Kidney Stone Treatment Overview
Your first diagnosis of kidney stones often occurs when you see your doctor or go to an emergency room because you are in great pain. Your doctor may suggest that you wait for the stone to pass and take pain medicine or have a procedure to remove the stone.
Most small stones [less than 5mm] move out of the body (pass) without the need for any treatment other than taking pain medicine and drinking enough fluids.
The smaller a stone is, the more likely it is to pass on its own. About 9 out of every 10 stones smaller than 5mm and about 5 out of every 10 stones 5mm to 10mm pass on their own. Only 1 or 2 out of every 10 kidney stones need more than home treatment.
The average time a stone takes to pass ranges between 1 and 3 weeks, and two-thirds of stones that pass on their own pass within 4 weeks of when the symptoms appeared.
Not all kidney stones are diagnosed because of immediate symptoms. Your stone may not be causing you pain, and your doctor may find it during a routine exam or an exam for another condition or disease. In this case, you have the same treatment options as noted below.
Treatment for your first stone
If your doctor thinks the stone can pass on its own, and you feel you can deal with the pain, he or she may suggest home treatment, including:
Using pain medicine. Nonprescription medicine, such as nonsteroidal anti-inflammatories (NSAIDs), may relieve your pain. Your doctor can prescribe stronger pain medicine if needed.
Drinking enough fluids. You'll need to keep drinking water and other fluids when you are passing a kidney stone. If you don't get enough fluids, you could get dehydrated. Drink enough fluids to keep your urine clear, about 8 to 10 glasses a day. If you have kidney, heart, or liver disease and are on fluid restrictions, talk with your doctor before increasing your fluid intake.
Your doctor may prescribe medicine to help your body pass the stone. Alpha-blockers have been shown to help kidney stones pass more quickly with very few side effects.5 Ask your doctor if these medicines can help you.
If your pain is too severe, if the stones are blocking the urinary tract, or if you also have an infection, your doctor will probably suggest medical or surgical treatment. Your options are:
Extracorporeal shock wave lithotripsy (ESWL). ESWL uses shock waves that pass easily through the body but are strong enough to break up a kidney stone. This is the most commonly used medical treatment for kidney stones. See a picture of ESWL.
Ureteroscopy. The surgeon passes a very thin telescope tube (ureteroscope) up the urinary tract to the stone's location, where he or she uses instruments to remove the stone or break it up for easier removal. Occasionally, you may need a small hollow tube (ureteral stent) placed in the ureter for a short time to keep it open and drain urine and any stone pieces. Ureteroscopy is often used for stones that have moved from the kidney to the ureter. See a picture of ureteroscopy.
Percutaneous nephrolithotomy or nephrolithotripsy. The surgeon puts a narrow telescope into the kidney through a cut in your back. He or she then removes the stone (lithotomy) or breaks it up and removes it (lithotripsy). This procedure may be used if ESWL does not work or if you have a very large stone. See a picture of nephrolithotomy.
Open surgery. The surgeon makes a cut in the side or the belly to reach the kidneys and remove the stone. This treatment is rarely used. source
Kidney Stone Treatment Overview
Kidney stones treatment without surgery
Kidney stones treatment without surgery
Kidney stones are one of the most common disorders of the urinary tract. These develop from crystals that separate from the urine and build up on the inner surfaces of the kidney. If the crystals remain small, they can travel through the urinary tract and pass out unnoticed while urinating. However, if the crystals accumulate and form a large stone or stones, they can impair the function of the kidneys that can obstruct the flow of urine and cause excruciating pain. In cases like these, treatment should be done. If left untreated, kidneys may be permanently damaged by an obstructing stone in only a few days.
Diet, dehydration (not drinking enough water when doing manual labor or indulging in sport), and family history are just a few of the reasons why stones occur.
The common symptoms of stone disease are sharp pain in the abdomen or lower back, fever, blood in the urine, and pain when urinating.
