Kidney stones are hard deposits of minerals that form in the kidneys. These stones can cause pain, nausea, and an array of other symptoms if they are left untreated. The physicians at Affiliated Urologists specialize in a number of therapies for kidney stones.
Dissolution Therapies
Dissolution therapy is an effective treatment option for patients who have kidney stones caused by high levels of uric acid. This chemical is not usually visible on standard X-rays, so diagnosing and treating kidney stones of this caliber can be somewhat difficult during an initial evaluation. Nevertheless, when these kidney stones are accurately diagnosed, a urologist may recommend a type of dissolution therapy before considering minimally invasive surgery. It is important for patients to receive treatment for these kidney stones as soon as possible because high levels of uric acid in the blood can lead to the formation of gout, a painful disease that causes uric acid to crystallize and deposit in the joints.
There are three ways patients can dissolve their kidney stones over several weeks or months. Depending on their size and location, a urologist may first recommend increasing fluid intake. Drinking plenty of water will help allow more uric acid to dissolve in the urine, making it easier for these stones to pass. Lowering blood uric acid levels with the help of a medication called Allopurinol can also help dissolve kidney stones. Lastly, using urine alkalinizing agents such as Ural or Citravescent can help dissolve uric acid in the urine.
Shockwave Lithotripsy (ESWL)
Shockwave lithotripsy uses high-intensity sound waves to treat kidney stones from outside the body. This very common procedure is highly effective and does not involve any surgical intervention. The goal of this non-invasive procedure is to break down kidney stones in order to make them easier for patients to pass. Candidates for this procedure include those who have kidney stones that are too large to pass and are at risk of infection. The stones must be visible on an X-ray device. Patients should not undergo this procedure if they are pregnant, obese, or have continuous issues with the kidneys. This procedure may be suitable for very large kidney stones, but it is most effective on smaller kidney stones.
This procedure typically involves local or general anesthesia, even though no incisions are made. Because of this, patients may be asked not to eat food the night before and morning of the procedure. Patients should arrive at the hospital with any and all imaging tests. Patients may be asked to give a urine test before the procedure begins. Once the patient is under anesthesia, they are positioned according to the physician’s preference. X-ray machines and a water-filled cushion may be used to help the physician during the procedure. After the X-ray has located the stones, the sound waves are directed at the kidney and transmitted at a high frequency. The waves are able to get through the tissue and into the kidney to break up the stones. Overall, this procedure can take anywhere from 30 minutes to an hour depending on the position, location, and size of the kidney stones. When the procedure is over, patients are taken to a recovery room to be monitored as they awake from the anesthesia.
Because this is an outpatient procedure, patients can leave the hospital the same day after a brief monitoring period. Once patients arrive home, they should rest for a day or two at home and limit physical activity. Patients may notice blood in their urine and experience abdominal pain as the stones pass. Pain medication may help ease symptoms, but the best thing a patient can do is drink plenty of water to help the stone fragments pass. There is a possibility that the stones may still be too large to pass. If this is the case, shockwave lithotripsy can be repeated or other kidney stone treatments can be discussed with an Affiliated Urologists physician.
Percutaneous Surgery
Percutaneous surgery, also referred to as percutaneous nephrolithotomy, is a minimally invasive procedure that removes kidney stones. This treatment is typically reserved for patients who are not candidates for more conservative or non-invasive therapies. Most often, percutaneous surgery is performed on patients with kidney stones over two centimeters in diameter.
On the day of surgery, x-ray images may be taken to identify the exact location of the kidney stones. When the patient is ready, they are given general anesthesia and positioned on their stomach with their back exposed. A small incision is made in the upper back above the kidneys. A small instrument is inserted through the opening so the surgeon can get a clear view inside of the affected kidney. If necessary, the surgeon can use another instrument to break up the stone if it is too large. The stones are then removed, and any remaining particles are suctioned out. A drainage tube may be used during the procedure to remove excess fluid in the kidney. Finally, the incision is closed and the patient is taken to the recovery room where he or she will awaken from the anesthesia.
Because this is a minimally invasive surgery, patients may experience less pain and bleeding, as well as fewer days in the hospital. The hospital staff may administer antibiotic medication and pain relievers to reduce the risk of post-operative infection and pain. Any catheters placed during the surgery may be removed at the hospital, but the drainage tube may need to stay in place for about a week after surgery. It’s normal to experience blood in the urine. This side effect may subside after the first couple of days. After arriving home, patients should rest and avoid physical activity, but move around to minimize the risk of a blood clot. Pain medication can be taken if the patient is uncomfortable. When cleaning the incision, patients should shower, not bathe, and pat the area dry. It is important to always keep the incision site clean to avoid infection. If an infection is suspected, call Affiliated Urologists immediately.
Ureteroscopy
Kidney stones can travel through the urinary tract and into the ureter, which is located between the kidneys and bladder. These stones are called "ureteral" stones. Ureteroscopy is a minimally invasive procedure that removes ureteral stones from the affected ureter. This procedure can be effective in removing any size stone, but it is often ideal for ureteral stones that are too large for non-invasive treatments like shockwave lithotripsy or dissolution therapy. This procedure does not actually require any incisions, and it is performed solely through the urethra.
For this procedure, patients are given either a spinal epidural to numb the lower half of the body or general anesthesia. Patients should prepare for the anesthesia by avoiding food and non-clear beverages the night and morning before arriving at the hospital. An Affiliated Urologists physician will meet with the patient beforehand to answer any questions they may have about the procedure.
At the hospital, patients may be asked to give a urine sample or simply empty their bladder before the procedure begins. After the patient is given the preferred method of anesthesia, he or she is positioned appropriately. The urethral opening is then cleansed and sterilized. Shortly thereafter, an ureteroscope is inserted into the urethra. The ureteroscope is a long, tube-like device that allows the physician to see the stone without having to make an incision.
After the ureteroscope passes through the bladder and into the ureter, the stone can be identified. Depending on the size of the stone and the physician’s preference, the stone may be treated with shockwave lithotripsy or another procedure. This way, the kidney stone can be broken up and passed normally. More commonly, ureteroscopy is used to remove the stone in one procedure. Once the ureteroscope reaches the stone, the physician releases a basket on the end of the device and captures the stone. Sometimes, if the stone is too large, another tool, typically a laser, may be used to break up the stone before the basket collects the smaller pieces. It is a relatively short procedure compared to some of the other kidney stone treatments available to patients.
Ureteroscopy is an outpatient procedure, meaning, patients can return home the same day. In some cases, patients may be asked to stay a day or two in the hospital. In either case, patients should arrange for a caregiver to drive them home. At home, patients may feel a burning sensation when they urinate and notice a small amount of blood in their urine. This is a short-term side effect that should subside within a few days. While unlikely, patients may develop complications such as a fever or a sharp increase in pain. If this is the case, patients should call Affiliated Urologists immediately. Patients may be given antibiotics to lower their risk of infection and avoid painful side effects. Patients should drink plenty of water and take pain medication to relieve any discomfort as needed.
