Kidney Stone Treatment

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• QWhat is the best treatment for staghorn kidney stones?

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  A Dr. Sangtae Park, MD , Urology, answered on behalf of NorthShore University HealthSystem

  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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• QWhat are treatment options for kidney stones?

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  A National Kidney Foundation answered

  A kidney stone starts to hurt when it causes irritation or blockage. This can build rapidly to extreme pain. In most cases, kidney stones pass without causing damage—but usually not without causing a lot of pain.

  Doctors usually first try to let kidney stones pass on their own. You may be asked to drink a lot of water to help pass the stone. For small stones, pain relievers may also be needed.

  But if the stone is too large, blocks the flow of urine, or if there is a sign of infection, it may be removed with a non-invasive procedure or surgery. Shock-wave lithotripsy is a noninvasive procedure that uses high-energy sound waves to blast the stones into fragments that are then more easily passed out in the urine. In ureteroscopy, an endoscope is inserted through the ureter to retrieve or obliterate the stone.

  Rarely, for very large or complicated stones, doctors will use percutaneous nephrolithotomy/nephrolithotripsy. This surgery involves entering the kidney through a small incision in the back to insert a miniature fiberoptic camera and other small instruments  to either remove the stone or break it up.

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• QIs lithotripsy necessary for a kidney stone?

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  A Dr. Sangtae Park, MD , Urology, answered on behalf of NorthShore University HealthSystem

  While lithotripsy is not mandatory for all kidney stones, the majority of them would benefit from it. 

  This is because stones grow over time, can cause sudden severe pain requiring an Emergency room visit or admission to the hospital, and in some cases cause chronic blockage of the kidney thereby causing kidney failure.

  In some cases, the stone is small enough 2-3mm to pass by itself, but it is wise to see a urologist and get follow-up Xrays to make sure they are indeed passed, and not causing any problems.

• QWhat procedures help treat kidney stones?

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  A National Kidney Foundation answered

  Shock-wave lithotripsy is a noninvasive procedure that uses high-energy sound waves to blast kidney stones into fragments that are then more easily passed out in the urine. In ureteroscopy, an endoscope is inserted through the ureter to retrieve or obliterate the stone. Rarely, for very large or complicated stones, doctors will perform a surgical procedure called nephrolithotomy or nephrolithotripsy which involves entering the kidney through a small incision in the back to insert a miniature fiberoptic camera and other small instruments  to either remove the stone or break it up.

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• QAre there OTC medications to treat uric acid kidney stones?

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  A Dr. Arthur R. Crowley, MD , Urology, answered

  Sodium Bicarbonate (chewable tablets or powder) is probably the only readily available over-the-counter (OTC) medication to treat uric acid kidney stones. It is useful in patients who have persistent acidic urine as the cause of their uric acid stones. Patients must test their urine regularly with pH paper (which turns different colors depending on whether the urine is acidic or alkaline). Too much sodium bicarbonate will make the urine too alkaline and promote the formation of calcium phosphate stones.
  Note: Consult your health care provider before starting any OTC or other medication. Patients taking sodium bicarbonate may experience an increase in side effects or a decrease in effectiveness of their current medications. 
• QWhen should infected kidney stones be removed?

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  A Dr. Arthur R. Crowley, MD , Urology, answered

  Infected kidney stones should be removed shortly after detection or diagnosis. The infected stones generally grow rapidly and serve as a nidus (or center) for further stone formation. This stone matrix is believed to protect the bacteria from antibiotics. In essence, antibiotics cannot clear the associated infection unless the stone material is completely removed.
• QHow effective is ESWL for kidney stones?

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  A Dr. Arthur R. Crowley, MD , Urology, answered

  The outcome of Extracorporeal Shock-Wave Lithotripsy (ESWL) is dependent on a variety of factors, including the stone size, composition, location, and the anatomy of the collecting system. ESWL is generally most effective for stones that are less than 1.5 to 2.0 cm in diameter. Stones composed of uric acid, calcium oxalate dihydrate, struvite (magnesium ammonium phosphate), and calcium oxalate monohydrate are more readily fragmented with ESWL. Stones composed of cystine and calcium phosphate (brushite) are the most resistant to shock waves. The outcome for patients with lower pole kidney stones is generally worse than the outcome for those with stones in other locations in the kidney. Therefore, ESWL should be limited to stones less than 1cm, if the stone is in the lower pole. 

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• QWhen should a kidney stone be treated?

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  A Dr. Arthur R. Crowley, MD , Urology, answered

  Kidney stones should be treated when:
  Pain is not readily or easily controlled with oral medications.
  Associated symptoms are present (for example, nausea, vomiting).
  Fever or infection is present or suspected (can be life threatening).
  Involved patient has:

  • single (solitary) kidney.
  • poor overall kidney function.
  • complete blockage of urine flow.

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• QWill I need to be in a hospital to have large kidney stones removed?

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  A National Kidney Foundation answered

  The procedures used to remove large kidney stones -- percutaneous nephrolithotomy and percutaneous nephrolithotripsy -- require general anesthesia and a short hospital stay, usually two or three days. The recovery time takes a week or so. Depending on the position of the stone, the procedure itself takes about 20 to 45 minutes. The goal is to take out all of the stones so that none are left to pass through the urinary tract.