How are kidney stones treated?
There are a number of treatment options for kidney stones. A number of factors must be taken into consideration such as: size, location, presence of infection, presence of renal impairment, comorbid conditions, duration of symptoms, inability to tolerate oral intake, and intensity and duration of pain.
Can kidney stones be treated medically, i.e. without surgery?
Depending on the size, location, intensity of symptoms, and type of kidney stones, kidney stones can sometimes be treated without surgery. Medical management may include increasing fluid intake, straining the urine for stones, and oral medication such as Tamsulosin which has been shown to increase the rate of stone passage. If medical management fails, patient’s symptoms worsen, or blood work indicates worsening infection or renal impairment, treatment typically proceeds to surgical intervention.
Can medicine dissolve kidney stones?
Kidney stones can sometimes be dissolved with medication depending on the composition and size of the kidney stone. Commonly, this requires that the patient previously have had a kidney stone specimen sent for stone analysis.
What are the different surgical treatments?
There are three main types of surgeries that are performed for kidney stones: ESWL (extracorporeal shock wave therapy), endoscopic treatment with lasers, and percutaneous surgery. The determining factors are frequently the size and location of the kidney stones and patient preference.
What types of stones are best treated with ESWL?
ESWL is a type of surgery in which ultrasound is applied the outside of the body leading to a fragmentation of kidney stones. ESWL are best used when the kidney stone is close to the kidney or close to the bladder while still located in the ureter. Size and stone composition frequently determine whether a kidney stone can successfully be treated with this surgical approach. ESWL is typically performed under general anesthesia.
What types of stones are best treated with endoscopic treatment?
Endoscopic treatment of kidney stones can be used to treat kidney stones anywhere in the urinary tract. Endoscopic therapy involves inserting small, telescope instruments through the patient’s native urinary tract. Laser fibers inserted through the instruments are then used to break up the stones into smaller pieces that can be passed spontaneously. No incisions are needed. Depending on the size of the kidney stone, multiple endoscopic treatments may need to be performed in order to fully treat the kidney stone. Frequently a stent is left in the kidney to allow passage of the kidney stone fragments. This procedure is typically performed under general anesthesia.
I was told my kidney stone needed to be “stented” prior to being treated. What does this mean exactly?
There are many reasons a kidney stone is stented prior to definitive treatment. Occasionally, a kidney stone is associated with infection in which case the kidney needs to be drained, or decompressed, prior to treating the kidney stone. Additionally, the ureter is sometimes too narrow to allow safe passage of endoscopic instruments to the level of the kidney stone. Stent placement allows the ureter to dilate and frequently accommodate endoscopic instruments at the next visit. Finally, placing a stent concomitantly or prior to ESWL helps preventing stone fragments from obstructing the kidney and can help in spontaneous fragment passage.
What is percutaneous nephrolithotomy and when is it performed?
Percutaneous nephrolithotomy involves placing larger endoscopic cameras and instruments directly into the kidney through the back. This type of surgery is typically reserved for large kidney stones that are not amenable to ESWL or laser lithotripsy. Percuneous nephrolithotomy is performed under general anesthesia.