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How are Kidney Stones treated?

Is there anything I can do to prevent the stones forming?

One of the most effective ways of preventing stones is to drink planty of fluids. If the urine becomes too concentrated, then crystals can appear in the urine which can grow into stones. You should drink at least 2 litres of fluid per day (more on hot days). If the urine is dark or yellow, then this may be a sign of being mildly dehydrated.

Any fluids can be taken, but water and ceratin fruit juices may be particularly helpful (eg pineapple juice, orange juice).

Calcium oxalate and Phosphate

Altering your diet to try and reduce the amount of calcium does not prevent these stones forming in fact it may even increase the risk of them. Reducing your ordinary salt intake will help and also reducing meat consumption to, say 1-2 portions per day. There is no difference between red and white meat or fish. 

Calcium magnesium ammonium phosphate

Removing the stone completely is the only way to really prevent these stones forming. Once the stones have been removed, then plenty of fluids will help prevent re-infection.

Uric Acid

If you have been diagnosed with gout, then your doctor may put you on a medication called Allopurinol which prevents large amounts of uric acid being made. Good volumes of fluid help to dilute the urine and making urine alkaline (which may be advised by your doctor) may help. Reducing the amount of meat will also be of benefit.

Cystine

Large volumes of fluids are advised even drinking during the night. Drugs can be given that mop up the cystine from the urine but this treatment will be life long.

How are urinary stones treated?

If you have severe pain or infection in the kidney you will require admission to hospital. Pain relieving tablets are given to start with and often anti-inflammatory drugs like Diclofenac given as a tablet or a suppository are extremely effective. If they are not, you will need to have Morphine. If you have a high temperature, you will require strong antibiotics. 

Your doctor will arrange an Xray test which is usually a CT scan. This will give information on the position of the stone and how much the kidney seems to be blocked. If the stone is in the ureter (kidney tube), then about 60% will pass on their own over the next few weeks. There are some drugs e.g. Tamsulosin which help the stones to pass.

If you have an infection in the kidney, then you may need to have a little plastic tube inserted through the side under local anaesthesia into the kidney to drain off the infection. This is called a nephrostomy. 

Once you are over your acute episode of pain you will probably be allowed home. 

For some ureteric stones and stones in the kidney, intervention to remove the stone will be recommended. Some little stones that are in crevices may not be treated and simply followed up in out-patients.

What types of treatment could I have?

Lithotripsy

This is a treatment where an energy beam is focused through the side onto the stone. It looks rather like an x-ray machine but has some additional energy source. Patients experience a tapping feeling. You will be given some painkillers but are not put to sleep. The treatment lasts for about an our and you may need several of them, 1-2 weeks apart.

For stones that are in the kidney which are less than about 2.5cms this would be the treatment of choice with a success rate of 80-90%. The very hardest of stones are the ones least likely to fragment.

Percutaneous nephrolithotomy

For large stones in the kidney and ones where lithotripsy has been ineffective, this keyhole technique is the best treatment. Under a general anaesthetic a telescope is inserted through the side into the kidney and the stone then fragmented and the particles sucked out. This has a 90% chance of full clearance. Stag horn stones probably have a combination of this technique plus lithotripsy as the prongs in the crevices can be difficult to access.

Ureteroscopy

For stones in the ureter and for some in the kidney this is the treatment of choice. Under a general anaesthetic a thin telescope is passed up the urethra through the bladder and then up the ureter towards the stone. The stone is then fragmented often with a laser and the fragments then pass out afterwards. Sometimes a narrow plastic tube is left inside the ureter extending from the kidney to the bladder to help drain urine. It is then removed by inserting a telescope into the bladder some weeks later.

Open operation

With all these non-invasive and endoscopic techniques it is uncommon to perform an open operation for a stone. Some very large kidney stones, though, are best treated by this technique. They are quite big operations.