stones which are either too large to pass or the stones that are associated with issues such as bleeding, damage to kidney or UTI usually need procedures to remove the out of the body.

These procedures are done by a urologist (doctor specialized in surgeries of the renal and urinary system) and are as follows:

ESWL (Extracorporeal shock wave lithotripsy):

It is a technique that uses sound waves to develop strong vibrations to break the larger stones into smaller tiny pieces that can be passed out through urine.

• Procedure: sedation or light anesthesia is given as the procedure may cause moderate pain. The procedure takes around 45 to 60 minutes

• Success rate: is quite high ie. 80%-90% for larger kidney stones that are present in the pelvic region of the kidney or ureteropelvic junction (where the upper ureter begins)

ESWL kidney stones

Indications

• Used for larger stones of size less than 20mm, especially useful for certain situations such as:

– People with a single kidney

– People whose work requirements can’t support a sudden onset of pain such as pilots or defense forces.

– People with an underlying condition that can affect kidney function such as hypertension, diabetes, etc.

• Contraindications: this technique is to be avoided in the following situations:

• Urinary tract infections

• Bleeding diathesis

• Pregnancy

• Morbid obesity

• Abdominal aortic aneurysm

• Complications: ESWL can cause the following problems:

• Blood in the urine

• Bruising on the back or abdomen

• Bleeding around the kidney and adjacent organs

• Discomfort or pain while passing stone fragments through the urinary tract.

 

Cystoscopy and ureteroscopy:

• Procedure: A thin tube with a camera and tools are passed into the urinary bladder( cystoscope) and ureter (ureteroscope) which localizes the stone and removes or breaks it into smaller pieces. The procedure is done under general or local anesthesia. After the removal of the stone, the doctor may put a thin tube (stent) in the ureter to relieve swelling and aid healing.

• Advantage: Compared with ESWL, the ureteroscopy has a higher likelihood of providing a stone-free state (more than 90% of cases). However, it may be associated with a longer hospital stay and a higher rate of complication.

• Indication: done in cases where conservative treatment doesn’t help in the removal of ureteral stone.

• Contraindications: to be avoided in cases of uncorrected

• Urinary tract infections

• Bleeding diathesis

• Complications

• Ureteral tear and strictures- however, seen rarely in less than 1% of the cases.

ureteroscopy kidney stone copy 1

 

Percutaneous nephrolithotomy (PCNL):

• Procedure: the doctor passes a tube-like structure with a camera and tools into the kidney through the skin of your back. The stone is removed directly or broken and removed with the help of the instruments. The procedure is done under anesthesia and requires a hospital stay for several days.

• Advantage: is more effective than ESWL for the removal of kidney stones. This is the procedure of choice for kidney stones of a size larger than 2 cm.

• Indications:

• Large stone more than 20mm in size or irregularly shaped stones

• Where ESWL or ureteroscopy fails to break and remove the stone

• Failed conservative treatment for resolution of ureteral obstruction

• Contraindication:

• Uncorrected coagulopathy

• Complications

• Fever

• Transfusion

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