Is Surgery Needed For Kidney Stones

Can You Remove Kidney Stones Without Surgery

Kidney Stone Treatments

Once your doctor determines that you actually do have a kidney stone, youll discuss the various methods to help it pass as quickly as possible. While you will experience discomfort during the process, its possible and extremely common to pass a kidney stone on your own within 48 hours. If its not too painful, your doctor may suggest that you wait it out and do the following things to help pass the kidney stone at home:

Adding 2 tablespoons of apple cider vinegar to a glass of water can help dissolve kidney stones. Additionally, its known to help ease the pain.
Pomegranate juice is not only delicious but it also improves kidney function by flushing stones and toxins from your system.
Kidney bean broth is known to dissolve kidney stones. Just cook the beans, strain the liquid and drink it throughout your day.
Dandelion root juice stimulates your bodys production of bile which helps eliminate waste, increase urine output, and improve digestion.
Drinking 2 to 8 ounces of wheatgrass juice increases your need to urinate which helps to pass kidney stones. Wheatgrass is packed with many nutrients that help cleanse your kidneys.
Do NOT drink any alcohol until your stone passes.

If youre able to successfully pass a kidney stone on your own, you may want to save it to take to your doctor for testing. You can do this by using a strainer every time you urinate until it passes. Delivering your stone for further testing can help him develop a prevention plan for the future.

How Do I Know If My Kidney Stone Requires Surgery

Kidney stones often pass on their own without any medical intervention. However, surgery may become necessary to break up or remove some stones. Those reasons include when the stone:

Is too large to pass on its own
Has become stuck in the ureter tube after moving through the urinary tract
Blocks the flow of urine
Results in one or more urinary tract infections
Causes unbearable pain that needs to be alleviated

In these situations, surgery will help the stone pass and relieve the pain.

Overview Of Kidney Stones Surgical Treatment

There are four types of kidney stones surgical treatments that may be done if you are experiencing kidney stones. Kidney stones are typically hard deposits that are made of calcium and are found in the kidneys. In some cases, kidney stones are too large to be passed without surgery. To decide which procedure will be right for you, then you will need to schedule a consultation with our physicians.

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Surgery For Kidney Stones

Although most kidney stones pass on their own, your doctor may decide that surgery is the best treatment if you have stones lodged in the ureters, the tubes that carry urine from the kidneys to the bladder large or particularly painful kidney stones stones causing an obstruction of urine flow or stones resulting in bleeding or infection.

At NYU Langone, our doctors also frequently treat people with more advanced kidney stone conditions, such as staghorn stones, which are large and can be caused by infection, and bilateral stones, which develop simultaneously in both kidneys or in the ureters.

Our surgeons perform hundreds of kidney stone surgeries each year, many of which involve minimally invasive techniques that do not require a hospital stay. In fact, traditional or open surgery, as it is commonly known, is now rarely performed at NYU Langone for the treatment of kidney stones.

The goal in any kidney stone surgery is to treat all stones at once. However, some people with kidney stones require a staged treatment approach in which more than one surgery is needed to reduce or clear the stones.

Kidney Stones Are The Most Treated Condition By Urologists

Men and women both get kidney stones, and sometimes require medical or surgical treatment.

Children with kidney stones often get a comprehensive workup.

Because kidney stone formers often have stones again, urologists often recommend different workups to see if a medication may be right to keep stones from forming again in the future.

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Medical Treatment To Prevent Stones

Factors which increase the risk of stones include:

Gender: Men are more likely than women to form kidney stones, although the rate is increasing faster in women and soon men and women might have equal risk of kidney stone formation
Family history: If you have family members with stones, you have a higher risk of developing kidney stones
Diet: Diets high in fat, processed sugar, and salt place people at risk of forming kidney stones
Weight: Obesity is strongly associated with kidney stones
Personal history: If you formed your first stone when you were young, or if you have already formed more than one stone, you are at greater risk of having more stones

The cornerstone of medical treatment to prevent stones is increasing fluid intake. It is recommended that you drink enough fluid to produce 2 liters of urine each day. That is the equivalent to the amount of fluid in a 2 liter soda bottle. Its important that you spread this out over the entire day rather than drinking the whole amount at one time. It is recommended that you include a glass of water just before bedtime. The goal is to make sure your urine has the appearance of water. If the urine is yellow then you probably arent drinking enough.

There Are Several Possible Options That May Be Recommended For Kidney Stones

Evidence of kidney stones has been found in ancient Egyptian mummies. Even today, the accumulation of mineral deposits that stick together in urine results in about 3 million visits to urologists and other doctors in the United States each year.

Kidney stones, which can range in size from grains of sand to golf balls, sometimes naturally pass through with nothing more than temporary discomfort.
It’s when these stones remain in place that treatment becomes necessary.

