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Treatment of Kidney Stones


Kidney stones are small masses of salts and minerals that form inside the kidneys and may travel down the urinary tract. Kidney stones range in size from just a speck to as large as a ping pong ball. Signs and symptoms of kidney stones include blood in the urine, and pain in the abdomen, groin, or flank. About 5% of people develop a kidney stone in their lifetime.

The kidneys regulate levels of fluid, minerals, salts, and other substances in the body. When the balance of these compounds changes, kidney stones may form. There are four types of kidney stones, each made of different substances. Uric acid and cystine are two compounds that may comprise kidney stones. Factors known to increase the risk of kidney stones include dehydration, family history, genetics, and the presence of certain medical conditions. Having one or more family members with a history of kidney stones increases the risk of the condition.

Type of kidney stone Possible medicines prescribed by your doctor
Calcium Stones
  • Potassium citrate, which is used to raise the citrate and pH levels in urine
  • Diuretics, often called water pills, help rid your body of water
Uric Acid Stones
  • Allopurinol, which is used to treat high levels of uric acid in the body
  • Potassium citrate
Struvite Stones
  • Antibiotics, which are bacteria-fighting medications
  • Acetohydroxamic acid, a strong antibiotic, used with another long-term antibiotic medication to prevent infection
Cystine Stones
  • Mercaptopropionyl glycine, an antioxidant used for heart problems
  • Potassium citrate

Treatment

Treatment for kidney stones varies, depending on the type of stone and the cause.

Small stones with minimal symptoms

Most small kidney stones won't require invasive treatment. You may be able to pass a small stone by:

  • Drinking water. Drinking as much as 2 to 3 quarts (1.9 to 2.8 liters) a day may help flush out your urinary system. Unless your doctor tells you otherwise, drink enough fluid — mostly water — to produce clear or nearly clear urine.
  • Pain relievers. Passing a small stone can cause some discomfort. To relieve mild pain, your doctor may recommend pain relievers such as ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others) or naproxen sodium (Aleve).
  • Medical 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.

Large stones and those that cause symptoms

Kidney stones that can't be treated with conservative measures — either because they're too large to pass on their own or because they cause bleeding, kidney damage or ongoing urinary tract infections — may require more-extensive treatment. Procedures may include:

  • Using sound waves to break up stones.For certain kidney stones — depending on size and location — your doctor may recommend a procedure called extracorporeal shock wave lithotripsy (ESWL).
    ESWL uses sound waves to create strong vibrations (shock waves) that break the stones into tiny pieces that can be passed in your urine. The procedure lasts about 45 to 60 minutes and can cause moderate pain, so you may be under sedation or light anesthesia to make you comfortable.
  • Surgery to remove very large stones in the kidney. A procedure called percutaneous nephrolithotomy (nef-row-lih-THOT-uh-me) involves surgically removing a kidney stone using small telescopes and instruments inserted through a small incision in your back. You will receive general anesthesia during the surgery and be in the hospital for one to two days while you recover. Your doctor may recommend this surgery if ESWL was unsuccessful.
  • Using a scope to remove stones. To remove a smaller stone in your ureter or kidney, your doctor may pass a thin lighted tube (ureteroscope) equipped with a camera through your urethra and bladder to your ureter. Once the stone is located, special tools can snare the stone or break it into pieces that will pass in your urine. Your doctor may then place a small tube (stent) in the ureter to relieve swelling and promote healing. You may need general or local anesthesia during this procedure.
  • Parathyroid gland surgery. Some calcium phosphate stones are caused by overactive parathyroid glands, which are located on the four corners of your thyroid gland, just below your Adam's apple. When these glands produce too much parathyroid hormone (hyperparathyroidism), your calcium levels can become too high and kidney stones may form as a result.
    Hyperparathyroidism sometimes occurs when a small, benign tumor forms in one of your parathyroid glands or you develop another condition that leads these glands to produce more parathyroid hormone.
  • Prostate Laser Surgery

    Prostate laser surgery is used to relieve moderate to severe urinary symptoms caused by an enlarged prostate — a condition known as benign prostatic hyperplasia (BPH). During prostate laser surgery, your doctor inserts a scope through the tip of your penis into the tube that carries urine from your bladder (urethra). The prostate surrounds the urethra. A laser passed through the scope delivers energy that shrinks or removes excess tissue that is preventing urine flow.

    Lasers use concentrated light to generate precise and intense heat. There are several different types of prostate laser surgery, including:

    • Photoselective vaporization of the prostate (PVP). A laser is used to melt away (vaporize) excess prostate tissue and enlarge the urinary channel.
    • Holmium laser ablation of the prostate (HoLAP). This procedure is similar to PVP but uses a different type of laser.
    • Holmium laser enucleation of the prostate (HoLEP). A laser is used to cut and remove the excess tissue that is blocking the urethra. Another instrument is then used to cut the prostate tissue into small pieces that are easily removed. HoLEP can be an option for men who have a severely enlarged prostate.

    The type of laser surgery your doctor recommends will depend on several factors, including:

    • The size of your prostate
    • Your health
    • The type of laser equipment available
    • Your doctor's training

    Why it's done

    Prostate laser surgery helps reduce urinary symptoms caused by BPH, including:

    • Frequent, urgent need to urinate
    • Difficulty starting urination
    • Slow (prolonged) urination
    • Increased frequency of urination at night
    • Stopping and starting again while urinating
    • The feeling you can't completely empty your bladder
    • Urinary tract infections

    Laser surgery might also be done to treat or prevent complications due to blocked urine flow, such as:

    • Recurring urinary tract infections
    • Kidney or bladder damage
    • Inability to control urination or an inability to urinate at all
    • Bladder stones
    • Blood in your urine

    Laser surgery can offer several advantages over other methods of treating BPH, such as transurethral resection of the prostate (TURP) and open prostatectomy. The advantages can include:

    • Lower risk of bleeding. Laser surgery can be a good option for men who take medication to thin their blood or who have a bleeding disorder that doesn't allow their blood to clot normally.
    • Shorter or no hospital stay. Laser surgery can be done on an outpatient basis or with just an overnight hospital stay.
    • Quicker recovery. Recovery from laser surgery generally takes less time than recovery from TURP or open surgery.
    • Less need for a catheter. Procedures to treat an enlarged prostate generally require use of a tube (catheter) to drain urine from the bladder after surgery. With laser surgery, a catheter is generally needed for less than 24 hours.
    • More-immediate results. Improvements in urinary symptoms from laser surgery are noticeable right away. It can take several weeks to months to see noticeable improvement with medications.