Kidney stones treatment

This article discusses treatment options for kidney stones, from lifestyle changes such as drinking plenty of water, to surgical intervention.


How are kidney stones treated?

The kidneys are two bean-shaped organs that are roughly four inches in length found at the back of the abdomen, on either side of the spine. The function of the kidneys is to remove waste products from the blood and these are then passed out of the body in urine. However, the waste products in the blood can occasionally form crystals inside the kidneys and over time these can build up to form a hard stone-like deposit.

Fortunately, surgery to remove kidney stones is not usually necessary. Most can pass through the urinary system by drinking plenty of water — two to three litres a day — to help move the stone along. It is often possible to remain at home during this process, drinking fluids and taking pain medication as needed. Your doctor will usually ask you to save the passed stone(s) for testing.

Lifestyle changes

A simple and most important lifestyle change to prevent kidney stones from developing is to drink more liquids — water is best. Someone who tends to form kidney stones should try to drink enough liquids throughout the day to produce at least two litres of urine in every 24-hour period.

There are a number of different types of kidney stone - calcium stones, which are the most common and often have no specific cause, uric acid stones, often caused by a protein-rich diet, cysteine stones, which are rare and arise due to an inherited defect in amino acid transport within the kidney and struvite or infection stones, which are usually associated with urinary tract infections. Struvite stones can become very large in size and if left untreated can cause chronic infection and damage to the kidney.

In the past, people who had a tendency to form calcium stones were told to avoid dairy products and other foods with high calcium content. However, recent studies have shown that foods high in calcium, including dairy products, may actually help to prevent calcium stones. Taking calcium as a supplement in pill form, however, may increase the risk of developing stones.

Patients may be told to avoid food with added vitamin D and certain types of antacids that have a calcium base. Someone who has highly acidic urine may need to eat less meat, fish, and poultry as these foods increase the amount of acid in the urine.

To prevent cystine stones, a person should drink enough water each day to dilute the concentration of cystine that escapes into the urine, which may be difficult. More than four litres of water may be needed every 24 hours, and a third of that must be drunk during the night.

Medical therapy

During the acute renal colic phase, painkillers including non-steroidal anti-inflammatory drugs (NSAID) such as diclofenac, or opiates are recommended.

Calcium and uric acid stones

A doctor may prescribe certain medications to help prevent calcium and uric acid stones. These medicines control the amount of acid or alkali in the urine which are key factors in crystal formation. The medicine allopurinol may also be useful in some cases of hyperuricosuria.

Doctors usually try to control hypercalciuria, and thus prevent calcium stones, by prescribing certain diuretics, such as hydrochlorothiazide. These medicines decrease the amount of calcium released by the kidneys into the urine by favouring calcium retention in bone. They work best when sodium intake is low.

Rarely, patients with hypercalciuria are given the medicine sodium cellulose phosphate, which binds calcium in the intestines and prevents it from leaking into the urine.

People with hyperparathyroidism sometimes develop calcium stones. In these cases, surgery is usually required to remove the parathyroid glands, which are located in the neck. In most cases, only one of the glands is enlarged. Removing the glands cures the patient’s problem with hyperparathyroidism and kidney stones.

Cystine and struvite stones

If cystine stones cannot be controlled by drinking more fluids, a doctor may prescribe medicines such as tiopronin and penicillamine, which help to reduce the amount of cystine in the urine.

For struvite stones that have been totally removed, the first line of prevention is to keep the urine free of bacteria that can cause infection. A patient’s urine will be tested regularly to ensure no bacteria are present.

If struvite stones cannot be removed, a doctor may prescribe a medicine called acetohydroxamic acid (AHA). AHA is used with long-term antibiotic medicines to prevent the infection that leads to stone growth.

Medical expulsive therapy

A meta-analysis of nine randomised controlled trials suggests that treatment with a calcium channel blocker or an alpha blocker improves the chance of the spontaneous expulsion of small distal urinary stones, which would spare patients from surgery.

