Patient's question:
I have a stone at the end of my right ureter (a 1.4 cm stone) and right kidney hydronephrosis (it was severe two months ago, but it's not as severe now). During these two months, I had six lithotripsy sessions. A month ago, only one or two small stones were visible in the imaging, and after that, none were seen passed out. When I went back, the doctor said that all my stones had already shattered—except for two 0.4 cm and 0.5 cm stones that hadn't been fully broken (so I had my sixth lithotripsy). As for whether they are completely shattered or not, I don't know. In the meantime, I drank a lot of water and exercised, but the doctor said my stones haven't passed yet. I'm very worried. I still have to work, and I still have to help with the farm work at home, and I still have to...Doctor's answer:
The first choice for stone removal treatment should be extracorporeal shock wave lithotripsy (ESWL);(1) For various kidney stones and ureteral stones less than 1.2 cm in diameter, extracorporeal shock wave lithotripsy should be the preferred treatment. This is because it causes no kidney damage, ensures thorough stone removal, is safe and painless, and avoids secondary damage from shock wave fragmentation. If the stone diameter exceeds 1.2 cm, extracorporeal shock wave lithotripsy should first be used to fragment the larger stone, followed by ESWL for complete stone removal, achieving complementary advantages.
(2) It is particularly suitable for acute ureteral stones and the associated conditions such as hydronephrosis, renal pelvis dilation, ureteral hydronephrosis, ureteral dilation, and renal colic. It can rapidly expel ureteral stones, immediately relieving pain and quickly alleviating the aforementioned symptoms, making it the preferred treatment method for ureteral stones at present.
(3) For patients with multiple kidney stones complicated by ipsilateral ureteral stones, the ureteral stones should first be removed before addressing the multiple kidney stones to prevent the formation of a "stone street" in the ureter.
(4) For large kidney stones that remain in the lower pole of the kidney pelvis or calyces after ESWL fragmentation, small residual stones are the best indication for ESWL for thorough stone removal. This is because handheld high-frequency superconducting shock waves can directly contact the stones in the lower pole of the kidney, moving them into the renal pelvis and ureter for expulsion.
(7) Due to concurrent urinary tract infections leading to conditions such as pyelonephritis, ureteritis, cystitis, prostatitis, urethritis, as well as biliary infections causing cholecystitis and intrahepatic or extrahepatic cholangitis, the inflammatory congestion and swelling of the mucosa can hinder stone removal. Therefore, antibiotic anti-inflammatory treatment must be administered first, and ESWL can only be performed after the inflammation subsides.
Clinical observations by Professor Chen Bangjing suggest that extracorporeal shock wave lithotripsy is a leading new technology for treating stones both domestically and internationally, having been granted a national invention patent. It is currently the preferred method for treating kidney stones, ureteral stones, gallstones, and extrahepatic, as well as intrahepatic. Its completely thorough stone removal effect, lack of secondary damage to any organs, and low cost have benefited a vast number of patients. For stones beyond the scope of ESWL, extracorporeal shock wave lithotripsy should first be used to fragment the stones before removal. For large renal cast stones and gallstones, surgical stone removal is recommended as soon as they are detected.