How are kidney stones treated?
1. General treatment for small kidney stones
A doctor may determine that a kidney stone is small enough to be passed through the natural urinary tract process (from the kidneys, through the ureters and excreted from the bladder via urine). Small stones with mild or minimal symptoms do not require medically invasive treatment measures.
What will a doctor consider to be a ‘small kidney stone’?
A stone that is about 1 and half inches (or 5 millimetres) in diameter or smaller has a greater chance of being passed naturally. If larger than this, odds of passing the stone naturally are reduced and the condition will likely require medical intervention as a means of treatment. The location of the stone is also a determining factor of the likelihood of passing it naturally. For instance, if the stone is higher up along the urinary system, closer to the kidneys, the chances of passing it spontaneously decrease.
A doctor may advise that during the natural passing process, some pain may be experienced and can potentially take as little as a few days (often within 48 hours), and sometimes up to a week or two.
To counteract symptoms causing discomfort, he or she may recommend drinking a lot of water (avoiding alcohol altogether) to help flush out the urinary system, and also recommend medications (over-the-counter or prescription) to assist with keeping pain and nausea, in particular, at bay. If a person is a little dehydrated or experiencing nausea and vomiting, a doctor may assist by administering fluids intravenously (through an IV line in a vein in the arm) until the patient is strong enough to take in fluids on their own.
An alpha blocker (medication) may also be recommended so as to relax muscles in the ureter and thus assist the body in being able to pass a stone with minimal discomfort or a little sooner. The particular use of alpha blockers, such as tamsulosin (0.4mg taken daily), have shown to have improved outcomes in passing a stone. Any signs of bacterial infection may be treated with antibiotics. Calcium channel blockers may also be prescribed sometimes to help ease things along.
If possible, a doctor may also request that a strainer be used so as to potentially catch any stone/s that are passed for laboratory analysis.
If symptoms are severe or there are signs of infection, a person may be admitted to hospital and treated with intravenous fluids and medications. A positive response to medications will determine whether a person can safely be discharged and sent home, allowing for the stone to be passed naturally in time.
Within a week or two after the initial diagnosis, a follow-up consultation is likely to be requested to assess either a passed stone or determine whether medical intervention may be necessary at this stage, should the stone not have been passed and symptoms persist.
At a follow up, laboratory analysis of the stone may help to determine the cause of its development and initiate the need for a metabolic work-up so as to find better ways to prevent recurrence of kidney stone formation.
If a kidney stone is not passed within 6 weeks (even after follow-up consultations) and other symptoms have cropped up in the meantime, such as blood in urine, severe pain, fever, nausea, vomiting and body chills, it is best to consult a treating doctor as soon as possible. Alternative means of treatment may be necessary.
2. General treatment for large kidney stones
Stones which are larger and cause more severe symptoms due to the nature of obstruction in the urinary system, will require medical intervention. Conservative measures (i.e. passing through the system naturally) will cause further distress to the functionality of the system, resulting in kidney damage, rupture of the ureters, internal bleeding and chronic urinary tract infections.
Treatment options which a doctor may recommend include:
- Extracorporeal (‘outside the body’) shock wave lithotripsy (ESWL): High-energy sound waves (via a lithotripter machine) are used to travel through the body from the outside (non-invasive means) and create strong vibrations in an effort to break up a kidney stone into smaller pieces. Smaller pieces of stones can then be encouraged to pass through the urinary system naturally. The procedure (no surgical incisions are made) can be performed over a 45 to 60-minute period under light anaesthetic sedation (local, regional or sometimes general), with very moderate levels of pain or discomfort being experienced. A person can return home after a few hours of recovery, on the same day following the procedure. Some bleeding can occur during the process (resulting in some blood present in urine), as well as a little bruising (normally around the back or abdominal area). If smaller, broken stone pieces are able to be passed, some discomfort or pain may be experienced (but can be adequately managed with medications). It is a good idea to take a day or two to rest following the procedure and drink plenty of water during the next several weeks to flush out the system. If the procedure is to be performed, a doctor will advise against the taking of certain medications which can cause bleeding, such as aspirin and NSAIDs (non-steroidal anti-inflammatory drugs) beforehand.
- Ureteroscopy: Smaller stones can sometimes be removed using a ureteroscopic procedure (normally while under a regional anaesthetic, such as a spinal block). A thin, flexible lighted tube with a small camera is inserted via the urethra and bladder to the ureter where the stone is located (no surgical incisions are made). A monitor is set up along with the camera to determine the location, giving the doctor a detailed view. Tools (including a little cage) will be fed through the scope, using the real-time visuals on the monitor as a guide to break up a stone for natural passing or removal. A small stent (tube) may also be placed in the ureter to assist in alleviating swelling. A stone (or broken up fragments of one) which is removed will be sent to a laboratory for analysis.
- Percutaneous nephrolithotomy (Tunnel surgery): A large kidney stone causing an obstruction may need to be surgically removed. Removal is also considered if the stone is too large to be passed naturally or symptoms of pain cannot be controlled adequately enough. Small telescopes and surgical instruments are inserted through an incision in the back while under general anaesthesia, and the stone removed. This procedure takes place in a hospital environment and will likely require a stay of one or two days before being discharged and returning home. This procedure may be recommended if an ESWL was not successful in helping broken pieces to pass naturally.
- Parathyroid gland surgery: Overactive parathyroid glands (4 small glands in the neck – at the four corners of the thyroid gland - which help to regulate calcium blood levels in the body) can sometimes lead to calcium phosphate kidney stones. This condition is known as hyperparathyroidism, and simply means that excess parathyroid hormones have been produced, increasing calcium levels. Sometimes, a small (benign) tumour can result in this excess production. If during testing, a doctor determines an abnormality relating to these glands, treatment will be targeted at the source of the problem. If there is a tumour or growth that forms in one of these glands, surgery to remove the growth will be recommended, thus treating the cause of kidney stones, as well as other potential complications and related health problems.