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Treatment For Kidney Stones

Kidney stones dont always require surgery. Well work closely with you to minimize their impact and educate you about preventative options. Small, pain-free kidney stones may be passed naturally with help from dietary changes, medication, and guidance from your urologist. Larger, complex kidney stones may require more advanced intervention and an overnight hospital stay.

Will I Be Hospitalized For This Procedure

Observation: Non-surgical Approach to Kidney Stones

Yes. This requires general anesthesia. You will need a short hospitalization. You may be off work for a week or so. Depending on the position of the stone, the procedure is completed in 20 to 45 minutes. The goal is to take out all of the stones so that none are left to pass through the urinary tract.

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How Successful Is Shock Wave Lithotripsy

ln those patients who are thought to be good candidates for this treatment, some 50-75% are found to be free of stones within three months of SWL treatment. The highest success rates seem to be in those patients with smaller stones .

After treatment, some patients may still have stone fragments that are too large to be passed. These can be treated again if necessary with shock waves or with another treatment.

Do You Need Surgery To Remove Kidney Stones

A kidney stone is a hard mineral material that forms in either your kidney or urinary tract. Some kidney stones form because of a kidney infection, others because your body is producing too much of a certain mineral or because your body is experiencing a decrease in urine volume. The size of kidney stones can differ, ranging from a fraction of an inch to several inches. In extreme cases, kidney stones can become as large as the size of your entire kidney. The treatment options to remove kidney stones can vary, depending on their size.

Anyone can develop kidney stones, but there are some variables that cause them to develop in some individuals more than others. Age is one factor. In fact, most kidney stones develop in people between the ages of 20 to 49 years old and, once youve had your first stone, its more likely that additional ones will form. 40% of the people who get kidney stones have relatives who have them, too.Kidney stones are most common in men, people who are obese, and those that live with diabetes.

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Ureteroscopy And Laser Lithotripsy

Along with SWL, ureteroscopy is a preferred method for the treatment of small-to-medium sized kidney stones located in any part of the urinary tract. Washington University was one of the first centers in the world to offer ureteroscopic stone treatment. Our highly skilled endourologists are available to offer advanced ureteroscopic stone management.

Ureteroscopy and laser lithotripsy are typically performed as a same-day procedure with the patient under general anesthesia. During the procedure, the urologist passes a small scope through the urinary opening into the bladder and from there up into the ureter, the small tube that drains urine from the kidney to the bladder. Once the stones are located, they are targeted with a laser that breaks the stone into smaller pieces, which are then extracted, or into tiny pieces of dust that wash out of the kidney with normal urine flow.

Often, a small tube, called a stent, will be placed temporarily to help the kidney drain after the operation. The stent is completely internal, and is generally removed after 3-10 days. Removal is performed quickly and easily in the office without the need for anesthesia.

Although slightly more invasive than SWL, ureteroscopy may be the preferred option if you have certain types of hard stones that dont respond to SWL, or a stone that is not visible on X-ray. In addition, ureteroscopy is often preferable to SWL for stones that are low in the urinary tract, in the region approaching the bladder.

Medical Support To Help The Stone Pass

Kidney Stone Removal With Stent Placement

Since most urinary stones are small enough to pass without the need for surgery, with medical support most patients can pass their stone.

Hydration with water and other fluids is important to move the stone down the ureter and out of the urinary tract. If nausea or vomiting are preventing hydration then you need to contact your doctor.

Pain medication may be needed to help control periods of renal colic. If oral pain medication cannot keep pain under control, then further medical attention is needed.

Certain medications have been shown to improve the chance that a stone will pass. The most common medication prescribed for this reason is Flomax . Tamsulosin has been shown to improve the chance that the stone will pass.

If you develop fever while trying to pass a stone, you need immediate medical evaluation.

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Why Do Kidney Stones Hurt

Kidney stones may be formed, and then pass into the tube that connects the kidney to the bladder called the ureter. The ureter tries to push urine passed the stone, and if it cannot the urine may back up into the kidney. The kidney does not like to be stretched, and receptors in the kidney fire pain signals to your brain. Although the stones seem sharp, its actually the blockage of flow of urine that causes the pain that is seen with kidney stones

Purpose Of Kidney Stone Surgery

The purpose of kidney stone surgery is to remove a stone in order to reduce symptoms and/or reverse a medical condition associated with the presence of the stone .

