Effective Kidney Stone Treatments: From Medication to Surgery

Kidney stones can quietly form in the urinary tract without any immediate signs or symptoms.  About 1 in 100 hospital emergencies are due to severe kidney stone pain and it has become a global health issue! Kidney stones affect nearly 12% of the worldwide population, and in India, approximately 15% of people in the northern regions are affected.

There is an interesting fact that came from studies related to kidney stones worldwide: one in every adult is suffering from it, and the risk is high in 11% of men and 9% of women. These tiny deposits slowly start hampering your life, your daily routine, and your concentration on your work. If these stones are left untreated, they can gradually go through severe pain, infection, and other complications like impaired or disrupted functioning of the kidney. This is why you need effective treatment options for kidney stones, whether via medication or surgery.

Before we begin to talk about the treatment options & process, it’s important to understand the real cause or symptoms behind pain or discomfort.

TABLE OF CONTENTS

• What are kidney stones, and what are the causes of their formation?
• What are the symptoms you have to go through?
• What type of treatment do you need for kidney stones?
• Conclusion 

What are kidney stones, and what are the causes of their formation?

Kidney stones, also medically known as nephrolithiasis or urolithiasis, are hard deposits made of minerals & salts that form inside the kidneys. These can be diagnosed in various kinds or sizes, including different types like calcium-based, oxalate-based, or cholesterol-based stones. Depending on their composition and size, kidney stones either pass naturally or medical intervention is required.

The size of a kidney stone can range from as small as a grain of sand to as large as a golf ball. The stones can only pass through the urinary system if they are much smaller than 4 mm. This means if it’s a size ranging between 3 to 4 mm or less, it generally doesn’t need any medical intervention. However, some stones greater than 5 mm can impair the urinary flow, eventually leading to straining pain and bleeding in the urine. It may also affect kidney function or cause an infection, which is very commonly noticed as pyelonephritis, chronic kidney disease, hydronephrosis, etc. Prompt diagnosis and intervention are crucial in preventing these risks.  

To prevent kidney stone formation, it's essential to understand the underlying causes that lead to their development. There is no single cause of kidney stones. Instead, multiple factors play their roles:- 

• Dehydration: Not drinking enough water or losing water through sweat can lead to kidney stones. 
• Diet: Eating too much salt, sugar, or protein or not enough calcium can contribute to kidney stones. 
• Medications: Some medications used to treat cancer, kidney disease, or HIV can increase the risk of kidney stones. 
• Obesity: People with a body mass index (BMI) of 30 or higher are almost twice as likely to get kidney stones. 
• Exercise: Too much or too little exercise can contribute to kidney stones. 
• Family history: Kidney stones can run in families. 
• Infections: Repeated urinary tract infections can increase the risk of kidney stones. 
• Metabolic conditions: Some metabolic conditions, like renal tubular acidosis, can cause kidney stones. 

It is essential to achieve a harmonious balance between promoting kidney health and prohibiting factors that lead to kidney stones.

What are the symptoms of kidney stones you might be going through?

Once you have a stone as large as 5 mm or more in your kidney, chances are it gets lodged and produces symptoms that feel like: 

• Sharp, intense pain in the lower back or side, often radiating to the abdomen or groin.
• A burning sensation or discomfort while urinating
• Presence of blood in the urine, which may appear pink, red, or brown.
• A need to urinate more frequently, especially if the stone is near the bladder.
• Upset stomach or vomiting, often due to severe pain or kidney irritation.
• Urine may appear cloudy or have an unpleasant odor, indicating infection.
• Dull or achy pain in the lower back or side (flank)
• Symptoms of infection, such as fever or chills
• A sensation of incomplete urination or inability to pass urine
• Larger stones may cause significant bleeding

While these are some of the common symptoms, people often complain about it to our urologists. Not everyone indeed experiences the same symptoms of kidney stones. However, the warning signs are the same for everyone: extremely unbearable pain.

What type of treatment do you need for kidney stones?

