Managing Kidney Stones: Effective Treatments and Options for Relief

Kidney stones

Hello, Doctor! I would like to ask you a question.
I previously had a ureteral stone and underwent extracorporeal shock wave lithotripsy three times, which was ineffective.
Later, I had endoscopic laser treatment, but the stone moved to my kidney, and now the kidney stone has grown larger, approximately over 1 cm.
Will extracorporeal shock wave lithotripsy be effective again? If I do not undergo extracorporeal shock wave lithotripsy, will the stone pass on its own? Are there other methods to improve this situation?

Yin Yin, 50~59 year old female. Ask Date: 2013/04/23

Dr. Xu Weikai reply Urology

Hello, you may consider extracorporeal shock wave lithotripsy for stones larger than 1 cm, as they are difficult to pass.
Daily life recommendations: 1.
Drink plenty of water; aim for a daily urine output of over 1000 cc.
2.
Reduce salt intake; avoid sauces, consume less broth, limit hot pot, pickled foods, and processed products (such as sausages) which are high in salt.
Opt for a lighter diet.
3.
Avoid selective eating.
If you have further questions, feel free to ask for more discussion and research.
Online responses should only serve as a reference; if necessary, you should seek medical care at a healthcare facility.
This message is from Dr.
Hsu Wei-Kai, Chief of Urology, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2013/04/23

More Info

Managing kidney stones can be a complex process, especially when previous treatments have not been effective. In your case, where you have a history of ureteral stones and have undergone multiple extracorporeal shock wave lithotripsy (ESWL) sessions without success, it is crucial to consider various treatment options and their effectiveness.

Understanding Kidney Stones
Kidney stones are hard deposits made of minerals and salts that form inside your kidneys. They can vary in size and can cause significant pain, especially when they move through the urinary tract. The most common types of kidney stones include calcium oxalate, calcium phosphate, uric acid, struvite, and cystine stones. The treatment approach often depends on the size, type, and location of the stones, as well as the symptoms they cause.

Treatment Options
1. Extracorporeal Shock Wave Lithotripsy (ESWL): This non-invasive procedure uses sound waves to break up stones into smaller pieces that can be passed more easily. However, as you've experienced, ESWL may not always be effective, especially for larger stones or those that are hard and dense. The success rate decreases with stone size, and stones larger than 2 cm often require alternative treatments.

2. Ureteroscopy with Laser Lithotripsy: This method involves using a thin tube with a camera (ureteroscope) to locate the stone and then using a laser to break it into smaller pieces. This approach is often more effective for stones that have moved to the kidney after previous treatments, as it allows for direct access and removal of the stone fragments.

3. Percutaneous Nephrolithotomy (PCNL): For larger stones (typically over 2 cm), PCNL is often recommended. This minimally invasive surgery involves making a small incision in the back to remove the stone directly. It is effective for larger stones and can provide immediate relief.

4. Medical Management: In some cases, medications can help facilitate the passage of smaller stones. Alpha-blockers like tamsulosin can relax the muscles in the ureter, making it easier for stones to pass. However, this is generally more effective for smaller stones.

Will the Stone Pass on Its Own?
For a stone measuring around 1 cm, there is a possibility that it could pass on its own, especially if it is located in the kidney and not obstructing the urinary tract. However, the likelihood of spontaneous passage decreases as the size of the stone increases. If the stone is causing pain, obstruction, or infection, it is advisable to seek intervention rather than waiting for it to pass.

Recommendations for Improvement
1. Hydration: Increasing fluid intake is crucial. Aim for at least 2-3 liters of water per day to help dilute urine and reduce the concentration of stone-forming substances.

2. Dietary Modifications: Depending on the type of stone, dietary changes may be necessary. For example, reducing oxalate-rich foods (like spinach, nuts, and chocolate) can help with calcium oxalate stones. Increasing citrus intake (lemons and oranges) can help increase citrate levels in urine, which may prevent stone formation.

3. Follow-Up Imaging: Regular follow-up with imaging studies (like ultrasound or CT scans) can help monitor the size and location of the stone, guiding further treatment decisions.

4. Consultation with a Specialist: Given your history and the size of the stone, it may be beneficial to consult with a urologist who specializes in stone disease. They can provide tailored recommendations based on your specific situation and may suggest alternative treatments or interventions.

Conclusion
In summary, while ESWL may not be the best option for your current situation, other treatments like ureteroscopy or PCNL may be more effective. It is essential to have a thorough discussion with your urologist about the best course of action based on the size and location of your kidney stone, as well as your overall health. Additionally, maintaining hydration and making dietary adjustments can play a significant role in managing and preventing future stones.

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