If you have been diagnosed with a kidney or ureteral
stone, there are different treatment options which you can discuss with the
urologist. Together, you can decide which approach is right for you.
Factors that influence the decision include:
·
Your symptoms
·
Stone characteristics
·
Your medical history
·
The kind of treatment
available in the hospital and the expertise of your doctor
·
Your personal
preferences and values
Not all stones require treatment. You need treatment if
your stone causes discomfort and does not pass or likely to pass, naturally
with urine. Urologist may also advise treatment if you have pre-existing
medical conditions.
There are different treatment methods for emergency and
non-emergency situations.
Treatment of emergency situations
Acute renal colic
Renal colic is an acute, painful situation caused by a
stone that blocks the ureter. Go to the family doctor or the nearest emergency
room as soon as possible to relieve the pain.
Pain is usually relieved with NSAIDs (non-steroidal
anti-inflammatory drugs), which you can take as a tablet or a suppository. If
this first step of treatment does not help, you will get stronger painkillers
called opioids. Usually, they are injected directly into the vein. On a rare
occasion, drugs do not work. In this case, the doctor may need to drain urine
from your kidney. This is called decompression.
There are two methods
of decompression:
- By placing a ureteral JJ-stent in the ureter through the urethra.
- By inserting a percutaneous nephrostomy tube into your kidney directly through the skin
Both methods are equally effective
Obstructed and
infected kidney
If there is renal colic together with fever, one should
go to the closest urological department at once. Get blood, urine tests and
imaging, to check if you have an infected, obstructed kidney. If you do, you
need immediate decompression to relieve the pressure in the kidney.
After the decompression, one will get antibiotics to
clear the infection. Treatment of stones in such situations to be done only
after the infection is gone.
Treatment of non-emergency situations
If kidney or ureteral stone does not cause discomfort and
likely to pass spontaneously (smaller in size, closer the stone to
bladder……more likely to pass, bigger the stone…lessen the chance of passing), urologist
can prescribe drugs to ease the process. This is called conservative treatment.
Urologist will give you a time schedule for regular control visits to make sure
your condition does not get worse.
If your stone continues to grow or causes frequent and
severe pain, you will get active treatment.
Conservative stone treatment
Urologist can prescribe drugs if stone is smaller and
causing pain or discomfort to ease its expulsion. This therapy is called as
medical expulsive therapy(MET). If you have a very small stone, there is a 95%
chance of passing this stone within 6 weeks.
During MET, you should visit urologist regularly - how
often depends on his recommendation. The doctor needs to check if the stone
keeps moving and if your kidneys continue to function well.
Active stone treatment
Kidney or ureteral stones should be treated if they cause
symptoms. If you don't have symptoms, you may still get treatment in case:
·
The stone continues
to grow
·
You are at high risk
of forming another stone
·
You have an infection
·
Your stone is very
large
·
You prefer active
treatment
Urologist will recommend to remove a stone in the ureter
if:
·
It seems too big to
pass with urine
·
You continue to
suffer from pain while you take medication
·
Your kidneys have
stopped or may stop to function properly
There are three common ways to remove stones: shock-wave
lithotripsy (SWL), ureterorenoscopy/Retrograde intra-renal surgery (URS/RIRS),
and percutaneous nephrolithotomy (PNL). Each of these procedures has advantages
and disadvantages. It is important to talk about your symptoms and test results
with the urologist to find the most efficient treatment option for you.
Shock-wave lithotripsy (SWL)
SWL is done with a machine that can break stones from
outside the body. To break the stone, focused shock waves (short pulses of high
energy sound waves) are transmitted to the stone through the skin. The stone
absorbs the energy of the shock waves and this breaks it into smaller pieces.
The fragments then pass with urine
When is SWL not
recommended?
There are several contraindications for SWL that either
have to do with your physical condition or with the characteristics of the
stone.
