Kidney stone treatment at a glance
- Many kidney stones pass through the urine stream on their own at home, aided by drinking plenty of fluids and taking a mild pain reliever.
- Treatment for other stones includes medication to assist in passing the stone, destruction by sound waves and surgical options.
- Some people may require medication to prevent further kidney stones from forming.
What are kidney stones and how are they treated?
Kidney stones are hard, rock-like accumulations of salts and minerals. They typically form in the kidneys, some in the bladder, but may be found anywhere in the urinary tract.
Most people with kidney stones know they have them because the stones cause severe pain as they work their way through the urinary system. Small stones may pass on their own. Larger stones may require medical or surgical intervention to prevent complications.
Anyone experiencing a kidney stone should contact a doctor.
People who can manage the pain of a kidney stone, and whose doctor thinks the stone will pass on its own, can often treat a kidney stone at home. This treatment involves drinking plenty of water (2-3 quarts per day) and watching the urine to check whether the stone has passed.
The physician may ask the patient to urinate through a strainer that will catch the stone. Nonprescription pain medication may be sufficient. A doctor can offer advice on appropriate pain medication after an appropriate evaluation.
Most physicians ask patients to bring a stone they have passed at home in for analysis. A laboratory can examine the stone’s composition to determine what caused the stone. The results help physicians determine if the patient can take steps to prevent stones from forming in the future.
Medication to treat kidney stones
Some medications are under evaluation which may help the stone pass by relaxing the ureter.
Extracorporeal shock wave lithotripsy (ESWL) – non-surgical kidney stone treatment
Extracorporeal shock wave lithotripsy (ESWL), the most common kidney stone treatment. It uses high-energy sound waves to break up kidney stones inside the body. It does not require a surgical incision. Instead, it breaks stones into smaller pieces which are able to be passed in the urine. The treatment takes approximately 1 hour. ESWL is usually provided under mild anesthesia, which helps the patient lie still and remain comfortable.
After treatment, most patients may feel some discomfort as they pass the stone fragments. They also may see blood in their urine. This process may take up to a week or even longer. Meanwhile, most patients may return to their daily activities as usual.
Within three months after treatment, 70-90 percent of patients are free of kidney stones. ESWL appears to be most successful for patients with stones in the kidney and upper ureter (the upper urinary tract). If stones are still present after treatment, they can be re-treated with ESWL.
The efficacy of ESWL is determined by many factors including stone size, location, composition, and body habitus.
ESWL usually is not appropriate for patients who:
- Have a urinary tract infection, kidney infection or kidney cancer.
- Have kidney abnormalities.
- Are pregnant, because the sound waves and X-rays may be harmful to the fetus.
- Have a bleeding disorder.
Ureteroscopy for kidney stones – minimally invasive treatment
Ureteroscopy is the process of a urologist using a small scope to look inside the ureter (the tube that carries urine from the kidney to the bladder). The scope, called a ureteroscope, is about the size of a cocktail straw and allows stones, lesions, or blockages to be assessed and treated.
Our urologists perform ureteroscopy in an operating room under anesthesia and the procedure typically takes 30-45 minutes.
In some cases, a stent is temporarily placed in the ureter to help kidney stone fragments pass more easily. The stent is a small tube that enlarges the ureter temporarily and may be placed before or at the time of ureteroscopy. Stents are typically removed after 1 week during an office visit.
After the procedure, most kidney stone patients have immediate relief from their discomfort. The stent may be slightly uncomfortable or create a feeling of having to urinate often. There usually is blood in the urine for a few days. The patient may feel sore for a few days, but can return quickly to regular activities.
Percutaneous nephrolithotomy (PCNL)
Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure. Urologists use PCNL to remove larger stones in the kidney or upper ureter, or stones that can’t be removed with ESWL.
During PCNL, our surgeons make an incision in the back and insert a scope directly into the kidney under general anesthesia. The stones are fragmented and removed.
Patients usually stay in the hospital for a day or two after a PCNL procedure.
Preventing kidney stones
When a person has had one kidney stone, he or she is more likely to have kidney stones again. Several lifestyle changes and/or medications can help prevent additional stones.
After an appropriate evaluation, patients may lower their risk of having kidney stones if they:
- Drink plenty of water. Doctors recommend that people who have had kidney stones before drink 2 to 3 quarts of water every day. People who live in dry, hot climates or who exercise a lot might need to drink more. An easy way to check is to make sure urine is light-colored or clear.
- Don’t eat too many oxalate rich foods. For people who form calcium oxalate kidney stones, doctors might suggest eating fewer oxalates, which is a compound found in many foods. These foods include beets, chocolate, nuts, okra, rhubarb, soy products, spinach, Swiss chard, sweet potatoes and tea.
- Avoid eating too much salt and animal protein. Consider a salt substitute and consume more plant-based protein sources, such as beans and legumes.
- Be careful about calcium supplements. Calcium supplements have been linked to kidney stone formation. Calcium in food doesn’t increase the risk. For some people, eating too few foods with calcium can increase risk.
Medications can help prevent certain types of stones from forming and help others dissolve. This usually requires a stone analysis and metabolic profile which may reveal other causes of stones.