Stones can be treated with shock wave lithotripsy, ureteroscopic lithotripsy, tube (PCNL) and occasionally open or laparoscopic surgery. Basic metabolic evaluation consists of urine analysis and electrolytes especially checking for hypercalcemia.
Full metabolic work-up is usually reserved for repeat stone formers using 24 hour urine testing.
Kidney stone treatment depends on the size and type of stone as well as whether infection is present. Stones 4 mm and smaller in about 90 percent of cases; those 5–7 mm do so in 50 percent of cases; and those larger than 7 mm rarely pass without a surgical procedure.
Medications called alpha blockers have been shown to increase the spontaneous passage of kidney stones, especially smaller stones in the lower ureter near the bladder.
These medications have the ability to relax the ureter. This relaxation serves to improve spontaneous stone passage rates by about 30 percent. Some of the alpha blocker medications include tamsulosin (Flomax), alfuzosin (Uroxatral), terazosin (Hytrin), and doxazosin (Cardura). If you are trying to pass a stone often the patient is instructed to strain their urine to collect the stone.
ESWL – ExtraCorpeal Shockwave Lithotripsy
Extracorpeal Shock wave lithotripsy (ESWL) is used to treat stones in the kidney.
Xray or ultrasound is used to find the stone, then shock waves are used to breakdown the stone. The smaller pieces of the stones pass out in the urine over the course of a few weeks. ESWL does not work well on hard stones made of cystine, calcium oxalate and calcium phosphate or when stones are large. Patients can go home the same day and resume normal activities in two to three days. Risks and side effects are blood in the urine, passing stone parts, infection, or abscess, or hematoma around the kidney.
Ureteroscopy (URS) is used to treat stones in the kidney and ureter using a camera and a laser to blast the stones.
URS involves passing a very small telescope, called an ureteroscope, that goes into the bladder, then up into the ureter and into the kidney. Once the urologist sees the stone with the ureteroscope, a small, basket-like device grabs smaller stones and removes them. If a stone is too large to remove in one piece, it can be broken into smaller pieces with a laser or other stone-breaking tools.
Once the stone has been removed then a ureteral stent is placed. The stent does not stay forever, but can stay in for about 3-4 months. This can cause urgency and frequency of urination and some bladder discomfort. A stent is a tiny, rigid plastic tube that helps hold the ureter open so that urine can drain from the kidney into the bladder. The stent is removed in the office or clinic 7-10 days later in most situations. Just like shockwave treatment, patients go home the same day as the URS and can begin normal activities in two to three days. Sometimes a string is left on the end of the stent so you can remove it on your own.