Kidney Stones

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 5 mm (0.2 in.)] move out of the body (pass) without the need for any treatment other than drinking extra fluids and taking pain medicine.¹

• The smaller a stone is, the more likely it is to pass on its own. About 9 out of every 10 stones smaller than 5 mm (0.2 in.) and about 5 out of every 10 stones 5 mm (0.2 in.) to 10 mm (0.4 in.) pass on their own.¹ Only 1 or 2 out of every 10 kidney stones need more than home treatment.¹
• The average time a stone takes to pass ranges between 1 and 3 weeks,¹ and two-thirds of stones that pass on their own pass within 4 weeks of when the symptoms appeared.²

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 examination or an examination 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:

• Drinking more fluids. You need to drink enough water to keep your urine clear, about 8 to 10 glasses a day. Try to drink 2 glasses of water every 2 hours while you are awake. If you have kidney, heart, or liver disease and are on fluid restrictions, talk with your doctor before increasing your fluid intake.
• Not drinking grapefruit juice. Drinking grapefruit juice may increase your risk for developing kidney stones.
• Using pain medicine. Non-prescription medicine, such as non-steroidal anti-inflammatories (NSAIDs), may relieve your pain. Your doctor can prescribe stronger pain medicine if needed.

Your doctor may prescribe medicine to help your body pass the stone. Calcium channel blockers and alpha-blockers have been shown to help kidney stones pass more quickly with very few side effects.¹¹ Ask your doctor if one of 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.
• 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.
• 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.
• 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.

Should I use extracorporeal shock wave lithotripsy (ESWL) for my kidney stones?

Preventing future stones

After you have had a kidney stone, you are more likely to have one again. Almost half of all people who have a stone will have more stones within 5 years unless they take preventive measures.³ You may be able to prevent getting more kidney stones by drinking more fluids and making changes in your diet. If you have risk factors for having more stones, such as a family history of stones, your doctor may suggest medicines that help prevent stones from forming.

What To Think About

Your doctor may ask you to collect your urine for 24 hours after you pass a stone so your urine can be tested to find out the type and cause of the stone. Knowing the type of stone can help determine what you can do to avoid having another.

In rare cases, a person forms kidney stones because the parathyroid glands produce too much of a hormone, which leads to higher calcium levels and possibly calcium kidney stones. To help prevent stones from coming back, your doctor may suggest surgery to remove a parathyroid gland or glands (parathyroidectomy).

You may require more treatment for your kidney stones if you have continuing problems and:

• A lot of urinary tract infections.
• Decreased kidney function.
• A single kidney.
• An impaired immune system.
• Have had a kidney transplant.

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Author:	Douglas Dana Monica Rhodes	Last Updated: July 13, 2007
Medical Review:	Adam Husney, MD - Family Medicine Anne C. Poinier, MD - Internal Medicine Philip Belitsky, MD, FRCSC - Urology
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