Advanced Treatments to Break Up or Remove Kidney Stones
This is part 2 in a 2-part series about kidney stones. Part 1 laid out their causes and symptoms, along with who is at risk for a stone and how to avoid getting them.
There are uncomplicated, “garden-variety” kidney stones, and there are stones considered more complex. A variety of treatments are available to deal with them, depending on their size, location, composition and symptoms.
In what follows, Dr. Luay Alshara, an associate professor of urology and an associate attending urologist at Weill Cornell Medicine, explains the treatment options for all types of stones—treatments ranging from pain management to hydration, medication and minimally invasive procedures to break them into fragments or remove them altogether.
Treatments for uncomplicated kidney stones
“Small stones—those less than 5 mm—can be treated conservatively,” he says. “Small, asymptomatic stones in the kidney can be monitored with imaging. Other small stones that are causing pain, mainly as they pass down the ureter to the bladder, require a combination of hydration, pain management and medication to make it easier for the stone to pass.”
Most small stones will pass by themselves in days or weeks. But larger stones, or those that cause severe symptoms, will require the intervention of an endourologist like Dr. Alshara, who specializes in minimally invasive procedures using small instruments and advanced imaging techniques.
The procedures offered at Weill Cornell Medicine for the management of uncomplicated stones include the following:
- Extracorporeal shock wave lithotripsy (ESWL) uses ultrasonic shock waves to break the stone into smaller pieces that can pass more easily.
- Ureteroscopy (URS) employs a thin scope that’s inserted through the urethra and bladder to visualize the stone, break it up with laser energy and remove its fragments.
- Percutaneous nephrolithotomy (PCNL), a surgical procedure used to treat larger stones (those greater than 2 cm), involves making a small keyhole incision in the patient’s back to access the kidney and remove the stone.
“Under some emergency conditions, when the stone has caused a kidney blockage with infection or severe pain, we place a stent in the ureter to relieve the obstruction,” he adds.
Treatments for pain
Over-the-counter medications such as ibuprofen (Motrin, Advil), naproxen (Aleve) and acetaminophen (Tylenol) are the first line of defense against pain, Dr. Alshara says. “However, your pain may require stronger, prescribed painkillers and muscle relaxants to help ease the passage of a stone.
“We also encourage patients to drink plenty of water to help flush out the urinary system,” he continues. “That may help the stone to pass more quickly. A heating pad can also be applied to the affected side to relax the muscles and relieve pain.”
If your pain is persistent and severe, seek emergency care, he advises.
What are complex kidney stones?
These are stones that are challenging to treat due to their large size, location, composition, number or anatomy, with associated complications.
Large size
Location
Composition
Anatomical abnormalities (e.g., strictures or fused/twisted kidneys)
Complications
Treatments for complex kidney stones
There are 4 ways to treat complex stones. Two of these, PCNL and URS, are also used to treat uncomplicated stones as described above.
- PCNL is appropriate for treating large stones (greater than 2 cm) or those that fill the kidney’s collecting system. To fragment the stone, PCNL is often combined with lithotripsy (laser or ultrasonic energy).
- URS with laser lithotripsy is best for smaller, complex stones in the ureter or kidney. These procedures can also be used for larger, complex stones when other surgeries can’t be done. URS is combined with the laser treatment to break the stone into smaller pieces, which are either removed or dusted into “sand” that can easily pass.
- Endoscopic Combined Intra-Renal Surgery (ECIRS)—a combination of PCNL plus URS—is used to treat very large or complex stones, allowing the surgeon to access the kidney via a small skin incision in the back and from below through the bladder up to the kidney.
- Robotic surgery is reserved for extremely large or complex stones that can’t be treated with PCNL or URS, or when another urological condition—a congenital obstruction of the kidney, for example—needs to be treated at the same time.