Kidney stones can be treated through surgery, the most common form of treatment. Surgery is painful, leaves a scar, and requires a long recovery period — about four to six weeks. Lithotripsy or extracorporeal shock wave lithotripsy (ESWL) is the therapy of choice. This non-invasive technique uses shock waves instead of a knife to remove the stones from the kidney and urinary tract. The shockwaves pass harmlessly through body tissues. When the shock waves strike the kidney stone, cracks appear in the kidney stone’s surface. After about one hour, the stone is pulverized. The fragments pass out naturally during urination for a number of days or even weeks after lithotripsy.
Lithotripsy uses a simple device called a lithotripter. The physician localizes and then focuses shock waves directly on the stone. The lithotripter is very precise, delivering the right amount of energy to break the stone without damaging organs or surrounding tissues. The treatment usually consists of several thousand shocks which break the stone into very small fragments. These fragments are passed spontaneously during urination. The procedure usually lasts about one hour and is performed on an outpatient (OPD) basis. Re-treatment may be necessary in some cases to completely disintegrate larger stones.
The procedure is safe and performed worldwide with excellent results. It is non-invasive and conducted under the supervision of a highly-trained physician and technician. Occasional side effects are bruising around the treatment area, blood in urine, and pain for a few days following lithotripsy. While most people can undergo lithotripsy, inform your doctor if you have high blood pressure, a blood clotting disorder, or a urinary tract infection. Pregnant women must not undergo lithotripsy. To date, over 25,000 patients have been treated in the Philippines in the last 15 years with stone-free rates ranging from 70 to 100 percent, depending on the stone burden, location, and number of treatments.
For more information on non-surgical kidney stone treatment and related concerns, call De Los Santos Medical Center Stone Center at 723-0041-54 local 127 and 129 or direct line 726-3572 from Monday to Friday. source
what causes kidney stones
what causes kidney stones
Men are four times more likely to get kidney stones than women, and if you have previously had a kidney stone then you will have a 50 percent chance of developing another one within five years. Most people have no predisposing factors to explain why they develop kidney stones. You may have an increased risk of developing kidney stones if you:
1, have a family history of kidney stones
2, are aged between 20 and 50
3, are taking certain medicines - for example indinavir (in the treatment of HIV infection) and taking too many laxatives or taking them too often
4, have only one kidney, or an abnormally shaped kidney
5, eat a diet high in protein
6, don't drink enough fluids
Diagnosis of kidney stones
Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history. Your GP may do further tests to confirm the diagnosis and to show the size, location and type of your kidney stone. These include:
blood tests - to identify excess amounts of certain chemicals which cause kidney stones
urine analysis - to look for signs of infection
taking an X-ray image - stones that contain calcium usually show up white on X-ray images
intravenous urogram (IVU) - injection of a special dye that shows up the whole urinary system and any stones on X-ray images; or a CT (computed tomography) scan - this uses X-rays to make a three-dimensional image of the area
ultrasound scan - this uses high frequency sound waves to produce an image of the internal organs
Treatment of kidney stones
Your treatment will depend on the type and cause of your kidney stone. Most stones can be treated without surgery. If you drink a lot of water (two and a half to three litres per day) and stay physically active, this is often enough to remove stones smaller than about 5mm from your body. Your GP may then prescribe medicines to reduce the pain.
Your GP may ask you to catch the kidney stone by passing your urine through filter paper or a tea strainer. The stone can then be analysed to find out what type it is, to help guide your treatment.
If you have a kidney stone that hasn't passed out of the body within one to two months, it's unlikely to pass without treatment.
