From the Guidelines
For symptomatic patients with kidney stones, the treatment approach should be based on the size and location of the stone, with options including shock wave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL) [ 1 ]. When considering the treatment of kidney stones, several factors come into play, including the size, location, and composition of the stone, as well as the patient's overall health and symptoms.
- For small stones (less than or equal to 10mm), particularly those in the lower pole, SWL or URS are recommended as first-line therapies [ 1 ].
- For stones larger than 10mm, especially those in the lower pole, URS is preferred over SWL due to its higher stone-free rate and lower need for repeat procedures [ 1 ].
- In cases where the stone burden exceeds 20mm, PCNL is strongly recommended as the first-line therapy due to its higher stone-free rates compared to SWL and URS [ 1 ].
- The choice between these procedures also depends on factors such as the patient's body habitus, the presence of any anatomical abnormalities, and the stone's composition and density.
- Additionally, prevention strategies, including increased fluid intake and dietary modifications, are crucial in reducing the risk of recurrent kidney stones [ 1 ].
- Medications like thiazide diuretics, citrate, or allopurinol may be considered for patients with recurrent stones, especially when increased fluid intake is not sufficient to prevent stone formation [ 1 ].
From the Research
Kidney Stone Treatment
- Kidney stone disease is a significant and worldwide health problem, and various treatment options are available, including extracorporeal shock wave lithotripsy (ESWL), uretero-renoscopy (URS), and percutaneous nephrostolithotomy (PCNL) 2.
- Medical expulsion therapy (MET) has been investigated as a supplement to observation to improve spontaneous stone passage rates, and alpha-1 blockers have been found to be effective in increasing the efficacy of ESWL to treat renal stones 2, 3, 4, 5.
- Alpha-blockers, such as tamsulosin, silodosin, and alfuzosin, have been shown to increase stone clearance rates, reduce the need for auxiliary treatments, and decrease stone clearance time 3, 4, 5, 6.
- The use of alpha-blockers as adjuvant medical expulsive therapy after ESWL may result in improved stone clearance, less need for auxiliary treatments, fewer major adverse events, and a reduced stone clearance time compared to usual care alone 4.
- The efficacy of alpha-blockers may vary with stone size, with larger stones (>5 mm) showing a greater response to treatment than smaller stones (≤5 mm) 6.
Treatment Options
- ESWL is a widely used method to treat renal and ureteral stones, and alpha-blockers may assist in promoting the passage of stone fragments 2, 4.
- Uretero-renoscopy (URS) and percutaneous nephrostolithotomy (PCNL) are also effective treatment options for kidney stones, but may be associated with more risks and complications than ESWL 2.
- Medical expulsion therapy (MET) with alpha-blockers may be a useful adjunct to ESWL, particularly for patients with larger stones (>10 mm) 3, 4, 5.
Benefits and Risks
- Alpha-blockers may increase stone clearance rates, reduce the need for auxiliary treatments, and decrease stone clearance time, but may also be associated with an increased risk of major adverse events 4, 6.
- The use of alpha-blockers as adjuvant medical expulsive therapy after ESWL may result in improved outcomes, but the certainty of evidence is limited, and more research is needed to fully understand the benefits and risks of this treatment approach 4.