Surgical treatment for kidney stones

Surgery may be needed to remove a kidney stone if it:

  • Does not pass after a reasonable period of time and causes constant pain.
  • Is too large to pass on its own or is caught in a difficult place.
  • Blocks the flow of urine.
  • Causes an ongoing urinary tract infection.
  • Damages kidney tissue or causes constant bleeding.
  • Has grown larger, as seen on follow-up imaging.

Until twenty years ago, open surgery was necessary to remove a stone. The surgery required a recovery time of four to six weeks. Today, treatment for these stones is greatly improved, and many options do not require major open surgery and can be performed using minimally invasive techniques requiring only a few hours hospital stay.

Extracorporeal Shock Wave Lithotripsy

Extracorporeal Shock Wave Lithotripsy (ESWL) is the most frequently used procedure for the treatment of small kidney stones. In ESWL, shockwaves that are created outside the body travel through the skin and body tissues and target the denser stones. The stones break down into small particles and are easily passed through the urinary tract in the urine.

Several types of ESWL devices exist. Most devices use either x-rays or ultrasound to help the urologist pinpoint the stone during treatment. For most types of ESWL procedures, anaesthesia is not required.

In many cases, ESWL may be done on an outpatient basis. Recovery time is relatively short, and most people can resume normal activities the next day.
Complications may occur with ESWL. Some patients have blood in their urine for a few days after treatment. Bruising and minor discomfort in the back or abdomen from the shockwaves can occur. To reduce the risk of complications, we would usually tell patients to avoid taking aspirin and other medicines that affect blood clotting for two weeks before treatment.

Sometimes, the shattered stone particles can cause a minor blockage as they pass through the urinary tract and cause discomfort. In some cases, the doctor will insert a small tube called a stent through the bladder into the ureter under general anaesthetic to help these fragments pass. Sometimes the stone is not completely shattered with one treatment, and additional treatments may be needed.

As with any interventional, surgical procedure, potential risks and complications will be discussed with the urologist before making a treatment decision.

Percutaneous nephrolithotomy

Sometimes a procedure called percutaneous nephrolithotomy (PCNL) is recommended to remove a kidney stone. This treatment is often used when the stone is quite large or in a location that does not allow effective use of ESWL or flexible ureterorenoscopy (an endoscopic examination of the ureter).
In this procedure, the urologist makes a one inch incision in the back and creates a tunnel directly into the kidney. Using an instrument called a nephroscope, the urologist locates and removes the stone. For large stones, the Swiss LithoClast® Master, which produces simultaneous ultrasonic and pneumatic lithotripsy, may be needed to break the stone into small pieces. Often, patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the hospital stay.

A major advantage of percutaneous nephrolithotomy is that the urologist can remove all of the stone fragments directly instead of relying solely on their natural passage from the kidney.

Ureteroscopic Stone Removal

Although some stones in the ureters can be treated with ESWL, ureteroscopy may be needed for mid- and lower-ureter stones and a flexible ureterorenoscopy for small kidney stones not amenable to ESWL. No incision is made in this procedure. Instead, the urologist passes the ureteroscope, a small fiberoptic instrument, through the urethra and bladder into the ureter. The urologist then locates the stone and either removes it with a basket-like device or shatters it with Holmium laser, a special instrument that vaporises the stone into sand particles with minimal trauma to the wall of the ureter or kidney.

Complications of stone treatment

Blood in urine is a very common feature as a result of treatment. It is often transient and settles rapidly.

Urine infection may occur, as stones are often full of bacteria. The urologist tends to give a large dose of antibiotics in theatre and often send patients home on antibiotics.

Discomfort or pain - Stents can cause discomfort or pain, commonly in the bladder and kidney area, but sometimes in other areas such as the groin, urethra and genitals. The discomfort or pain may be more noticeable after physical activities and after passing urine.

