What are your treatment options?
Kidney stones:
If you’ve been diagnosed with kidney stones (urolithiasis), you may have several options for treatment. These include medical therapy, extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotripsy (PCNL), and ureteroscopy.
kidneys (two organs that filter waste and extra water from the blood) ureters (two tubes bringing urine from each kidney to the bladder) bladder (organ that collects urine) urethra (a single tube through which urine in the bladder passes out of the body).
The evaluation for kidney stones
If your symptoms suggest kidney stones, imaging is often the first step in an evaluation. For many years the standard of care was a type of abdominal x-ray called an intravenous pyelogram (IVP). In most medical centers, this has been replaced by a type of computed tomography (CT) called unenhanced helical CT scanning. In some cases, such as when a person has impaired renal function or a contrast dye allergy, renal ultrasound may be used as an alternative.
You will also have blood tests, including tests for renal function (creatinine, BUN). Your doctor may suggest other blood tests as well. A urinalysis will be obtained and if infection is suspected, a urine culture will be sent.
Keeping kidney stone pain under control
If you are experiencing the intense discomfort of kidney stones (renal colic), pain control is a top priority. A 2018 analysis of multiple randomized trials looked at different pain relief medicines given to people treated in the emergency department for acute renal colic. It compared nonsteroidal anti-inflammatory drugs (NSAIDS, such as aspirin, ibuprofen, or naproxen) with paracetamol (similar to acetaminophen) or opioids. The study found NSAIDS offered effective pain relief with fewer side effects than paracetamol or opioids. NSAIDS directly inhibit the synthesis of prostaglandins, which decreases activation of pain receptors and reduces renal blood flow and ureteral contractions.
Medical therapy for kidney stones
Most evidence suggests that stones less than 10 mm in diameter have a reasonable chance of passing through the urinary tract spontaneously. You may be offered medical expulsive therapy (MET) using an alpha blocker medication, such as tamsulosin. It’s important to understand that this is an off-label use of the drug.
Extracorporeal shock wave lithotripsy
All shock wave lithotripsy machines deliver shock waves through the skin to the stone in the kidney. Most but not all of the energy from the shock wave is delivered to the stone.