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KIDNEY STONE MANAGEMENT
Thomas Stormont, MD
Immediate care of the patient with a kidney stone depends upon the size and location of the stone, whether there are any complicating medical conditions such as infection, the degree of blockage seen on x-ray, and how much pain is present.
Outpatient Management
For the otherwise healthy person with an acute stone <5mm in diameter, trying to pass the stone at home is appropriate. Patients are instructed to drink plenty of fluids, strain the urine to catch and save the stone for analysis, and take pain medication as needed. Tamsulosin (Flomax) is sometimes prescribed to help pass the stone. Follow-up should include an x-ray every week or so, to monitor progress of the stone. Stones larger than 5mm are unlikely to pass, and these patients should consider earlier intervention. Rarely, certain stones (uric acid) can be dissolved with medication.
Inpatient Management
High grade obstruction, as seen on x-ray, or stones >5mm should consider early intervention. High fever, uncontrollable pain, severe nausea with dehydration, diabetics and those with a single kidney should be admitted to the hospital and subsequently treated.
Surgical Treatments
- ESWL (ExtraCorporeal Shock Wave Lithotripsy) uses sound waves that is focused on the stone, breaking it into small pieces that can pass. It requires an anesthetic, but is usually an outpatient procedure. It is safe and effective for most kidney stones.
- Flexible Ureteroscopy with Laser Lithotripsy uses a thin fiberoptic scope to locate a stone, then a Holmium laser to break the stone into small enough pieces to remove with a basket or pass. An ansesthetic is need for this outpatient procedure which requires a temporary ureteral stent.
- Percutaneous Nephrolithotomy is a more invasive procedure using a small incision through the back to allow access to the inside of the kidney. It is usually only necessary for the rare, large or dense stone that is could not be successfully treated with the less invasive methods such as ESWL or laser.
Prevention
Stones recur in up to 50% within 5 years, if no preventive measures are taken. The main preventive strategy is to drink more fluids, but it may also require avoiding certain foods and/or medications.
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