The Kidney Stone Symptoms
Kidney Stone Symptoms
Kidney stones can form in some people without causing any symptoms, however, some stones may cause the following:
severe pain, which usually starts suddenly and may last from minutes to hours, followed by long periods of relief. Kidney stone pain usually starts in the kidney or lower abdomen and later may move to the groin.
nausea and vomiting
burning and the urge to pass urine
frequent urination
cloudy or foul-smelling urine
fever
chills
blood in the urine
bloating
pus in the urine
Diagnosis of Kidney Stones
The doctor will perform a number of diagnostic tests to diagnose kidney stones. Diagnostic tests include a blood test, a urine test and a 24-hour urine collection test. The 24-hour urine test is done to monitor urine volume, levels of acidity, and if a stone has passed into the sample, the make-up of stone (i.e., calcium-based, uric acid based, etc.) is also determined.
Other diagnostic tests include a kidney-ureter-bladder (KUB) x-ray, a kidney ultrasound, an intravenous pyelogram (IVP) and if recommended, a CAT (CT) scan.
A KUB x-ray involves low doses of electromagnetic energy to produce a picture of the kidney-ureter-bladder area. This x-ray will reveal kidney stones in these areas.
A kidney ultrasound is a diagnostic technique in which high frequency sound waves are passed into the kidney to detect obstructions and changes.
During an IVP, a colorless substance is injected into the vein. This substance circulates to the kidney and is excreted and concentrated, making the area in and around the kidney white. Obstructed and dilated areas will fill with white contrast much slower than normal.
A CT scan involves injecting a dye into the body that infiltrates the kidneys and accentuates the images. Using a series of cross-sectional x-rays, the images, made by the dye, make it possible to detect kidney stones.
Treatment of Kidney Stones
Fortunately, most stones can be treated without surgery. About 90 percent of all kidney stones can pass through the urinary system spontaneously with the help of plenty of water (two to three quarts a day) to help the stone move along. In addition to extra water consumption, the doctor may prescribe antibiotics to fight infection, pain relievers to help with the pain, an antispasmodic to relax the ureter muscles or diuretics to prevent urine from staying in the kidney. About 90 percent of all stones that leave the kidney will pass through the ureter within three to six weeks.
Surgical treatment is recommended if the stones:
are too large to pass or have grown larger
have not passed after a reasonable period of time
are causing constant pain
are blocking the urine flow
cause ongoing urinary tract infections
damage the kidney tissues
Surgical Treatment
Currently there are four (4) methods of stone removal:
Extracorporeal Shockwave Lithotripsy (ESWL)
ESWL uses non-electrical shock waves that are created outside of the body to travel through the skin and body tissues until the shockwaves hit the dense stones. The stones become sand-like and are passed. For this procedure, patients acre placed in a tub of warm, purified water or onto a water cushion machine that acts as a medium for transmitting these non-electrical shockwaves.
Percutaneous Nephrolithotomy (PNL)
Percutaneous nephrolithotomy is often used when the stone is quite large or in a location that does not allow effective use of extracorporeal shockwave lithotripsy (ESWL). In this procedure, the surgeon makes a tiny incision in the back and creates a tunnel directly into the kidney. Using an instrument called a nephroscope, the stone is located and removed. For large stones, an energy probe (ultrasonic or electrohydraulic) may be needed to break the stone into smaller pieces for removal.
Ureteroscopic Stone Removal
Ureteroscopic stone removal is achieved by passing a small fiberoptic instrument (a ureteroscope) through the urethra and bladder into the ureter. The surgeon then locates the stone and either removes it with a cage-like device or shatters it with a special instrument that produces a form of shockwave. A small tube (or stent) may be left in the ureter for several days after treatment to help the lining of the ureter to heal.
Open (incisional) Surgery
Open surgery involves opening the affected area and removing the stone(s). Another, less known procedure (called coagulum pyelolithotomy) also removes kidney stones. This procedure involves the injection of a liquid containing calcium chloride, cyroprecipitate, thrombin and indigo carmine into the kidney. This injection of substances forms a jelly-like clot that traps the stones inside. Through an incision made in the kidney, the doctor extracts the stone with forceps.
Prevention of Kidney Stones
People who have had more than one kidney stone are likely to form another. Therefore, prevention is very important. There are two types of preventive measures that help in preventing other kidney stones from developing - life-style changes and medical intervention.