An effective treatment for kidney stones depends on the size, location, and composition of the kidney stone, as well as the severity of the symptoms. However, according to insights from our urologists, here’s a fact sheet we can share with you:

Small stones 

• 4 mm and smaller: About 90% of these stones pass naturally. The remaining 10% may require medication or treatment if complications like infection or blockage occur.
• 5–7 mm: About 50% of these stones need medication. The remaining 50% may require additional treatment, either to facilitate the passage or remove the stone using surgical or non-invasive techniques

Large stones

• 6 mm and larger: 59% of these stones require surgical or non-invasive procedures (such as RIRS, ureteroscopy, or PCNL) because they are unlikely to pass naturally. The remaining 41% might pass with medical intervention like medication or ureteral stenting, depending on the stone's location and the patient's condition.
• 8 mm and larger: These stones are unlikely to pass without surgery. Surgery or other advanced treatments are typically needed for nearly 100% of these cases.

Treatment of kidney stones is usually handled by a urologist using these methods:

Medications:

For small stones that can pass normally through medications, usually of size 4 mm. 

• Pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) to alleviate discomfort.
• Alpha-blockers: Medications relax the muscles in the ureter, helping stones pass more easily.
• Preventive drugs: For recurrent stones, medications may be prescribed to reduce stone formation. 

Minimal Invasive Surgery options:

RIRS: Retrograde Intrarenal Surgery (RIRS) is a minimally invasive surgery conducted to remove kidney stones that are usually located in the upper urinary tract. The procedure involves using a flexible ureteroscope to insert a laser into the kidney to break down the large stones of 6 mm or more. 

Procedure involves:

• Firstly, the patient is given anesthesia.
• A thin, flexible ureteroscope is inserted into the urethra into the bladder and moved up into the kidneys.
• The laser beam is used to break down the stones, collected in a basket, and removed through a ureteroscope.

Benefits of RIRS:

• Safe and efficient process
• A good option for patients taking anticoagulants or antiplatelets.
• Shorter hospital stay and faster recovery.

It is highly effective for complex or large stones less than 12mm to 15 mm and suitable for patients seeking less invasive options. Temporary side effects like mild discomfort or blood in the urine usually resolve quickly, allowing patients to resume normal activities within days.

PCNL: Percutaneous Nephrolithotomy (PCNL) is a minimally invasive technique that involves a small incision in the back, enabling direct access to the kidney for precise stone removal under general anesthesia. A nephrostomy tract is created through the incision, allowing the insertion of a nephroscope equipped with a camera and light. This provides real-time visualization of the kidney and stones. Depending on the stone’s size and location, ultrasound, laser energy, or specialized tools are used to fragment and remove the stones.

When it's performed

• PCNL is used when other treatments, like extracorporeal shock wave lithotripsy (ESWL), are not effective. 
• It's not performed on patients who are taking anticoagulants or have bleeding disorders

PCNL’s advantages include:

• Single procedure 
• High success rates
• Precise targeting
• Minimizing the need for multiple surgeries.

Post-procedure, a catheter may be placed for drainage and is typically removed within a few days, ensuring faster recovery and excellent outcomes.

Mini-PERC: Mini-PERC or mini-Percutaneous Nephrolithotomy (mini-PCNL) is an advanced minimal surgical procedure that is a very effective kidney stone. A refined version of Percutaneous Nephrolithotomy (PCNL) is used to treat large kidney stones. 

What this process involves:

• A smaller incision is made in the skin
• Smaller instruments and cameras are used
• Narrower tracts are created to access the kidney

Benefits include less pain and discomfort, quick recovery, less blood loss, and safe procedures.

Who is it for?

• People with kidney stones that are larger than 5mm but smaller than a full staghorn calculi
• Children with large renal stones
• Patients with stones that are inaccessible by ureteroscopy
• Patients with stones in complex urinary tracts

Conclusion 

At MASSH, effective kidney stone treatment is a cornerstone of our commitment to patient care. Our approach combines personalized care with advanced surgical techniques, including Retrograde Intrarenal Surgery (RIRS), Miniperc, mini-Percutaneous Nephrolithotomy (mini-PCNL), and Percutaneous Nephrolithotomy (PCNL). These options prioritize patient comfort, ensure high success rates, and minimize complications. Consulting with our skilled urologists can help determine the best course of action, empowering patients to regain their health and prevent recurrence.