From the Guidelines
Treatment for kidney stones should be based on the size and location of the stone, with options including watchful waiting, pain management, and medical procedures such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, or percutaneous nephrolithotomy. For symptomatic patients with a total non-lower pole renal stone burden ≤ 20 mm, clinicians may offer SWL or URS 1. The choice of treatment depends on various factors including stone size, location, and patient symptoms. Some key points to consider include:
- For stones smaller than 10mm, watchful waiting with pain control is often recommended as they may pass naturally within a few days to weeks.
- Larger stones or those causing severe symptoms might require procedures such as ESWL or ureteroscopy.
- In some cases, percutaneous nephrolithotomy may be necessary for very large stones.
- Prevention strategies include maintaining hydration, limiting sodium and animal protein intake, and sometimes medications like thiazide diuretics, potassium citrate, or allopurinol depending on the stone type.
- The treatment approach varies based on stone composition, size, location, and individual patient factors. It's also important to note that in symptomatic patients with a total renal stone burden >20 mm, clinicians should offer PCNL as first-line therapy 1, and in patients with total renal stone burden >20 mm, clinicians should not offer SWL as first-line therapy 1. Additionally, clinicians should offer SWL or URS to patients with symptomatic ≤10 mm lower pole renal stones 1, and clinicians should not offer SWL as first-line therapy to patients with >10 mm lower pole stones 1. Overall, the treatment of kidney stones requires a comprehensive approach that takes into account the individual patient's needs and circumstances.
From the Research
Treatment Options for Kidney Stones
- Alpha-blockers have been found to be beneficial in increasing stone clearance rates after extracorporeal shock wave lithotripsy (ESWL) for renal or ureteral stones 2, 3, 4, 5
- The use of alpha-blockers as medical expulsive therapy (MET) for ureteral stones has been shown to increase stone clearance rates and reduce stone expulsion time 2, 6
- Tamsulosin is the most widely used alpha-blocker for this purpose, with a dose of 0.4 mg daily being the most commonly used 2, 5
- Alpha-blockers may also reduce the need for auxiliary treatments after ESWL and decrease the time to expulsion of stone fragments 3, 4
- The effectiveness of alpha-blockers may vary depending on stone size, with larger stones (>5 mm) showing a greater benefit from alpha-blocker therapy 6
Benefits of Alpha-Blockers
- Increased stone clearance rates after ESWL 2, 3, 4, 5
- Reduced stone expulsion time 2, 6
- Decreased need for auxiliary treatments after ESWL 3, 4
- Reduced pain and analgesic usage 5
- Fewer major adverse events 4
Potential Drawbacks
- Alpha-blockers may increase the risk of major adverse events, although this is still a topic of debate 4, 6
- The effectiveness of alpha-blockers may vary depending on stone size and location 6
- More research is needed to fully understand the benefits and drawbacks of alpha-blocker therapy for kidney stones 2, 4, 6, 5