The role of medicine and diet for kidney stone treatment is mainly for the prevention of future stones or to prevent the growth of existing stones. Prevention will be addressed below.
In rare instances, stones can be dissolved. This is only effective for a smaller, purely uric acid stone and requires frequent medication adjustments and at-home urine testing up to 4 times per day by the patient.
For 90% of stones, there is no proven way to dissolve them or to medically treat a stone that has already formed.
Treatment options for most patients: non invasive, minimally invasive, and surgical procedures for kidney stone treatment and kidney stone removal.
There are some options available to treat all urinary tract stones. Kidney stone size and location is an important factor in deciding which treatment is best for you:
1. Do Nothing : This is best saved for very small stones that could pass easily, or for very large asymptomatic stones in older patients. However, if the stone is causing pain, blockage or infections, it should be treated with some medications.
2. Lithotripsy (shock wave lithotripsy, SWL, ESWL): It is the easiest procedure. The patient lies on a table or in a tub and shock waves are focused on the stone. It is non-invasive, but if the stone is over 1 cm, you will likely need a cystoscopy and stent to help the pieces pass. Patients can go home the same day. Lithotripsy is only 60 - 85% effective for making your kidney or ureter stone free in a single treatment (depending on stone size and location) . The recurrence rate is quite high. 42% of patients will have another stone within two years, probably from small fragments left behind that grow into new stones.
3. Endoscopic treatment (ureteroscopy, with or without laser stone fragmentation): A urologist can look inside the bladder and all the way up to the kidney with a small scope and either remove the stone or break it up with a laser and remove the pieces. It is minimally invasive. There is no incision as the instruments go through the patient's existing "plumbing." Patients can go home the same day. In experienced hands, the stone free rate is 90-95% for stones in the ureter. The stone free rate is 80-90% for stones in the kidney depending on size and location.
4. Percutaneous Removal (Percutaneous Nephrolithotomy) : Very few urologists are proficient at this technique, which is why many urologists will not offer it as an option for their patients. PCNL is the treatment of choice for stones over 15 - 20 mm (1.5 to 2 cm). Associated Urologists of Orange County routinely uses this technique for patients with large stones or stones refractory to other procedures.
While it is minimally invasive, it requires a one inch incision in the back. A channel is made from the skin straight into the kidney. It is invasive, but still considered minimally-invasive. Patients typically spend one night in the hospital (two for older patients). The stone free rate is 90 - 95% for these very large stones that otherwise would require multiple procedures to completely clear.
5. Open surgery: It is extremely rare to need a large incision to remove a stone from the urinary tract.
The choice of treatment will depend on the size and location of the stone. In addition, the more invasive the procedure, the higher the success rate. (Associated Urologists of Orange County)
In rare instances, stones can be dissolved. This is only effective for a smaller, purely uric acid stone and requires frequent medication adjustments and at-home urine testing up to 4 times per day by the patient.
For 90% of stones, there is no proven way to dissolve them or to medically treat a stone that has already formed.
Treatment options for most patients: non invasive, minimally invasive, and surgical procedures for kidney stone treatment and kidney stone removal.
There are some options available to treat all urinary tract stones. Kidney stone size and location is an important factor in deciding which treatment is best for you:
1. Do Nothing : This is best saved for very small stones that could pass easily, or for very large asymptomatic stones in older patients. However, if the stone is causing pain, blockage or infections, it should be treated with some medications.
2. Lithotripsy (shock wave lithotripsy, SWL, ESWL): It is the easiest procedure. The patient lies on a table or in a tub and shock waves are focused on the stone. It is non-invasive, but if the stone is over 1 cm, you will likely need a cystoscopy and stent to help the pieces pass. Patients can go home the same day. Lithotripsy is only 60 - 85% effective for making your kidney or ureter stone free in a single treatment (depending on stone size and location) . The recurrence rate is quite high. 42% of patients will have another stone within two years, probably from small fragments left behind that grow into new stones.
3. Endoscopic treatment (ureteroscopy, with or without laser stone fragmentation): A urologist can look inside the bladder and all the way up to the kidney with a small scope and either remove the stone or break it up with a laser and remove the pieces. It is minimally invasive. There is no incision as the instruments go through the patient's existing "plumbing." Patients can go home the same day. In experienced hands, the stone free rate is 90-95% for stones in the ureter. The stone free rate is 80-90% for stones in the kidney depending on size and location.
4. Percutaneous Removal (Percutaneous Nephrolithotomy) : Very few urologists are proficient at this technique, which is why many urologists will not offer it as an option for their patients. PCNL is the treatment of choice for stones over 15 - 20 mm (1.5 to 2 cm). Associated Urologists of Orange County routinely uses this technique for patients with large stones or stones refractory to other procedures.
While it is minimally invasive, it requires a one inch incision in the back. A channel is made from the skin straight into the kidney. It is invasive, but still considered minimally-invasive. Patients typically spend one night in the hospital (two for older patients). The stone free rate is 90 - 95% for these very large stones that otherwise would require multiple procedures to completely clear.
5. Open surgery: It is extremely rare to need a large incision to remove a stone from the urinary tract.
The choice of treatment will depend on the size and location of the stone. In addition, the more invasive the procedure, the higher the success rate. (Associated Urologists of Orange County)
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