Specific indications for kidney stone surgery include:

Ureteral stones greater than 10 mm
Uncomplicated distal ureteral stones less than 10 mm that have not passed after four to six weeks of observation
Symptomatic kidney stones without any other explanation for the patient’s pain
Ureteral or kidney stones in pregnant women that have not passed after an observation period
Persistent kidney obstruction related to stones
Recurrent urinary tract infections linked to stones

Aside from the above indications, emergency surgery to remove a kidney stone may be warranted in the following cases:

If the flow of urine from both kidneys is blocked and there is acute kidney injury
If a patient has acute kidney injury from an obstructing stone and only one functioning kidney
If a patient has an obstructing stone and a urinary tract infection

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Types Of Kidney Stones

The most common stone composition is calcium oxalate. These stone can also have a small percentage of calcium phosphate.
Patients with recurrent urinary tract infections may have stones made of magnesium ammonium phosphate . The bacteria in the urine cause the urine pH to become basic and this causes the stone salts to precipitate out rapidly and these stones can become large and fill the kidney .
Less common stone composition includes uric acid stones in about 8 to 10 percent of patients and even less common are stones composed of cystine. This is an amino acid one of the building blocks of proteins and they tend to develop in children around the onset of puberty.

Treating Small Kidney Stones

Treating kidney stones without surgery

Small kidney stones may cause pain until you pass them, which usually takes 1 or 2 days.

A GP may recommend a non-steroidal anti-inflammatory drug to help with pain.

To ease your symptoms, a GP might also recommend:

drinking plenty of fluids throughout the day
anti-sickness medicine

You might be advised to drink up to 3 litres of fluid throughout the day, every day, until the stones have cleared.

To help your stones pass:

drink water, but drinks like tea and coffee also count
add fresh lemon juice to your water
avoid fizzy drinks
do not eat too much salt

Make sure you’re drinking enough fluid. If your pee is dark, it means you’re not drinking enough. Your pee should be pale in colour.

You may be advised to continue drinking this much fluid to prevent new stones forming.

If your kidney stones are causing severe pain, your GP may send you to hospital for tests and treatment.

Urine Collection And Analysis

After an initial appointment, you will use a urine collection kit to capture your urine over a 24-hour period. The kit can be returned to a lab using pre-paid postage. Results help your urologist determine the cause of your kidney stones. The most common treatment recommendation is often dietary changes. Your provider may also recommend medications or procedures to help prevent future occurrences.

What To Think About

During recovery at home, if you have:

Nausea or vomiting.
Signs of infection, such as swelling or redness around the incision.

The use of extracorporeal shock wave lithotripsy , percutaneous nephrolithotripsy, and ureteroscopy to remove kidney stones has nearly eliminated the need for open surgery to remove stones.

The recovery time following open surgery is much longer than the recovery time for the treatments listed above.

Frequently Asked Questions About Shockwave Lithotripsy

Where are your SWL services available?

We offer SWL services at our Barnes-Jewish Hospital and Barnes-Jewish West County Hospital locations

Why should I choose SWL?

SWL is an outpatient procedure, and one of the preferred treatments for small- to medium-sized stones. It is considered a safe and effective procedure with an excellent track record. As it is an outpatient procedure, you will be home just a few hours after the procedure. Recovery is generally very rapid.

Does SWL have any limitations?

As with any technology, there are limitations. Certain types of stones are very hard and resistant to breakage with shockwaves. Other, less common stones are invisible on X-ray, which means that they cannot be targeted for treatment. Therefore, if you have a history of cystine, monohydrate or uric acid stones, SWL may not be the best treatment for you.

Also, very large stones or stones that have traveled into the lower part of the urinary tract may be better treated by other methods. There are also some patient factors, including other medical conditions, which may affect your suitability for SWL. For instance, patients who are on blood-thinning medications or who may be pregnant should not undergo SWL procedures.

Is SWL associated with any side effects?

How can I make an appointment to discuss SWL with a Washington University urologist?

Please call 362-8200 to schedule an appointment at any of our clinic locations.

Why You Get Stones

Part of preventing stones is finding out why you get them. Your health care provider will perform tests to find out what is causing this. After finding out why you get stones, your health care provider will give you tips to help stop them from coming back.

Some of the tests he or she may do are listed below.

Medical and Dietary History

Your health care provider will ask questions about your personal and family medical history. He or she may ask if:

Have you had more than one stone before?
Has anyone in your family had stones?
Do you have a medical condition that may increase your chance of having stones, like frequent diarrhea, gout or diabetes?

Knowing your eating habits is also helpful. You may be eating foods that are known to raise the risk of stones. You may also be eating too few foods that protect against stones or not drinking enough fluids.

Understanding your medical, family and dietary history helps your health care provider find out how likely you are to form more stones.

Blood and Urine Tests

Imaging Tests

When a health care provider sees you for the first time and you have had stones before, he or she may want to see recent X-rays or order a new X-ray. They will do this to see if there are any stones in your urinary tract. Imaging tests may be repeated over time to check for stone growth. You may also need this test if you are having pain, hematuria or recurrent infections.

Stone Analysis

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