Kidney Stone Treatment
Peter Loisides (Board Certified Urologist, Saint John's Health Center) gives expert video advice on: What does it mean to "pass" a kidney stone?; What precautions should I take if I pass a kidney stone at home?; When is surgery necessary to remove a kidney stone? and more...
Will my kidney stone go away on its own?
Well, interestingly, a kidney stone may go away on its own. It has to pass. We would put you through what we call a trial of passage (only once we've diagnosed your stone) and if it's small enough statistically to pass, that is, five millimetres or less, we could get your pain under control. If we can control your pain through medications, usually narcotic medications, then what we can do is to have you strain the urine to see if you can collect a stone, and add the use of medication to help relax the ureter so that the stone will pass with a higher frequency.
What does it mean to "pass" a kidney stone?
Passing a stone means that it literally passes from the kidney through the ureter, into the bladder and out through the urethra. So physically, the stone needs to migrate or move on down through the urinary system and pass out, basically.
What medications are normally prescribed for calcium and uric acid kidney stones?
The medications that we can use once we've detected an abnormality in the 24 hour urine study involve a multitude of different medications. First of all, the exact metabolic abnormality needs to be determined. If one has an increased oxalate excretion in the urine, that could be treated, first of all, by limiting intake of oxalate to reduce the eventual output into the urine. Additionally, calcium supplements can be given, which is counterintuitive, but calcium supplements can be given so that the oxalate are bound in the intestinal tract and prevented from being absorbed into the bloodstream and eventually secreted or excreted into the urine. Additionally, with uric acid stone production, again, if that is detected with certainty on a 24 hour urine study in the form of hyperuricose urea, the treatment would be to reduce the purine intake in the diet. That is red wine, poultry, fish, and nuts. And also, a drug called Allopurinol can be given to actually prevent the production of uric acid and the eventual excretion into the urine. And then additionally, alkalinization of the urine through a product called potassium citrate can be administered. Of late, it has been established that citrate in the form of lemon juice can be added to the diet on a daily basis. And my usual recommendation is one or two lemons per litre of fluid that is taken in each day, and a minimum of 2 litres need to be taken in for it to be adequate. And this provides you with enough citrate in your diet so that the urine can be alkalinized and thereby inhibit stones from forming in the urine.
What medications are normally prescribed for cystine kidney stones?
Cysteine stones, of course, are rare. Interestingly, cysteine stones can be prevented, again, by alkalinising the urine. An alkaline environment actually prevents all stones from forming. So, if we can artificially change the ph of the urine, then we can inhibit stone formation. However, if more is needed in the cysteine stone former, then what we can do is add one of two drugs, either Thiola or Penicillamine. The problem with these drugs, however, is that the side-effects are harsh and they are mainly gastro-intestinal. Rarely, blood disorders can form with the use of those drugs.
When is surgery necessary to remove a kidney stone?
Surgery is necessary to remove a kidney stone when a stone is too big to pass on its own, or if it's small enough to pass but just simply won't pass on its own, or if the person has a urinary tract infection at the same time that there's a stone with an obstruction of the system. That becomes a critical point where surgery should be entertained and performed on that individual. Finally, if the pain, nausea, vomiting, and dehydration that can occur from the vomiting are severe enough, then we would elect to move forward with surgery to remove the kidney stone at that point.
What is "Extracorporeal Shock Wave Lithotripsy" or "ESWL"?
Well, Extracorporeal Shock Wave Lithotripsy, or ESWL for short, is a minimally invasive technique that is utilised to treat many kidney stones. Most kidney stones that are either large enough to see on an X-Ray or in a position where it is just about to exit the urinary system but is basically stuck, can be addressed through ESWL. The treatment is performed on an outpatient basis under a mild sedative or light general anaesthetic, and the individual can wake up from the procedure and go home within about an hour after its end. About 80% of people have successful fragmentation of the stone, which then pass within the next few days or a week or two afterwards.
Is an extracorporeal shock wave lithotripsy painful?
Extracorporeal shock wave lithotripsy, or ESWL, could be painful if you did not have an anaesthetic. The procedure involves localising the stone in three dimensions in space, and if the shockwave is uncomfortable or painful to you, then you would have a tendency to move and the procedure would need to be stopped, the stone repositioned, and we'd need to start all over again. Therefore, an anaesthetic is essential in treating the individual with extracorporeal shock wave lithotripsy.
What is the recovery time for an extracorporeal shock wave lithotripsy?
For ESWL or extracorporeal shock wave lithotripsy the recovery time is quick. Within a day or two most individuals are feeling well enough to resume normal activities. You could feel a mild ache or tenderness in the flank overlying the area where the stone is located or was located. Some of the risks involved are that perhaps about 20% of the time the stone may not be fragmented either at all or enough for the fragments to pass easily. The fragments can become stuck or cause an obstruction of the urinary system which can then cause a recurrence of pain. But most people recover quickly. They are pain free afterwards and have absolutely no problems whatsoever after leaving the hospital.
What is a "Percutaneous Nephrolithotomy" or "PC NL"?
PC NL is Percutaneous Nephrolithotomy and what that means is that for people that have very large stones that can't be treated either through endoscopy or extracorporeal shockwave lithotripsy, direct access into the kidney through the flank needs to be performed so that a scope can be introduced directly into the kidney. Various means of either using ultrasonic lithotripsy or laser can be employed in order to break the stone apart into small fragments which are extracted from the body through the nephrostomy site.
What are the side effects and recovery time for a percutaneous nephrolithotomy?
Most individuals who undergo a PCNL, or a percutaneous nephrolithotomy, end up having to spend a day or two in the hospital. A catheter is left in the nephrostomy site, which is then removed prior to their discharge from the hospital. Once the patient leaves the hospital following a percutaneous nephrolithotomy, the recovery is very negligible.
What is "Ureteroscopic Stone Removal" or "URS"?
Ureteroscopic Stone Removal is the application of fiber optics to treating stones in the upper urinary system. A scope is passed under a general anesthetic through the urethra, through the bladder, and into the ureter. If the stone is retained within the ureter, it can be addressed at that point with a semi-rigid ureteroscope. Or, if the stone is up in the kidney, it can be addressed through a flexible ureteroscope and a number of other modalities are utilized. In other words, we use X-ray and we also use video cameras. We apply techniques such as laser lithotripsy as well as basket stone extraction.
What are the side effects and recovery time for ureteroscopic stone removal?
Most people recover from ureteroscopic stone removal within a few days. Symptoms afterwards can include urinary urgency and frequency, and blood in the urine can be present for a few days. On occasion, when there's a need to leave a ureteral stent in place, the stent is left for a few days and then is removed in the office setting. The stent, however, can be mildly to moderately uncomfortable, exacerbating those symptoms that people would normally get after the ureteroscopic stone removal.