Kidney Stones - Treatment

Highlights	Risk Factors	Other Treatments
Introduction	Diagnosis	Resources
Complications	Treatment	References
Causes	Prevention
Symptoms	Medications

Treatment

When tests have established the presence of a kidney stone, the next step is to determine treatment. The patient should be admitted to the emergency room if vomiting is severe, if fever is present, or if symptoms indicate an infection. X-rays are usually warranted at that time to determine the presence of a stone.

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Strong opioid painkillers such as meperidine (Demerol) are often required for a severe kidney stone attack, although doctors will usually not administer them until the presence of a kidney stone has been confirmed on the x-ray. In some cases, administration of powerful nonsteroidal anti-inflammatory drugs (NSAIDs) may be as effective as opioids and they have fewer side effects. They do take longer to have an effect, however.

General Guidelines for Follow-up Treatment

Watchful Waiting. In about 85% of patients, the kidney stones are small enough that they pass during normal urination, usually within2 to 3 days. In some cases, a stone may take weeks to months to pass, although pain usually subsides well before that. In one study, the likelihood of a stone passing spontaneously ranged from 87% for stones 1 mm in diameter (about 4/100 of an inch) to only 25% for stones larger than 9 mm (about a third of an inch). Stones in the lower ureter were also more likely to pass on their own (75%) than those in the upper ureter (48%).

The patient should drink plenty of water (two to three quarts a day) to help move the stone along, and take painkillers as needed. The doctor usually provides a collection kit with a filter and asks the patient to save any passed stones for testing.

If the stone has not passed in 2 to 3days, then additional treatments are warranted. In some severe cases, hospitalization may be necessary.

Indications for Lithotripsy or Surgery. Specific procedures vary depending on the size of the stone or complexity of the situation. Noninvasive procedures have largely replaced invasive surgery and are proving to be very beneficial in eliminating stones.

Extracorporeal shock wave lithotripsy is used for small stones (less than one centimeter, or slightly less than half an inch) that do not pass spontaneously and occur in the upper part of the ureter. One study indicated lithotripsy might even be safe and effective for patients whose stones are associated with malformed kidneys, although such patients are at higher risk for stone recurrence and should be carefully monitored.
For small stones that are lodged in the lower part of the ureter, ureteroscopy or shock wave lithotripsy are the procedures of choice.
For larger stones, ureteroscopy, percutaneous nephrolithotomy, and shock wave lithotripsy are all potentially useful, depending on location, abnormalities, and other considerations.
In some complicated cases, standard open surgical procedures (called nephrolithotomy) may be required.