Treatment for kidney stones

Patient's question:

Main symptoms; Abdominal and waist pain Onset time: 3 days Laboratory test results: Swelling of the upper part of the left ureter

Doctor's answer:

Urinary tract stones are one of the most common urological diseases. Males are more affected than females, with a ratio of about 4 to 5:1. The formation mechanism is not fully elucidated, and there are multiple theories. The recurrence rate is high. Currently, there are no entirely ideal preventive methods for most stones. The onset of urolithiasis has a regional distribution. In China, it is more common in areas south of the Yangtze River and relatively less common in the north. Over the past three decades, the incidence of upper urinary tract (kidney, ureter) stones in China has significantly increased, while lower urinary tract (bladder) stones have become increasingly rare. Among bladder stones, primary stones are significantly less common than secondary stones. In recent ten years, the treatment methods for urinary tract stones have rapidly developed, and about 90% of urinary tract stones can no longer be treated with traditional open surgery.
Recommendations:
1. Medication: Oral dissolution drugs can promote stone excretion, protect renal function, repair damage, alter the internal environment, and improve urine characteristics. However, for stones larger than 0.5 cm, the effect is often slow, and the medication may not be ideal, sometimes leading to recurrent pain and recurrence.
2. Extracorporeal Shock Wave Lithotripsy (ESWL): It avoids the disadvantages of drug and surgical treatments. Under monitor guidance, it can accurately fragment stones to achieve the therapeutic goal. A single treatment only takes 30 minutes, does not require hospitalization, is non-invasive, and does not affect work or daily life. Therefore, for stones larger than 0.5 cm, it is common to first perform lithotripsy followed by medication to promote excretion, which is faster and more effective.
- Ultrasound-guided lithotripsy machine: Ultrasound guidance is suitable for various types of negative stones in the kidneys, positive stones, various gallstones, and intrahepatic and extrahepatic bile duct stones.
- X-ray-guided lithotripsy machine: X-ray guidance is suitable for positive stones in the kidneys, ureters, and bladder. It has high energy and a success rate of over 90%.
3. Surgical Treatment:
1) Traditional surgery: Through surgical incision to directly remove the stones, which was a common method in the past and the most direct approach. However, surgery has certain indications, and not all patients are suitable. Additionally, open surgery causes significant trauma to the body, requiring a long period of hospital rest. Postoperative scars may accumulate residual stones, leading to recurrence. Therefore, with changes in living and working environments and the acceleration of life, people are increasingly reluctant to choose surgery.
2) Laser-induced endoscopic lithotripsy: Utilizing advanced endoscopic technology to directly fragment and remove stones, followed by medication for anti-inflammation. It is suitable for various types of ureteral stones, bladder stones, kidney stones, recurrent stones, and stones in the elderly.
- Ureteroscopy for stone removal can treat ureteral and bladder stones in a single session, with a short treatment time of 15–30 minutes, minimal damage, and high safety.
- Percutaneous nephrolithotomy (PCNL) has only a 0.5 cm incision, with rapid recovery, allowing patients to get out of bed within 5 hours postoperatively and stay in the hospital for 3–5 days. It has achieved excellent clinical results.
Lifestyle Management:
Prevention and Treatment of Urinary Tract Infections
Urinary tract infections are a major local factor in the formation of stones and directly affect the prevention and treatment of urolithiasis. Urinary tract infections caused by bacteria such as Proteus, Staphylococcus, and Streptococcus can easily induce stone formation. These bacteria can decompose urea into ammonia, making the urine alkaline and facilitating the precipitation of uric acid, which leads to stone formation. Additionally, bacteria and the abscesses, necrotic tissues they cause can serve as nuclei for stones, contributing to their formation. Therefore, timely treatment of urinary tract infections is crucial for preventing stone recurrence.