There are several ways to treat kidney stones

Kidney stone (also known as nephrolithiasis) is one of the most painful urologic diseases. It is the migration of stone that forms at the level of the kidney through the different structures of the urinary system (the uretere, urinary bladder and urethra). 

Kidney stone disease was described by ancient civilizations (Mesopotamia, India, China, Persia, Greece and Rome). It was discovered in the pelvis of an Egyptian mummy (dated to 4800 BCE). Among the famous leaders that suffered from this disease were Napoleon Bonaparte, Napoleon III, Peter the Great, Louis XIV, George IV and former U.S. President Lyndon B. Johnson. 

Clinically, during the process of migration, the stone can cause severe pain that typically starts in the flank. As the stone progresses, the pain starts to localize to the groin and the genital area, causing blood in the urine, nausea and vomiting. In most cases, the stone continues its migration and is eliminated in the urine. Many stones are formed and passed without causing symptoms. In a small percentage of patients, the stone is big in size and will block the uretere causing blockage of the urine flow compromising the kidney’s function and increasing the risk of infection of the kidney

TYPES OF STONES
 
There are several types of kidney stones which are categorized by the type of crystal forming the stone. The most common stones contain calcium oxalate, which can be formed without any predefined risk factors. The calcium phosphate is mainly common for patients with genetic or acquired defect in excretion of acidic materials in the urine. 

Struvite stones are exclusively present in patients with recurrent urinary tract infections. Cystine stones result from an inherited condition that causes an increase in the amount of cystine (an amino acid) in the urine. Uric acid stones form only in acidic urine and cannot typically be seen by X-ray imaging. 

TREATMENT
 
The treatment includes two parts: The acute management of the stone and the prevention of recurrence. The management during the acute kidney stone crisis is conservative and consists mainly of hydration (usually oral hydration is enough unless the patient has continuous vomiting) and pain medication (NSAIDs and/or opioids). 

The need for immediate evaluation by a urologist is warranted if the patient has a fever, is not producing urine or has acute renal failure. Intervention is indicated urgently in these cases to remove the stone which is blocking the urine flow. 

Patients are instructed to strain the urine in order to collect the stone and bring it to the lab for analysis. The stone size will determine the likelihood of passage. Most stones that are 4 millimeters (mm) in diameter pass spontaneously. Stones that are 10 mm in diameter are unlikely to pass. 

To facilitate stone passage several medications can be used. The most common medication is tamsulosin. For large stones, patients are referred for nonurgent urology evaluation. Current therapy options for stones that fail to pass include: 

*Shock wave lithotripsy, in which a doctor uses a machine to send shock waves directly to the kidney stone and break it into smaller stones that can pass in the urine. 

*Ureteroscopic lithotripsy with electrohydraulic or laser probes, which utilizes specialized probes to remove or fragment the stone. 

*Percutaneous nephrolithotomy, also known as tunnel surgery, in which a doctor makes a small cut into the patient’s back and makes a narrow tunnel through the skin to the stone inside the kidney. Using a special instrument that goes through the tunnel, the doctor can find the stone and remove it. 

*Laparoscopic stone removal, which uses small scopes inserted through the skin to remove the stone. 

Open surgical stone removal is rarely needed. The choice of therapy depends again on the size of the stone and the composition. 

PREVENTION 
    
Preventing a recurrence of kidney stones depends on the type of stones, but here are some general measures applicable for all types of kidney stones. 

*Increase fluid intake. Patients should increase their fluid intake to produce at least two liters of urine per day. However, be careful about the choice of fluid. Grapefruit juice may be associated with an increased risk of stones. Patients should avoid cranberry juice and calorie-containing beverages. Coffee, tea and alcohol have a lower risk of causing stones. 

*Reduce animal protein intake. 

*Increase fruit and vegetable intake (high in citrate an inhibitor of stone formation). 

*Limit dietary oxalate intake, such as spinach, rhubarb, peanuts, cashews and almonds. 

*Limit salt, sucrose, fructose, high dose vitamin C intake. 

*Weight control may be helpful in preventing stone recurrence. 

*Drug therapy is indicated if the stones are recurrent. Therapy is dependant on the type of stone. 
    

TREATMENT OF YOUR KIDNEY STONES

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)