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How Kidney Stones are Diagnosed and Treated

How Kidney Stones are Diagnosed and Treated

By: Urology Care Foundation | Posted on: 11 Mar 2020


Urine contains many dissolved minerals and salts. When the urine has high levels of minerals and salts, hard stones can form. These stones can be "silent" or very painful.

Kidney stones come in many different types and colors. Stones in the kidney may not cause any symptoms and can go undiagnosed.

When a stone leaves the kidney, it travels to the bladder through the ureter. Often the stone can become lodged in the ureter. When the stone blocks the flow of urine out of the kidney, it can cause the kidney to swell (hydronephrosis), causing a lot of pain. 

How are Kidney Stones Diagnosed?

"Silent" kidney stones, those that cause no symptoms, are only found when an X-ray is taken during a health exam. Most people have their stones diagnosed when sudden pain occurs while the stone is passing.

If the location of your kidney stone(s) is complex, other imaging tests may be done. A urinalysis (urine test) is often part of the exam to learn if there is an infection.

How are Kidney Stones Treated?

Treatment depends on the type of stone you have, it's size, location, and how long you've had symptoms. There are different treatments to choose from. It helps to talk with your health care provider about which option is best for you.

Wait for the Stone to Pass by Itself

Often you can drink more water and simply wait for the stone to pass through your urine. Smaller stones are more likely than larger stones to pass on their own. You may need pain medication if you feel pain.

Medication

Certain medications have been shown to improve the chance that a stone will pass. The most common medication prescribed for this reason is Tamsulosin. Tamsulosin (Flomax) relaxes the ureter, making it easier for the stone to pass.

Surgery

Surgery may be needed to remove a stone from the ureter or kidney if:

  • The stone fails to pass.
  • The pain is too great to wait for the stone to pass.
  • The stone is affecting kidney function.

An imaging test is done before surgery to make sure the stone(s) hasn't moved or passed.

What Are The Different Types Of Surgeries Available To Remove A Stone?

Shock Wave Lithotripsy (SWL)

Shock Wave Lithotripsy (SWL) is used to treat stones in the kidney and ureter. Shock waves are focused on the stone using X-rays or ultrasound to pinpoint the stone.

Repeated firing of shock waves on the stone usually causes the stone to break into small pieces. These smaller pieces of stones pass out in the urine over a few weeks.

Ureteroscopy (URS)

Ureteroscopy (URS) is used to treat stones in the kidney and ureter. URS involves passing a very small telescope, called an ureteroscope, into the bladder, up the ureter and into the kidney. The ureteroscope lets the urologist see your stone without cutting you.

Once your urologist sees the stone with the ureteroscope, a small, basket like device grabs the smaller stones and removes them, if a stone is too large it can be broken into pieces.

Rigid telescopes are used for stones in the lower part of the ureter near the bladder. Flexible telescopes are used to treat stones in the upper ureter and kidney.

Percutaneous Nephrolithotomy (PCNL)

Percutaneous Nephrolithotomy (PCNL) is the best treatment for large stones in the kidney. General anesthesia is needed to do a PCNL. PCNL involves making a half-inch incision (cut) in the back or side, just large enough to allow a rigid telescope (nephroscope) to be passed into the hollow center part of the kidney where the stone is.

An instrument passed through the nephroscope breaks up the stone and suctions out the pieces. The ability to suction pieces makes PCNL the best treatment choice for large stones.

Other surgery

Open, laparoscopic or robotic surgery may be used if all other options don't work, but this is rarely done.