Kidney stones: Treatment
About four out of five kidney stones are excreted by themselves in the urine. In many cases, treatment without active removal (Non-invasive) of the stone is therefore successful. You will probably want to know what are the most drastic and least invasive or intrusive measures to treat this health problem. Even after renal colic, the doctor can try various methods to support the spontaneous stone removal.
So-called conservative treatment includes in particular intensive pain relief, local heat (full baths, hot-water bottles or pillows, warm and moist compresses) and physical exercise (e.g. climbing stairs, jumping). Patients should also drink more. The effect of the measures must be monitored by regular ultrasound and/or X-ray examinations to document movements of the stone and to detect possible urinary retention in time.
If colics or infections occur during these examinations, the conservative therapy must be discontinued and the stone actively removed. A conservative treatment is also not promising if
the diameter of the stones exceeds eight millimetres.
severe colic cannot be controlled even by medication.
urinary retention occurs.
a febrile urinary tract infection occurs.
Active stone removal
Kidney stones can nowadays be removed using various methods:
Stone fragmentation by shock waves (extracorporeal shock wave lithotripsy)
Shock waves are mechanical pressure waves. They enable the removal of kidney stones without surgical intervention. The stone is crushed and the debris is eliminated naturally. The waves spread from the surface of the skin to the inside of the body and become increasingly bundled and focused on the kidney stone. This way they only unfold their effect in a small area and have only minor side effects.
The method can be applied throughout the entire urinary tract. It is painless and successful in almost 80% of cases. However, the treatment reaches its limits if the stones cannot be localised or are very large (> two centimetres). Since the shock waves always damage kidney tissue, patients excrete blood in their urine after treatment (haematuria). In every third patient colics can occur after the stone fragmentation, which are caused by the stone fragments leaving the body.
Minimally invasive stone treatment
The minimally invasive removal of kidney stones includes various methods: so-called percutaneous (reaching through the skin), endoscopic (looking in through natural body orifices) and laparoscopic (introduced via the abdominal cavity) techniques. In the percutaneous method, the doctor surgically creates an access channel to the kidney through the skin below the ribs. Through this channel he can bring working instruments to the stone, watch the destruction of the stone on a monitor and suck out the debris. This method is mainly used when large stones have to be removed or when shock wave therapy has been unsuccessful.
Endoscopic stone removal by means of a bladder or ureteroscopy has the advantage that the natural orifices of the urethra and ureter can be used as access routes to the stone. Today, modern endoscopes allow stone removal from the bladder, ureter and renal pelvis. A particular advantage of this procedure is that no incision is necessary and the patient can therefore be discharged from hospital quickly. This procedure cannot be used for very large stones either.
The laparoscopic procedure (“keyhole technique”) is used when neither shock waves nor endoscopic stone removal seem to be successful. The surgeon inserts the instruments through the abdominal cavity to the operating area. After this procedure, only small puncture marks remain.
Surgical stone removal
Due to the various new procedures, a kidney stone only rarely needs to be removed surgically, i.e. by open surgery. It is only used in 5% of cases. For example, very large stones, which for example completely fill the renal cavity system, can only be removed by open surgery.