A Doctor's View on Kidney Stone Treatment
Read the Comment by Melissa Conrad Stöppler, MD
Many kidney stones do not require treatment and they pass on their own. Drinking ample amounts of fluid facilitates the process. People who have kidney stones often require medications, such as over-the-counter ibuprofen or prescription ketorolac (Toradol) or narcotic medications, for pain control. Other treatments for kidney stones include:
- Calcium channel blockers like nifedipine (Procardia, Adalat) and alpha blockers like tamsulosin (Flomax) to speed the passage of kidney stones
- Shock wave therapy (lithotripsy) to break up kidney stones
What is the treatment for kidney stones?
The treatment for the renal colic of a kidney stone includes pain control and hydration. For severe pain, some patients present to the emergency department and often receive intravenous medications including narcotics, anti-inflammatory medications, and medications to control vomiting.
Once the pain is under control in the emergency department, the patient may be discharged home with pain medications and the recommendation to take ibuprofen as an anti-inflammatory. Tamsulosin (Flomax) is a medication often prescribed to help promote stone passage.
In the uncomplicated situation, the stone may be allowed to pass on its own and it may take 2 to 3 weeks or longer. However, there are certain situations where more urgent action may be required.
In patients with a solitary kidney, a kidney stone causing obstruction may lead to kidney failure and emergent referral to a urologist may be required to remove the stone or place a stent to bypass it. The type of procedure depends upon the location of the stone. If the stone is near the junction of the ureter or bladder, ureteroscopy may be an option, where a flexible fiberoptic scope is passed through the urethra into the bladder and ureter to snare the stone with a basket. If that is not possible, a long flexible stent can be passed from the bladder into the kidney to allow urine to drain and to relieve the obstruction. If the stone is high in the ureter near the bladder, an interventional radiologist may need to place a percutaneous nephrostomy or drain through the skin directly into the kidney to allow urine to drain.
Patients with obstructing kidney stones who develop urinary tract infections may need to have a stent or nephrostomy placed to prevent progression of the infection. Urine that is infected that cannot drain will act like an abscess and can cause the patient to become quite ill, often with fevers and chills.
Large stones that are located in the kidney or the upper ureter may be unable to be passed spontaneously. Lithotripsy, sometimes called extracorporeal shockwave lithotripsy (ESWL) uses ultrasound to deliver energy to break up the large stone into smaller stones and debris that then can be passed or captured by ureteroscopy.
Patients with a large stone that fills the whole kidney (staghorn calculi) may require removal using a special instrument inserted through an incision in the skin directly into the kidney (percutaneous nephrolithotomy).