Kidney stones, also known as urolithiasis, can cause significant discomfort and require medical intervention. Fortunately, several treatment options are available, each with its own advantages and limitations.
Understanding Your Urinary Tract:
Before delving into treatment options, let’s review the
anatomy of your urinary tract:
- Kidneys: Two organs filter waste and excess water from your blood.
- Ureters: two tubes carrying urine from each kidney to the bladder.
- Bladder: A muscular organ that stores urine.
- Urethra: A single tube through which urine exits the body.
Evaluating Kidney Stones:
If symptoms suggest kidney stones, imaging tests are typically the first step. Unenhanced helical CT scans have largely replaced intravenous pyelograms (IVP) as the standard imaging method. In some situations, renal ultrasound may be used instead. Blood tests like creatinine and BUN assess
kidney function, while urinalysis and urine cultures detect potential infections.
Managing Kidney Stone Pain:
Pain relief is crucial when dealing with the intense discomfort of kidney stones (renal colic). A 2018 analysis suggests
nonsteroidal anti-inflammatory drugs (NSAIDs) are more effective and have fewer side effects than paracetamol or opioids.
Medical Therapy:
For stones smaller than 10mm, spontaneous passage through the urinary tract is possible. Medical expulsive therapy (MET) with alpha-blockers like tamsulosin may be offered. However, the effectiveness of MET is debated, and its use requires careful consideration with your doctor or urologist.
Extracorporeal Shock Wave Lithotripsy (ESWL):
ESWL uses shock waves delivered through the skin to break up kidney stones. Its success depends on factors like stone size and location.
- Stones < 10mm: Generally successful.
- Stones 10–20 mm: Additional factors like composition and location play a role.
- Stones > 20mm: usually not suitable for ESWL.
Lower pole stones and obesity may also reduce ESWL effectiveness. Possible complications of ESWL include:
- Kidney tissue injury (hematoma): Usually heals without intervention.
- Steinstrasse (stone fragments blocking the ureter): Managed with a temporary stent.
- Hypertension: Mechanism not fully understood.
- Increased diabetes risk: Requires further confirmation.
Percutaneous Nephrolithotomy (PCNL):
For larger stones (2 cm+), complex stones, or lower pole stones (>1cm), PCNL is often preferred. This procedure involves a small incision in the back, allowing access to the kidney and fragmentation of the stones using
ultrasound or laser. The fragments are then flushed out through a tube or stent.
Possible complications include bleeding, infection, and injury to surrounding organs.
Ureteroscopy:
This procedure involves passing a thin, flexible tube through the urethra, bladder, and ureter to visualize and fragment stones using a laser or other source of energy. A temporary stent may be placed afterward. Complications are rare but can include injury or narrowing of the ureter and sepsis.
Choosing the Right Treatment:
The best treatment for you depends on several factors, including the size, location, and composition of your stones, as well as your overall health and preferences. It’s important to discuss all options with your doctor or urologist to make an informed decision.
Kidney stones, despite their size, can cause discomfort and distress. As a urologist, we frequently come across patients seeking guidance on how to treat kidney stones. In this guide, we will explore the intricacies of kidney stones, including treatments and preventive measures.
What are kidney stones?
Kidney stones are solid masses that develop in the kidneys when dissolved minerals in urine concentrate and crystallize. Ranging from tiny grains to large pearls, these stones may pass unnoticed, but when lodged in the ureters (the tubes connecting kidneys to the bladder), they cause intense pain, necessitating medical attention.
Formation of kidney stones:
The kidneys, vital for filtering waste from the blood and excreting it as urine, can lead to stone formation when minerals and salts become concentrated. Factors like inadequate fluid intake, high dietary mineral intake, or specific medical conditions can trigger crystallization and stone development.
Symptoms:
While kidney stones may be asymptomatic, the movement and blockage of stones in the ureter can cause:
- Severe back or side pain radiating to the lower abdomen or groin.
- Intermittent waves of pain intensify as the stone moves through the urinary tract.
- Blood in the urine (hematuria).
- Nausea, vomiting, and difficulty urinating.
- Frequent urination or fever and chills in severe cases.
Types of kidney stones:
The stone type influences treatment and prevention strategies. Common types include:
- Calcium oxalate stones (80% of cases): Formed when calcium combines with oxalate found in many foods.
- Uric acid stones: Associated with acidic urine, often linked to gout.
- Struvite stones: Developed in response to urinary tract infections.
- Cystine stones: Rare and genetic, caused by excessive cystine excretion.
Diagnosis and Treatment:
Diagnosis involves medical history, physical exams,
urine tests, and imaging. Treatment depends on stone size, location, and composition. Small stones may pass with pain relievers, increased fluids, and dietary changes. For larger stones:
- Extracorporeal shock wave lithotripsy (ESWL): Uses shock waves to break stones.
- Ureteroscopy: Minimally invasive procedure with a camera and laser.
- Percutaneous nephrolithotomy (PCNL): For larger, complex stones, involving a small back incision.
Prevention of kidney stones:
Reducing kidney stone risk involves lifestyle changes:
- Adequate fluid intake: Aim for eight glasses of water daily to dilute urine.
- Healthy diet: Limit salt, animal protein, and oxalate-rich foods.
- Maintain a healthy weight: Obesity increases the risk.
- Manage medical conditions: Address factors like gout or urinary tract infections.
Understanding kidney stone formation, symptoms, and treatment options empowers individuals to reduce risk and effectively manage the condition. Consultation with a healthcare professional ensures proper diagnosis and personalized treatment guidance