The part of the body that contains the stomach, intestines, liver, gallbladder and other organs. Full medical glossary
Has a sudden onset. Full medical glossary
An organic compound that is the basic building block of all proteins. Full medical glossary
A medication that reduces sensation. Full medical glossary
Any drug that suppresses inflammation Full medical glossary
Medication to treat infections caused by microbes (organisms that can't be seen with the naked eye), such as bacteria. Full medical glossary
One of the most used medicines. Full medical glossary
A group of organisms too small to be seen with the naked eye, which are usually made up of just a single cell. Full medical glossary
The organ that stores urine. Full medical glossary
A fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. Full medical glossary
An element that forms the structure of bones and teeth and is essential to many of the body's functions. Full medical glossary
The basic unit of all living organisms. Full medical glossary
A disease of long duration generally involving slow changes. Full medical glossary
Blood that has coagulated, that is, has moved from a liquid to a solid state. Full medical glossary
A severe spasmodic pain that occurs in waves of increasing intensity. Full medical glossary
A condition that is linked to, or is a consequence of, another disease or procedure. Full medical glossary
A fluid-filled, enclosed pouch developing in a bodily structure as part of a disease process Full medical glossary
Drugs that help to remove excess water from the body by increasing the amount lost in urine. Full medical glossary
A viral infection affecting the respiratory system. Full medical glossary
The basic unit of genetic material carried on chromosomes. Full medical glossary
An organ with the ability to make and secrete certain fluids. Full medical glossary
A condition whereby there are excessive amounts of calcium in the urine. Full medical glossary
Excessive secretion of parathyroid hormone from the parathyroid glands. Full medical glossary
A medical condition whereby there are excessive amounts of uric acid present in the urine. Full medical glossary
Invasion by organisms that may be harmful, for example bacteria or parasites. Full medical glossary
The section of gut, or gastrointestinal tract, from the stomach to the anus. Full medical glossary
The major part of the digestive tract. Full medical glossary
One of two bean-shaped organs that are located on either side of the body, below the ribcage. The main role of the kidneys is to filter out waste products from the blood. Full medical glossary
non-steroidal anti-inflammatory drug Full medical glossary
Any drug derived from or chemically similar to opium. Full medical glossary
A surgical procedure to create an opening in the body for the elimination of bodily waste. Full medical glossary
Usually related to medical procedures; entering the body through the skin. Full medical glossary
Compounds that form the structure of muscles and other tissues in the body, as well as comprising enzymes and hormones. Full medical glossary
A study comparing the outcomes between one or more different treatments for a disease (or in some instances, preventive measures against that disease) and no active treatment at all (the placebo group). Study participants are allocated to the various groups on a random basis. May be abbreviated to RCT. Full medical glossary
Studies comparing the outcomes between one or more different treatments for a disease (or in some instances, preventive measures against that disease) and no active treatment at all (the placebo group). Study participants are allocated to the various groups on a random basis. May be abbreviated to RCT. Full medical glossary
Relating to the kidney. Full medical glossary
septic arthritis Full medical glossary
One of the chemical components of salt (sodium chloride) and an important blood chemical. Full medical glossary
A tube placed inside a tubular structure in the body, to keep it patent, that is, open. Full medical glossary
A gland in the neck that produces hormones with a role in controlling metabolism. Full medical glossary
A group of cells with a similar structure and a specialised function. Full medical glossary
A physical injury or emotionally painful event. Full medical glossary
A diagnostic method in which very high frequency sound waves are passed into the body and the reflective echoes analysed to build a picture of the internal organs – or of the foetus in the uterus. Full medical glossary
A tube that carries urine from the kidneys to the bladder. Full medical glossary
Two tubes that carry urine from the kidneys to the bladder, where it is stored. Full medical glossary
The tube that carries urine from the bladder, and in men also carries semen during ejaculation. Full medical glossary
A waste product of the breakdown of nucleic acids in body cells. Full medical glossary
The channels that carry urine from the kidneys to the outside of the body. Full medical glossary
A specialist in the treatment of diseases of the urinary tract, the channels that carry urine from the kidneys to the outside of the body. Full medical glossary
Essential substances that cannot be produced by the body and so must be acquired from the diet. Full medical glossary