Treatment of your kidney stone depends on several factors that are specific to your case, such as:
- The size of the stone
- The location of the stone
- The composition of the stone
- Patient signs/symptoms
Most kidney stones do not require invasive treatment. In a patient who has a newly diagnosed ureteral stone <10 mm and whose symptoms are controlled, observation with periodic evaluation is an option for initial treatment. Patients who elect for an attempt at spontaneous passage should have well-controlled pain, no fever or evidence of infection, and adequate kidney function.
You should drink enough fluid — mostly water — to produce clear or nearly clear urine. Your doctor will likely give you a small strainer to urinate through, with the hopes that the passed stone can be collected for analysis. Straining your urine is crucial since once the stone is passed into the bladder and out of the body, it often does not cause pain.
To relieve the pain from stone passage, your doctor may recommend pain relievers such as ibuprofen (Advil, Motrin), acetaminophen (Tylenol), or naproxen sodium (Aleve). In some cases you may need a stronger medicine such as Vicodin or Percocet.
Medical Expulsive Therapy
Your doctor may give you a medication to help pass your kidney stone. This type of medication, known as an alpha blocker, relaxes the muscles in your ureter, helping you pass the kidney stone more quickly and with less pain. This is especially helpful with stones in the ureter close to the bladder.
Kidney stones that cannot be treated with conservative measures because of their size, location or patient signs/symptoms, or those that have failed to pass spontaneously with conservative measures, will need to be treated with a surgical procedure. The procedure that your doctor may recommend is based upon size, size location, and stone composition. These procedures are all considered to be minimally invasive, meaning that none require a significant incision.
Extracorporeal Shock Wave Lithotripsy (ESWL)
ESWL uses sound energy to create shock waves that fragment the stones into smaller pieces that can be passed through the ureter. It is used when stones are visible on a plain x-ray, which is used intermittently throughout the procedure to localize the stone. It is often used for stones in the kidney or high in the ureter. The procedure lasts 30 to 45 minutes and can cause moderate pain, so it involves light anesthesia/sedation to make you comfortable and limit movement during the procedure, which optimizes the efficacy of the lithotripsy.
ESWL can cause blood in the urine, bruising on the back or abdomen, bleeding around the kidney and other adjacent organs, and discomfort as the stone fragments pass through the urinary tract. Your surgeon may place a stent in the ureter during the procedure to help facilitate the passage of the stone fragments.
This procedure involves the passage of a thin fiber-optic telescope equipped with a camera through your urethra and bladder to your ureter. Once the stone is located, surgical tools can entrap the stone, or a laser fiber can be used to break it into small pieces that can be removed by the surgeon or pass in your urine. Your surgeon may place a stent in the ureter during the procedure to help facilitate the passage of the stone fragments to relieve swelling and promote healing. You may need general anesthesia during this procedure. This procedure is most effective in removing stones in the lower ureter near the bladder, or stones deemed to hard to fragment with ESWL.
This surgery may be recommended by your doctor to remove very large stones in the kidney. These stones are deemed too large to treat with ESWL or ureteroscopy. It involves removing a large kidney stone through a small incision (one inch) in your back using a fiber-optic telescope equipped with a camera. It involves general anesthesia and requires a hospital stay of one to two days to recover.
In patients with obstructing stones who are showing signs of infection with fever, chills, fatigue, and/or kidney injury, urgent decompression of the kidney with either percutaneous drainage or a ureteral stent is needed in combination with appropriate antibiotic therapy. This will serve to unblock the kidney and treat the underlying infection. Definitive treatment of the stone should be delayed until the infection is resolved. Other indications for emergent therapy include bilateral kidney obstruction with kidney injury, and unilateral obstruction with acute kidney injury in a patient with a solitary kidney.
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