From the Guidelines
Treatment options for kidney stones should be based on the size, location, and composition of the stone, with a focus on minimizing morbidity, mortality, and improving quality of life. For symptomatic patients with a total non-lower pole renal stone burden ≤ 20 mm, clinicians may offer SWL or URS 1. The choice between SWL and URS depends on various factors, including stone size, location, and composition, as well as patient preferences and medical history. For example, URS is associated with a lower likelihood of repeat procedure compared to SWL, while PCNL offers a higher stone-free rate than SWL or URS for larger stones (>20 mm) 1. In patients with total renal stone burden >20 mm, clinicians should offer PCNL as first-line therapy 1. Additionally, clinicians should not offer SWL as first-line therapy for patients with >10 mm lower pole stones or total renal stone burden >20 mm 1. Prevention strategies, such as increased fluid intake and dietary modifications, are also crucial in preventing recurrent kidney stones 1. Some key points to consider when treating kidney stones include:
- Stone size and location: smaller stones (<5mm) may pass naturally, while larger stones (>10mm) may require more invasive procedures
- Stone composition: dietary modifications and medications may be prescribed based on stone type
- Patient preferences and medical history: clinicians should consider individual patient factors when choosing a treatment option
- Minimizing morbidity, mortality, and improving quality of life: treatment options should prioritize these outcomes.
From the Research
Treatment Options for Kidney Stones
- Medical expulsion therapy: Alpha-blockers, such as tamsulosin, have been shown to increase expulsion rates of distal ureteral stones, decrease time to expulsion, and decrease need for analgesia during stone passage 2, 3.
- Pain control: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to alleviate pain associated with kidney stones 4.
- Conservative management: This approach involves pain control, medical expulsive therapy with an alpha blocker, and follow-up imaging within 14 days to monitor stone position and assess for hydronephrosis 4.
- Surgical intervention: May be necessary for stones larger than 10 mm, urinary infection, or other complications 4.
- Lifestyle modifications: Increased fluid intake is recommended for all patients, and thiazide diuretics, allopurinol, or citrates may be prescribed for patients with recurrent calcium stones 4.
Medical Expulsive Therapy
- Alpha-blockers: Have been demonstrated to promote stone passage in patients receiving shock wave lithotripsy, and may be able to relieve ureteral stent-related symptoms 2.
- Calcium channel blockers: May also improve renal stone passage when compared with placebo 5.
- Effectiveness: The effectiveness of medical expulsive therapy remains controversial, but studies suggest that alpha-blockers may increase stone clearance and reduce the need for surgical intervention 3.
Prevention and Management
- Nutritional management: Individualized medical and dietary management can help prevent recurrence of kidney stones, taking into account specific risks involved for each type of stone 6.
- Screening: All patients with kidney stones should be screened for risk of stone recurrence with medical history, basic laboratory evaluation, and imaging 4.
- Metabolic assessment: Patients at high risk of stone recurrence should be referred for additional metabolic assessment to guide tailored preventive measures 4.