Kidney Stone Treatment

Kidney Stone Treatment

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    If you have large kidney stones -- stones that are bigger than 2 cm, or about the size of a marble -- your doctor may remove them with either percutaneous nephrolithotomy and percutaneous nephrolithotripsy. Both of these treatments are used for people with large or irregularly shaped kidney stones, people with infections, stones that have not been broken up enough by ESWL (extracorporeal shock wave lithotripsy) or people who are not candidates for another common stone treatment called ureteroscopy.

    Both procedures involve entering the kidney through a small incision in the back. Once the surgeon gets to the kidney, a nephroscope (a miniature fiber optic camera on a thin tube) and other small instruments are threaded in through the hole. lf the stone is removed through the tube, it is called nephrolithotomy. lf the stone is broken up and then removed, it is called nephrolithotripsy. The surgeon can see the stone, use high frequency sound waves to break up the stone, and "vacuum" up the dust using a suction machine.

    This is what the words mean:
    • Percutaneous means through the skin.
    • Nephrolithotomy is a combination of the word roots nephro- (kidney), litho-(stone) and -tomy (removal).
    • Nephrolithotripsy is a combination of the word roots nephro- (kidney), litho (stone), and -tripsy (crushed).
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    The main risk of extracorporeal shock wave lithotripsy (ESWL) for kidney stones is that it doesn't always work. After ESWL, about 50% of people will be free of kidney stones within a month. In others, stone fragments of various sizes remain, and a repeat procedure (or a different procedure) is needed.

    ESWL has the potential to cause kidney injury. Whether or not ESWL causes or leads to the development of high blood pressure and diabetes remains controversial. These possibilities are still being studied. You should ask your doctor about risks and benefits of ESWL in your situation.
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    A answered
    Doctors may prescribe anti-inflammatories (NSAID) to help with the pain. The over-the-counter anti-inflammatory that I use is ibuprofen, usually 600 milligrams. For severe colic we use a stronger, injectable NSAID called ketorolac. It’s a very potent anti-inflammatory and will stop the spasms that you’re having with a kidney stone almost within a few minutes.
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    Most patients experience some degree of discomfort for a day or two after extracorporeal shock wave lithotripsy (ESWL) treatment for kidney stones. The pain is usually described as a dull ache over the kidney, and is typically at its worst the evening following surgery. The pain lessens over the following days. It is normal to see blood in the urine for several weeks after surgery.
    Several weeks following ESWL treatment, your urologist will perform a follow-up X-ray, to determine if the stone broke up into small pieces, and if those small pieces passed out of the kidney.

    If the stone has broken up into small fragments, but the fragments have not cleared, the x-rays may be repeated again following another several weeks.
    If the stone still has not broken up into small fragments, your urologist will likely recommend further treatment. In most cases, if the stone does not break up following one ESWL treatment, more ESWL treatments are unlikely to be successful. In this situation, other treatments may be recommended

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    Stents are inserted to unblock a ureteral stone, often in the setting of emergency for infection or pain. 
     
    For instance if the kidney is infected, a doctor won’t want to perform lithotripsy so they may put in a stent to drain it and then return when the infection has settled. They can also be used to relieve severe pain until lithotripsy can be performed.
     
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    Your doctor may recommend medicines that will help limit the recurrence of kidney stones. You may also take medicine such as calcium channel blockers or alpha-adrenergic blockers to help your kidney stones pass through your body. For small stones, you can take an over-the-counter pain reliever. If you have uric acid stones, your doctor may prescribe medicines like allopurinol to help melt the stones.

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    This is what you can expect during percutaneous nephrolithotomy (PCNL) surgery to remove kidney stones:
    1. General anesthesia. You'll have medication so you sleep through the surgery and have no sensation or memory of it.
    2. Inserting a tube. Your doctor will make a small incision (cut) in your back and insert a small tube called a nephroscope. Using x-ray guidance, your doctor will put the tube directly into the kidney.
    3. Removing the stone. Using laser or ultrasound, your doctor will break the stone into small pieces. The pieces will be removed through the tube.
    4. Inserting a stent. In some cases, a ureteral stent will be inserted during the surgery.
    5. Short hospital stay. In most cases, you'll need to stay in the hospital for a day or two. A tube will be left in the kidney -- the tube runs directly out the skin to your back or side. The tube will drain the kidney until the urine clears and the swelling goes down.
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    How Are Stones Outside of the Kidney Treated?
    Once a stone leaves the kidney, where it might lodge in the ureter determines treatment, says Jayram Krishnan, DO, a urologist at Sunrise Hospital. In this video, he explains when ureteroscopy might be needed.
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    Staghorn stones are large, branched stones occupying a large volume of the kidneys. The most effective treatment option is percutaneous nephrolithotomy, where the urologist inserts a scope directly into the kidney via a 1/2 inch tract made in your flank. Open surgery for kidney stones is strongly discouraged and reserved for only very rare cases with a very large stone burden or very unusual anatomy.

    In some cases, the stone is made of uric acid, and in these cases, medications alone may help dissolve the stone and one can avoid surgery.

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    Years ago, the treatment of kidney stones required major surgery, and was associated with long hospitalization and recovery periods. However, starting in the early 1980’s, doctors began treating patients with a revolutionary, non-invasive method called extracorporeal shock wave lithotripsy (ESWL).

    ESWL involves the administration of a series of shock waves to the targeted stone. The shock waves, which are generated by a machine called a lithotripter, are focused by X-ray onto the kidney stone. The shock waves travel into the body, through skin and tissue, reaching the stone where they break it into small fragments. For several weeks following treatment, those small fragments are passed out of the body in the urine.

    In the two-plus decades since ESWL was first performed in the United States, physicians have learned a great deal about how different patients respond to this technology. They have refined their ability to identify which patients are likely to experience a successful outcome following ESWL.