Kidney Stone Treatment

What is a kidney stone?

A kidney stone (also known as renal lithiasis or nephrolithiasis) are deposits composed of minerals and salts formed within your kidney. When the urine becomes concentrated, minerals crystallize and stick together. Whilst passing kidney stones can be a painful process, they usually do not cause any permanent damage unless there is an infection or a blockage that requires surgery.

Typically, the pain associated with kidney stones occurs when it is stuck in the ureter, triggering spasms and pressure buildup in the kidney due to urine accumulation.

When should I see a specialist for kidney stone treatment?

If you have a large kidney stone and experience severe pain or kidney problems such as those listed below, you should see a urologist for kidney stone treatment.

· severe pain in the side and back, just below the ribs
· radiating pain to the lower abdomen and pelvis
· fluctuating pain that comes in waves
· painful urination
· pink, red or brown urine
· cloudy or foul-smelling urine
· nausea and vomiting
· Persistent need to urinate or urinating more often than usual but with some amounts each time
· Fever and chills if an infection is present

The pain could change its location depending on the moment of the stone.

Did you know?

A systematic review published in 2015 suggests that citrate salts may prevent new stone formation and reduce further stone growth in patients with residual stones that predominantly contain oxalate¹.

What are the risks of kidney stone treatment?

Occasionally, complications may arise in the treatment of large kidney stones. This depends on the type of treatment, size, and position of your stones and includes:

· blockage in the ureter caused by stone fragments
· damage to the ureter
· urinary tract infection
· bleeding during surgery
· pain

How should I prepare for my appointment?

The urologist will ask if you have had kidney stones before. The specialist will also ask about your symptoms, when they started, duration, frequency, and the intensity.

To prepare for your appointment, you should be prepared with a list of your symptoms, keeping track of how much you have drunk and urinated as well as a list of your medication, vitamins or supplements that you are currently taking.

What can I expect during kidney stone treatment?

Treatment for kidney stones is generally dependent on the stone’s location, size and type. For some small stones, extra fluids to flush out the stone and medication to relax the ureters may be sufficient. Other forms of treatment may be necessary for larger stones such as:

· Extracorporeal shock wave lithotripsy, or ESWL, uses sound waves to break the stones into tiny pieces which then pass out of the body in urine. This is generally done as a day case with no overnight stay in the hospital. Complications are very rare although discomfort and blood in the urine are likely for 1-2 days after treatment.

· A ureteroscopy is a procedure where the specialist uses a thin tube equipped with a camera at the end, to guide it through your urethra and bladder to your ureter, to locate the stone and using special tools, break it into pieces to be passed through your urine. A temporary plastic tube called a stent may be placed in the ureter after the procedure to help the kidney drain better. The stent can be removed after 1-2 weeks.

· Percutaneous nephrolithotomy. This is a surgical procedure done under general anaesthesia, where a small telescope-like device called a nephroscope and several small instruments are inserted through a small incision in your back. The stone is either pulled out or broken into smaller pieces.

How do I prevent kidney stones after my treatment?

A combination of lifestyle changes and medications can help prevent kidney stones.

Lifestyle changes include:

· drinking about 2.5 litres of water throughout the day, more if you are living in a hot climate or exercise frequently
· eating fewer oxalate-rich foods such as spinach, sweet potatoes, nuts, tea, chocolate, black pepper, and soy products if you tend to form stones that are formed from calcium oxalate
· reduce your salt and animal protein intake
· continue to eat calcium-rich foods but take them with caution. Calcium supplements as these have been linked to increased risk of kidney stones. Diets low in calcium can increase kidney stone formation in some people.

Your urologist could prescribe medication to control the amount of minerals and salts in your urine which could be helpful in people who form certain kinds of stones.

As medication can help control the amount of minerals and salts in your urine which could be helpful in people who form certain kinds of stones, depending on the type of stone you have, your urologist could prescribe medication such as those below:

· For calcium stones, a thiazide diuretic, or a phosphate-containing preparation may be prescribed.

· For uric acid stones, medication to reduce uric acid levels in your blood and urine as well as keep your urine alkaline, may be suggested.

· For struvite stones, your urologist may recommend long-term use of antibiotics in small doses to keep your urine free of bacteria that cause infection.

· For cystine stones, your urologist may recommend that you drink more fluids to produce more urine. Alternatively, a medication that decreases the amount of cystine in your urine may also be suggested.

1. Phillips R, Hanchanale VS, Myatt A, Somani B, Nabi G, Biyani CS. Citrate salts for preventing and treating calcium containing kidney stones in adults. In: Biyani CS, ed. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2015. doi:10.1002/14651858.CD010057.pub2.