Author: John Maggioncalda MD
Once you have been diagnosed with a kidney stone the treatment options vary. Your urologist must take into account your health, the size of the stone, its location in the kidney or ureter, and even your prior history of passing stones.
One of the easiest ways to treat a kidney stone is to let it pass. In many cases a small stone (<4mm) will pass spontaneously with increased fluids and pain medication. If you have a history of passing stones in the same kidney previously, you are more likely to pass another one. This approach reduces the need for surgical intervention and any post-op pain associated with it. The time to pass the stone can vary however, from a few days to a few weeks. If the pain is too intense or the time to pass the stone becomes great (>4 weeks), or you have a solitary kidney or some form of obstruction to the ureter, then spontaneous passage may not be preferred.
If your stone is clearly visible on an x-ray and in the top part of the ureter, shockwave lithotripsy or ureteroscopy is a good option for treatment. Shockwave lithotripsy involves sending focused sound waves on to the stone to break it to small pieces. It is done under anesthesia in the operating room, and takes about 30 minutes. It is generally greater than 80% successful in breaking up a stone. There can be post-op discomfort but it is usually mild to moderate. Keep in mind that the stone must be visible on x-ray for this technique to work. Ureteroscopy involves passing a flexible fiber optic scope up the ureter to see the stone. A laser fiber is then passed through the scope and breaks up the stone on contact. This procedure is more invasive, takes about 30 minutes, and usually requires a stent for 5-7 days afterwards. Post-op pain can be significant but, it is more often moderate at worst. The benefit of ureteroscopy is that it can work on all stones, even those not visible on x-ray. It is also >93% successful in eradicating the stone.
Large stones in the kidney (>2cm) are very challenging and often require more invasive techniques to treat. Percutaneous nephrolithotomy involves the passage of larger instruments into the kidney through a patient’s back. It is also done in the operating room under anesthesia with the patient face down or prone. Larger instruments allow the urologist to fragment and remove larger stone pieces using this technique. Unlike the other procedures mentioned, this technique requires a hospital stay of 1-2 days and can be quite painful. The risk of bleeding as well as other complications is also higher with this procedure. The benefit of percutaneous nephrolithotomy is that a larger stone can often be treated efficiently with one trip to the operating room.
It is important to make sure you discuss all your treatment options with your urologist prior to planning surgery for a stone. Remember each stone episode may be different and the treatment will vary by stone and by patient.
