From the Guidelines
Treatment recommendations for kidney stones should be based on the size of the stone, with smaller stones (≤ 20 mm) potentially being treated with shock wave lithotripsy (SWL) or ureteroscopy (URS), and larger stones (> 20 mm) requiring percutaneous nephrolithotomy (PCNL) as first-line therapy. When considering the treatment options for kidney stones, it's essential to evaluate the size of the stone and its location.
- For stones ≤ 20 mm, SWL or URS may be offered as treatment options 1, as they have acceptable stone-free rates and less morbidity compared to PCNL.
- For stones > 20 mm, PCNL should be offered as first-line therapy 1, as it offers a higher stone-free rate than SWL or URS and is less invasive than open surgery.
- Additionally, SWL should not be offered as first-line therapy for stones > 20 mm 1, as it has significantly reduced stone-free rates and increased need for multiple treatments compared to PCNL. Some key points to consider when evaluating treatment options include:
- The location of the stone, with lower pole stones potentially requiring different treatment approaches than stones in other locations.
- The patient's overall health and ability to undergo certain procedures.
- The potential risks and benefits of each treatment option, including the risk of complications and the likelihood of successful stone removal. It's also important to note that follow-up imaging is crucial to confirm complete stone clearance, regardless of the treatment approach used 1. Overall, the treatment of kidney stones should be individualized based on the size and location of the stone, as well as the patient's overall health and preferences.
From the Research
Treatment Recommendations for Kidney Stones Based on Size
- The treatment of kidney stones depends on the size and location of the stone, as well as the patient's overall health and medical history 2.
- For stones less than 20 mm in diameter, extracorporeal shock wave lithotripsy (ESWL) is often the recommended treatment 3, 2.
- For stones larger than 20 mm, percutaneous nephrolithotomy (PCNL) is often the most effective treatment 3, 2.
- Flexible ureteroscopy is also an option for treating kidney stones, especially for stones in the lower pole of the kidney 4.
- The success rate of ESWL is lower for lower pole kidney stones compared to PCNL, but ESWL has a shorter hospital stay and duration of treatment 3, 5.
- For asymptomatic kidney stones, conservative management with pain control and follow-up imaging is often recommended, but stones larger than 10 mm may require active removal 6.
Stone Size and Treatment Outcomes
- Stones less than 10 mm in diameter can often be treated with ESWL or ureteroscopy, while stones larger than 10 mm may require PCNL or other more invasive treatments 2, 6.
- The success rate of ESWL decreases as stone size increases, with stones larger than 20 mm having a lower success rate compared to PCNL 5.
- PCNL has a higher success rate for larger stones, but also has a higher risk of complications compared to ESWL 3, 5.
Additional Considerations
- The location of the stone, as well as the patient's overall health and medical history, should also be taken into account when determining the best course of treatment 2, 6.
- Lifestyle modifications, such as increased fluid intake, can help prevent the recurrence of kidney stones, and medications such as thiazide diuretics, allopurinol, or citrates may be prescribed for patients with recurrent calcium stones 6.