Kidney stones are treated based on their size, location and what type they are. Small kidney stones often pass through the urinary tract without any treatment. If a small kidney stone can be passed, it can be caught for a lab test to know it’s type and decide on further preventive treatment. Larger kidney stones or kidney stones that block the urinary tract or cause great pain need immediate treatment. The treatment method for a kidney stone also depends on the size of the stone, what it is made of, whether it is causing pain and whether it is blocking the urinary tract. Investigations such as urine test, blood test, x-ray and CT scan may determine the size, type and location of the stone to decide on the best treatment.
In general, there is a consensus that small stones may be treated with conservative management. In contrast to ureteral stone, most kidney stones are asymptomatic. It is questionable for small stones, especially in the lower pole, if treatment is required. However, stone growth, potential obstruction, associated infection and pain are clear indications for the treatment of such kidney stones. Kidney stones that are less than 10 mm in diameter have a reasonable chance of passing through the urinary tract spontaneously. Most small sized kidney stones are allowed to be passed out in the urine with treatment at home but can be painful. The pain usually lasts a couple of days and disappears when these stones have cleared. Best treatment recommendations to ease symptoms of passing a small kidney stones include:
- drinking plenty of fluids at least 3 litres throughout the day, every day till stones are flushed out
- painkillers to reduce renal colic
- anti-sickness medicine to control vomiting or nausea
- alpha-blockers as Medical Expulsive Therapy (MET) to dissolve stones to be passed faster and easier.
kidney stones that are too big to be passed naturally have to be removed by surgery. The type of surgery will depend on the size and location of the stones. The demand for imperative complete stone removal has led to a shift toward endourology. A Urologist can remove the kidney stone or break it into small pieces choosing a combination of following procedures suitable to the size and location of the stone:
- shockwave lithotripsy (SWL) – is to use sound waves to fragment the kidney stone into small pieces. The smaller pieces of the kidney stone then pass down through the urinary tract.
- Holmium Laser – For larger kidney stones, laser beams are used to break the kidney stones into smaller pieces
- Ureteroscopy – uses a ureteroscope to see detailed images of the lining of the ureters and kidneys. The ureteroscope is inserted through the urethra to see the rest of the urinary tract. Once the stone is found, it can be removed or broken it into smaller pieces.
- Percutaneous nephrolithotomy (PCNL) – A thin viewing tool is directly inserted into the kidney through a small cut made on the back.
After these procedures, the urologist may leave a thin flexible tube called a ureteral stent in the urinary tract to help urine flow or a stone to pass. Once the kidney stone is removed, the kidney stone or its pieces are sent to a lab to find out what type it is. It may be necessary to collect urine for 24 hours after the kidney stone has passed or been removed. This is to measure how much urine is produced in a day, along with mineral levels in the urine. It is more likely to form stones if enough urine is not made each day or there is a problem with high mineral levels.
One of the major problems with kidney stones is the high rate of recurrence. After an initial stone, there is a 50% chance of forming a second stone within 7 years if left untreated. As most patients with stone disease have identifiable risk factors, it is worthwhile to evaluate for underlying causes of stone formation. The 24-hour urine collection is the cornerstone of the evaluation of patients with renal stones as it allows for calculation of urinary supersaturations for the various salts associated with formation of stones, such as calcium oxalate, calcium phosphate, and uric acid, as well as the identification of specific metabolic derangements that may be contributing to risk. Dietary modification and medical treatment aimed at lowering urinary supersaturation can significantly reduce the risk of recurrence.
Fluid intake and dietary modification are important interventions in all stone formers and remain the first-line in stone management and prevention of stone recurrence. Stone disease is common and has high morbidity. Medical therapy is effective in decreasing stone recurrence. The available treatment options for prevention of stone recurrence can be divided into lifestyle interventions and pharmaceutical therapies. These efforts lead to the development of effective targeted therapy in stone management. In practice, a combination of therapies is most effective.
- In general, all stone formers are counselled on a low sodium diet and increasing fluid intake to facilitate at least 2-2.5L of urine volume on a daily basis, a factor that is absolutely crucial in the prevention of recurrent stone disease.
- Therapy with alpha-1 blockers such as tamsulosin may be effective in promoting stone passage and decreasing stone passage time. NSAIDs can be used concomitantly for their analgesic effects.
- Hypercalciuria is common in calcium stone formers and can be effectively treated with thiazide diuretics
- Treatment with alkaline citrate is mostly effective in prevention of stone recurrence in idiopathic calcium stone formers.
- Alkali therapy for urinary alkalinisation is a cornerstone in the management of uric acid stone disease
There is no one best treatment to suit all kidney stones. In consultation with the urologist, natural home remedies can also be considered as adjustment treatment for best results. Kidney stone management requires a multifaceted approach involving both lifestyle and pharmacologic intervention. Decisions regarding best treatment are made on the basis of specific metabolic abnormalities identified by stone type and evaluation of potential commodities.