KIDNEY STONE TREATMENT

Treatment of a kidney stone that is causing obstruction depends upon the size and location of the stone, as well as your pain and ability to keep down fluids. If your stone is likely to pass, your pain is tolerable, and you are able to eat and drink, then you can be treated at home.

If you have severe pain or nausea, you will need to be treated with stronger pain medications and IV fluids, which are often given in the hospital. In addition, patients with stones and who also have a fever should be treated in the hospital as soon as possible to avoid a life-threatening infection. (See "Options in the management of renal and ureteral stones in adults".)

Home treatment — You can take non-prescription pain medication until the stone passes. This includes nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin) or naproxen (Aleve), but it is important to check with your doctor first.

Other medications, such as tamsulosin, may also be recommended to speed the passage of stones.

You will probably be asked to strain your urine to recover the stone; after you retrieve it, you should bring it to your doctor so it can then be analyzed in a laboratory to determine the composition of the stone (eg, calcium oxalate, uric acid, etc). Knowing what type of kidney stone you have is important in planning treatments to prevent future stones. (See 'Kidney stone prevention' below.)

If the stone does not pass — Stones larger than 9 or 10 millimeters rarely pass on their own and generally require a procedure to break up or remove the stone. Some smaller stones also do not pass. Several procedures are available.

Shock wave lithotripsy (SWL) — Lithotripsy is a reasonable treatment option in many patients who need help passing a stone. Lithotripsy is particularly good for stones 1 cm or less in the kidney and upper ureter. Lithotripsy is not effective for treating large or hard stones. You may require medication to make you sleepy and reduce pain during lithotripsy treatment, although this depends upon the type of lithotripsy equipment used.

Lithotripsy is performed by directing high-energy shock waves toward the stone. These sound waves pass through the skin and bodily tissues and release energy at the stone surface. This energy causes the stone to break into fragments that can be more easily passed in the urine.

Percutaneous nephrolithotomy (PNL) — Extremely large or complex stones, or large stones resistant to shock wave lithotripsy, may require a minimally invasive surgical procedure to remove the stone. In this procedure, a small endoscopic instrument is passed through the skin (percutaneously) of the back into the kidney to remove the stone.

Ureteroscopy — Ureteroscopy is a common endoscopic procedure that uses a thin scope, which is passed through the urethra and bladder, into the ureter and kidney. This endoscope allows the urologist to see the stone and remove it, or to break up the stone into smaller pieces that can pass more easily. Ureteroscopy is often used to remove stones blocking the ureter, and sometimes for small stones in the kidney.

Treatment of asymptomatic stones — If you have a kidney stone that is causing no symptoms, you may or may not need to remove the stone. The decision is based upon the size and location of your stone, as well as your ability to be treated quickly if symptoms were to develop. If there is a chance that you would not be able to get treatment quickly (eg, if you travel frequently), you are more likely to be advised to have the stone removed.

Regardless of the decision to treat or not, you should be evaluated for underlying health conditions that can increase the risk of kidney stones