Life-style changes include:
Drink eight to 13 glasses of water (or at least two quarts) a day.
Limit the amount of calcium and oxalate-based foods eaten. These include apples, black pepper, chocolate, coffee, cheese, grapes, ice cream, vitamin C, yogurt, tomatoes and oranges, to name a few.
Limit the amount of animal protein eaten.
Limit salt intake.
Limit supplemental intake of vitamin C and D. Consult the doctor before taking vitamin supplements.
Limit alcohol consumption.
Medical interventions include:
For calcium stones, the doctor may prescribe thiazide diuretics or phosphate-containing preparations. Additionally, in hyperparathyroid patients, removal of all or part of the parathyroid glands located in the neck helps prevent further stone development.
For uric stones, the doctor may prescribe allopurinol and a medicine to keep the urine alkaline.
For struvite stones, the doctor will monitor the urine for bacteria on a regular basis. Additionally, if struvite stones cannot be removed, the doctor may prescribe acetohydroamic acid (AHA). AHA is used with long-term antibiotics to prevent the infection that leads to stone growth.
For cystine stones, the doctor may prescribe Thiola. This medication helps reduce the amount of cystine in the urine.
Questions To Ask Your Doctor About Kidney Stones
What tests need to be done to diagnose the condition or to locate the stones?
Are there any risks to the tests?
What type of stone has formed?
What is the cause of the stones?
What type of treatment are you recommending?
How effective is the medication and treatment?
Will you be recommending extracorporeal shockwave lithotripsy?
What measures can be taken to prevent recurrence?
Has any permanent damage occurred?
Kidney stones symptoms and signs
Kidney stones symptoms and signs
The attacks of kidney stones are extremely painful and difficult to bear to self-diagnose unless you know what symptoms to look for. Here are some of the symptoms of kidney stones that can cause problems.
Anyone who has had the misfortune to suffer an attack of kidney stones will told you exactly how painful tyour condition can be. In fact, pain is most often compared to natural labor pains. Tyour is not an exaggeration or an illusion. The stabbing and shooting pains that accompany a major attack of kidney stones can bring literally on your knees, unable to drive back to proper medical care. Although the major pain-killers such as Demerol can do wonders for immediate distress, a victim of an attack of kidney stones has yet to face days of treatment of intravenous fluids and surgical intervention is possible before obtaining substantial relief. A permanent change in diet and lifestyle are often required, and the patient still faces the possibility of several reoccurances lifetime. Prevention is the real key to preventing kidney stone attacks serious, but genetics and gender are usually working against those who have a predisposition to kidney disease.
What are the warning signs and symptoms of an attack of kidney stones? It is difficult to be specific, as you may experience any combination of some of the symptoms in general. Some people with kidney stones may feel a dull pain, not indescribable pain in your lower back for days, while others are suddenly crippled by excruciating pain. These symptoms and warning signs are intended to be a general layman's guide to self-diagnosis of a possible attack of kidney stones, not a substitute for proper medical care. If you feel pains that are tenacious and strong, seek medical attention as soon as possible. Do not wait until the actual attack begins - a simple urine test at the office can usually diagnose a kidney stone long before the actual attack.
Here are the most common kidney stones symptoms and warning signs of an attack:
1. Medical history and gender. Although women are as likely to develop kidney problems, most kidney stone sufferers are men. Some researchers believe that family history of kidney problems can significantly increase the chances of developing kidney stones. Check out any known family medical history indicating a predisposition to kidney stones. Forewarned can be prevented. If you know that the attacks of kidney stones in your family, make sure that the proper use of preventive measures such as increased unsweetened, no fluid intake to avoid caffeine and excessive consumption of dairy products, especially at night. Never intentionally working your body in a state of severe dehydration, which can occur if you work long hours in a physically demanding job or spend too much time in the heat. Always drink plenty of water when you excessive working hours. Those who are prone to attacks of kidney stones should not be far from two things: a good supply of water and a bathroom. Retention of urine in an amount of time will work against you in the long run.
