Urinary Stone
KIDNEY STONE TREATMENT
Kidney stones (also called nephrolithiasis or urolithiasis) affect approximately 1 in 11 people (19 percent of men and 9 percent of women by age 70 years). Fortunately, treatment is available to effectively manage most stones. In addition, you can take steps to prevent kidney stones from recurring.
HOW KIDNEY STONES DEVELOP
A kidney stone can form when substances such as calcium, oxalate, cystine, or uric acid are at high levels in the urine. Stones can also form if these substances are at normal levels, especially if the amount of urine made each day is low. The substances form crystals, which become anchored in the kidney and gradually increase in size, forming a kidney stone.
Typically, the stone will move through the urinary tract and is passed out of the body in the urine. A stone may cause pain if it becomes stuck and blocks the flow of urine. Large stones do not always pass on their own and sometimes require a urologist for minimally invasive surgical procedure to remove them.
KIDNEY STONE SYMPTOMS
Pain — Pain is the most common symptom of kidney stones. Pain can range from a mild and barely noticeable ache to discomfort that is so intense it requires treatment in the hospital. Typically, the pain gets worse and better, but does not go away completely. Waves of severe pain, known as renal colic, usually last 20 to 60 minutes. Pain can occur in the flank (the side, between the ribs and the hip) or the lower abdomen .
Blood in the urine — Most people with kidney stones will have blood in the urine (hematuria). The urine may be pink or reddish, or the blood may be visible only with urine dipstick testing or microscopic examination of the urine.
Gravel — You may pass “gravel” or small stones in your urine.
Other symptoms — Other kidney stone symptoms include nausea or vomiting, pain with urination, and an urgent need to urinate.
Asymptomatic kidney stones — Many people with kidney stones have no symptoms (asymptomatic means without symptoms). These kidney stones are usually found when an imaging study (such as an ultrasound, x-ray or CT scan) is performed for other purposes. Stones can remain in the kidneys for many years without ever causing symptoms.
KIDNEY STONE DIAGNOSIS
Kidney stones are usually diagnosed based upon your symptoms, a physical examination, and imaging studies.
Computed tomography (CT) scan — A CT scan creates a three dimensional image of structures within the body. A particular type of CT scan (called noncontrast helical CT) is often recommended if kidney stones are suspected.
Ultrasound — An ultrasound (or sonogram) can also be used to detect kidney stones, although small stones or stones in the ureters (kidney tubes) may be missed. However, ultrasound is the procedure of choice for people who should avoid radiation, including pregnant women and children.
KIDNEY STONE TREATMENT
Treatment of kidney stones depends upon the size and location of your stone, as well as your pain and ability to keep down fluids. If your stone is likely to pass, your pain is tolerable, you are able to eat and drink, and you can be treated at home.
If you have severe pain or nausea, you will need to be treated with stronger pain medications and IV fluids, which are often given in the hospital. In addition, patients with stones and who also have a fever should be treated in the hospital as soon as possible to avoid a life-threatening infection.
Home treatment — You can take non-prescription pain medication until the stone passes. This includes nonsteroidal antiinflammatory drugs such as ibuprofen
Other medications, such as tamsulosin may also be recommended to speed the passage of stones.
You will probably be asked to strain your urine to recover the stone; it can then be analyzed in a laboratory to determine the content of the stone (eg, calcium, uric acid, etc). Knowing what type of kidney stone you have is important in planning treatments to prevent future stones
If the stone does not pass — Stones larger than 9 or 10 millimeters rarely pass on their own and generally require a procedure to break up or remove the stone. Some smaller stones also do not pass. Several procedures are available.
Shock wave lithotripsy (SWL) — Lithotripsy is the treatment of choice in many patients who need help passing a stone. Lithotripsy is particularly good for stones 1 cm or less in the kidney and upper ureter. Lithotripsy is not effective for treating large or hard stones. You may require medication to make you sleepy and reduce pain during lithotripsy treatment, although this depends upon the type of lithotripsy equipment used.
Lithotripsy is done by directing high-energy shock waves toward the stone. These sound waves pass through the skin and bodily tissues and release energy at the stone surface. This energy causes the stone to break into fragments that can be more easily passed in the urine.
Percutaneous nephrolithotomy (PNL) — Extremely large or complex stones, or stones resistant to shock wave lithotripsy, may require a minimally invasive surgical procedure to remove the stone. In this procedure, small endoscopic (telescopic) instruments are passed through the skin (percutaneously) into the kidney to remove the stone.
Ureteroscopy — Ureteroscopy is another type of endoscopic procedure that uses a thin scope, which is passed through the urethra and bladder, into the ureter and kidney. This endoscope allows the urologist to see the stone and remove it, or to break it up into smaller pieces that can pass more easily. Ureteroscopy is often used to remove stones blocking the ureter, and sometimes for small stones in the kidney.
Treatment of asymptomatic stones — If you have a kidney stone that is causing no symptoms, you may or may not need to remove the stone. The decision is based upon the size and location of your stone, as well as your ability to be treated quickly if symptoms were to develop. If there is a chance that you would not be able to get treatment quickly (eg, if you travel frequently), you are more likely to need to have the stone removed.
Regardless of the decision to treat or not, you should be evaluated for underlying health conditions that can increase the risk of kidney stones.