How Can I Manage Kidney Stones?
The symptoms from kidney stones (pain and obstruction) are addressed via:
- Fluids: volume expansion to encourage their passage and elimination
- Medication: to enhance passage
- Pulverization: via ultrasound
- Invasive removal: via cystoscopy or surgery
Increased oral intake of fluids or alternately, intravenous hydration, increase the volume of urine and the chance of passage of the stone to the bladder. The success of passage depends on its size and location. Small stones (<4mm) pass easily. After 4 mm, passage becomes increasingly problematic until unlikely at >10 mm.
If a patient with a newly diagnosed stone is not pain-driven for immediate resolution, a period of observation is acceptable during which surveillance for infection and kidney function is important. Designed to avoid the more invasive or aggressive remedies, passage can be enhanced by the use of antispasmodic agents, calcium channel blockers, and/or alpha-blocker medications, with or without corticosteroids.
Shock wave lithotripsy (ultrasound impacts focused on the stones from an external source) is used for stones higher in the urinary tract (kidneys) and has a high success rate. This makes it prudent to push stones lower in the urinary tract higher (within range) so that lithotripsy can be used (the “push-bang” technique). Stones are thus fragmented for easier passage.
- Stones: Especially those in the lower urinary tract, can be mechanically retrieved with the use of a flexible ureteroscope (small, lighted camera on a thin flexible tube that can steer along the urinary tract after entering the bladder by way of the urethra. Besides direct retrieval, flexible ureteroscopy can also be used to fragment stones in the ureter or bladder for easier passage.
- Laser: Can be used in conjunction with ureteroscopy as a type of “intracorporeal” lithotripsy.
- Percutaneous nephroscopy: Surgical approach to a renal stone through the tissues over the kidney to directly remove it. This is usually reserved for large, impacted kidney or high ureteral stones.
- Retroperitoneal laparascopy: The kidneys are retroperitoneal, i.e., lie under the floor of the abdomen, between the abdomen and the external tissues of the mid-back. Visualizing and working in this area do not, therefore, enter the abdomen, which reduces recovery time.