2. Dull, 'toothachy originating in the lower back or pelvis. This may be the first indication that something serious is in development.
The level of pain may be continuous or may come and go in waves. Rarely disappear completely. You can take an analgesic tablet or two, hoping the pain to dissipate. After a few hours or even days, the pain will most likely increase in the degree and be more precise in their location. Some victims feel a definite tension in the area of the kidneys, as if your urine is struggling to overcome a blockage. You may feel a 'squirting' sensation internally, as fluids try to overcome the blockade. Even if the pain is tolerable, should never be left unchecked.
3. Fever, disorientation, general 'blahs. Along with this dull ache in the lower back, many victims experience a general feeling of disorientation and fatigue. You can feel a fever or chilled. Your thought process can be more vague, and your energy level much lower. An actual fever may or may not be present, but you have the same nausea and drowsiness may be associated with a bad cold or stomach bug. Walking becomes more and more difficult, and the pain makes everyday tasks nearly impossible. You may experience trouble reaching above your head, or recovering from a bent position.
4. The signs of blood in the urine. If you can, observe the urine secreted during this time of trouble. You may be able to see traces of actual blood in the urine or the urine itself may be an unusual color.
If your urine is deep orange, which is most likely dehydrated. All the blood in the urine is cause for alarm. In combination, a dark-colored urine associated with sharp pains in the kidney region should be a red flag to seek help immediately. For less severe symptoms, it should dramatically increase your consumption of water and / or cranberry juice. Make an appointment to see a doctor if this does not relieve the minor symptoms and still notice unusual urine secretions.
5. Sharp, stabbing pain concentrated on one side of the lower back. If you start feeling sudden and severe pain that you feel as if your abdomen was open from the inside, which is more likely in the shooting of a real attack of kidney stones. If your pain level beforehand was hovering around a 5 or 6, is likely to jump to a 9 or 10 in a hurry. You want no, demand immediate medical attention at this point. If not already sitting in a doctor's office or emergency room, get one immediately. This is the worst part of the most kidney stones victims, even more painful than the final approval of the stone itself. Without the benefit of painkillers such as Demerol, you will feel a constant pain radiation from the lower back and progressing through your abdomen. Many victims will double in pain, or very unusual to find positions that will ease your discomfort. Some find that lying on the floor is helpful, or sitting in a chair backwards. Once you have received an analgesic, however, symptoms tend to be much more manageable.
What should you expect from a course of treatment? your first day in hospital was full of urine and possible x-rays. The urine test will confirm the presence of blood, indicating a possible blockage of the kidney. X-rays to identify the location of stones and their relative size. More than likely, you will be given intravenous fluids to restore the level of hydration and diet will be restricted to non-dairy foods and liquids without caffeine. After a day or two of bed rest and fluids, your doctor will recommend various courses of action, depending on the individual test results. Many kidney stones are removed naturally after a few days of increased fluid intake. The patient usually experiences an immediate sense of relief, as the stones, usually the size of tomato seeds, pass through the urinary tract. Others are not so fortunate. The doctor may advise the use of a resounding 'crush' device that will blast the stones into manageable chunks. This treatment may make you feel as if you've been in a boxing match or two, but is relatively noninvasive. The last option would be surgery, where a catheter is inserted through the urethra and a hook in fact traps and eliminates the physical blockage. It is so intrusive and exciting as it sounds. Rarely, open surgery is required to physically remove the stones through a small incision.
If all goes well, you should return to normal life within a week. Your doctor will advise you not to drink excessive amounts of sugary or caffeinated drinks, and reduce your intake of calcium during the night. You must remember to take more frequent water breaks at work, and avoid strenuous activity that could promote dehydration. Once you have had a kidney stone experience, it runs an important opportunity to have a few more in your life. You should follow your doctor's advice religiously if you do not want a repeat of your first attack of kidney stones.