SWL is not recommended if:
·
You are pregnant
·
You have high risk of
severe bleeding
·
You have any
uncontrolled infections
·
You have uncontrolled
high blood pressure
·
Your physique makes
it difficult to reach the stone
·
You have an aneurysm
·
You have an
anatomical obstruction in the urinary tract, below the stone or in the bladder
·
Your stone is very
hard (for instance cysteine stones)
Will I be stone free
directly after treatment?
No. SWL breaks stone into small pieces. These fragments
will pass with urine in the days or weeks after SWL. You may need multiple sessions
for larger stones
How long will it take
me to get back to my normal daily activities?
In general, one can go back to regular activities right
after treatment. However, make sure to get some rest on the day of the
procedure. If you have received medication against the pain or to calm you
down, do not drive a car or operate any other motorized vehicle within the first
24 hours after SWL.
Ureteroscopy/Retrograde intrarenalsurgery (URS/RIRS)
URS/RIRS is a type of treatment which is done with a
small-calibre endoscope(Rigid/Flexible). Stones can be located, disintegrated
(with laser or pneumatic), and removed in a single procedure. URS/RIRS success
rates are high, and the risk of complications is low.
Based on how the operation goes, your doctor may need to
place a JJ-stent in the ureter to make sure urine can flow through the urinary
system. The stent will be removed when your urine flow is back to normal. This
can take anywhere between several days and a few weeks.
When should I
consider URS/RIRS?
If your stone is not large (generally under 2cms), URS/RIRS
is an alternative to SWL. Although URS/RIRS is more invasive than SWL, it is a
safe and effective treatment option for kidney and ureteral stones. Because the
stone fragments are removed during the procedure, you don't have to pass them
afterwards. You have a high chance of being stone-free with a single operation.
When is URS/RIRS not
recommended?
In general, it can be performed in almost every patient,
as long as your condition allows anesthesia and you do not have an untreated
urinary tract infection. URS/RIRS can even be done without stopping medication
for blood clotting. However, it is always important to discuss your individual
situation with the urologist.
How long will it take
me to get back to my normal daily activities?
Usually you can leave the hospital 1 day after the
procedure and return to your normal daily activities. Your urine can contain
some blood for a couple of days. If a JJ-stent was placed during the procedure,
urologist will take it out after some time.
Percutaneous Nephrolithotomy (PNL)
PNL is a surgery to remove large stones directly from the
kidney. The advantage is that even very large stones are removed in a single
operation. However, compared to SWL and URS/RIRS, it is more invasive and there
is a slightly higher risk of complications. The most common complications of
PNL are bleeding and fever.
How is PNL performed?
PNL is carried out under general anesthesia. While you
are under anesthesia, the urologist punctures the kidney with a needle through
your skin. The doctor makes the puncture channel large enough to insert the
nephroscope. Depending on the size of the stone, it is either removed
completely or it is broken into smaller pieces first. Fragmentation of the
stone is done with laser, ultrasound, or a pneumatic lithotripter (which works
like a little jackhammer). At this point all stone fragments are removed.
Sometimes a JJ- stent or a percutaneous nephrostomy tube is placed to make sure
that urine can leave your kidney.
When should I
consider PNL?
PNL should be considered when your stone is very large
(bigger than 2 cms) and has not moved to the ureter. Urologist may also discuss
PNL as a treatment option if:
·
You have more than
one stone
·
Your stone is very
hard
When is PNL not
recommended?
PNL is a safe and effective procedure but there are some
contraindications because the stone is accessed directly through the skin. If
you take medication to prevent blood clotting, you should stop taking it before
the procedure. However, it is always important to discuss your individual
situation with the doctor. In addition, PNL is not recommended if you are
pregnant or if your physique makes it difficult to access the kidney.
How long will it take
me to get back to my normal daily activities?
After PNL you will stay in the hospital for two to three
days. In case, you have a percutaneous nephrostomy tube, you will be discharged
when it gets removed by the doctor. Your urine might be a little bloody for the
first couple of days. Do not plan physical exercise the first two weeks after
the procedure.
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