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Kidney stones are sharp substances that are formed when your urine contains excess calcium. The solid particles can be the size of a ball or a sugar cube and may cause severe pain if they are pushed in the ureters. You can face severe nausea, vomiting,or blood in the urine. However, if there is severe pain in the back or stomach it requires immediate medical intervention as it could be due to ectopic pregnancy or appendicitis. Persistent pain while urinating could be a sign of UTI or STDs. In case the stone is small, your doctor may recommend you to wait for it to pass out on its own or take medicine and drink atleast 8-10 glasses of water.
If you have been diagnosed with a kidney or ureteral stones, 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:
Characteristics of stone
Your medical history
The kind of treatment available in the hospital and the expertise of your doctor
Your personal preferences
There are different treatment methods for emergency and non-emergency situations.
Treatment for 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 Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), 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
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 done 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, you will get antibiotics to clear the infection.
Treatment for non-emergency situations
If kidney or ureteral stone does not cause discomfort and likely to pass spontaneously (stone smaller in size and closer 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 for kidney stones.
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 per cent chance of passing this stone within six weeks.
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 a high risk of forming another stone
You have an infection
Your stone is very large
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:
(i) Shock-wave Lithotripsy (SWL),
(ii) Ureterorenoscopy / Retrograde Intra-Renal Surgery (URS/RIRS) and (iii) Percutaneous Nephrolithotomy (PNL).
SWL: SWL is done with a machine that can break stones from outside the body. To break the stone, focused shock 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.
URS/RIRS: URS/RIRS is a type of treatment which is done with a small-caliber endoscope (rigid/flexible). Stones can be located, disintegrated (with laser or pneumatic), and removed in a single procedure.
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.
Note: Not all stones require treatment. You need treatment if the 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.