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Urological Treatments for Kidney Stones

Katelaris_1_Sept_KidneyStones

Kidney stones occur when salts in the urine form into solid crystals or ‘stones’. These stones can block the normal urine flow, and can be accompanied by severe pain. Kidney stones can also cause infection, and even kidney damage or failure in severe cases. There are several types of kidney stones, with the most common being what are known as calcium stones.

Symptoms, causes and diagnosis

Symptoms may include severe gripping pain in the back, blood in the urine, passing small stones in the urine, and a fever if infection is present. It’s also important to note that some people with kidney stones do not experience any symptoms at all.

Causes of kidney stones include high levels of calcium and other substances in the urine, as well as certain medications and medical conditions.

Diagnosis may be done by ultrasound, CT scan or x-ray. Stones that are passed in the urine can also be examined by a physician or kidney stone specialist to determine what category they fit into.

Kidney stone treatments

Kidney stone treatments vary, and will depend on the size and type of stone, and what problems it is causing for the patient.

In many cases, no treatment is necessary, as the patient will pass the stones in the urine. Pain relief might be required, and if pain is particularly severe, hospitalisation and strong medication might be necessary.

Kidney stone removal by open surgery is rarely used in Australia, usually being reserved for severe cases such as those where large obstructive stones are present, and / or there is a risk of complications such as organ damage.

Other urological treatments include:

  • Endoscopic removal – which involves passing a ureteroscope (a tube with a small camera attached) through the urethra or kidney to where the stone is located. Other instruments attached to the tube are used to break up the stone into fragments, enabling them to be removed.
  • ESWL (Extracorporeal Shock-Wave Lithotripsy) – this is a non-invasive procedure which uses shockwaves generated by electromagnets to fragment the stone so it can be passed in the urine. This treatment is usually used for smaller stones (less than 2cm). It may take several weeks for all the fragments to pass, and in about a quarter of cases the treatment may need to be repeated.
  • Percutaneous nephrolithotomy – this treatment is used for larger stones (over 2cm in length) and involves inserting a tube and small camera attached through a small incision in the skin. The camera enables the surgeon to see the stone so that he or she can fragment and remove it.

Even though treatments can be very successful, the chance of recurrence is always present. Patients can take steps to reduce their risk of recurrence by doing the following:

  • Drinking at least 2 litres of fluid a day, and avoiding dehydration.
  • Getting prompt treatment for any urinary tract infections that occur.
  • Reducing levels of salt in the diet.
  • Avoiding too much coffee or tea.

It is not normally necessary to reduce calcium in the diet, although this would need to be determined by a kidney stone specialist. Drinking cranberry and citrus juices may also help to reduce risk levels, but this too should be discussed with your specialist.

Where to get help

The first port-of-call should be to visit your doctor if you suspect you might have kidney stones. If urological treatments are required, you may be referred on to a urologist or kidney stone specialist who will discuss treatment options with you. If you do require urological treatment, the type of treatment recommended will depend on the details of your particular case.

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