From the Guidelines
For non-obstructing renal stones causing intermittent pain, the initial treatment should focus on pain management, medical expulsive therapy, and increased fluid intake to achieve at least 2 L of urine per day, as recommended by the American College of Physicians 1.
Key Components of Treatment
- Pain management with NSAIDs like ibuprofen (400-600mg every 6-8 hours) or naproxen (500mg twice daily) is preferred due to their anti-inflammatory properties and fewer side effects.
- Medical expulsive therapy with alpha-blockers such as tamsulosin (0.4mg daily) may help facilitate stone passage by relaxing ureteral smooth muscle, though this is more effective for stones that have entered the ureter.
- Adequate hydration with 2-3 liters of fluid daily is recommended to maintain good urine flow, as supported by the guideline from the American College of Physicians 1.
Monitoring and Follow-Up
- Patients should strain their urine to catch passed stones for analysis.
- If pain becomes severe or is accompanied by fever, nausea, vomiting, or inability to urinate, immediate medical attention is necessary as these may indicate complications like infection or obstruction.
Interventional Therapy
- For stones unlikely to pass spontaneously (typically >6mm), or if conservative management fails after 4-6 weeks, urological intervention such as shockwave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy may be necessary, as discussed in the context of acute onset flank pain-suspicion of stone disease 1.
- The choice of intervention depends on stone size, location, composition, and patient factors.
From the Research
Treatment Options for Non-Obstructing Renal Stones
- The treatment for non-obstructing renal stones with intermittent renal colic can involve various approaches, including pain management and surgical removal of the stones 2, 3.
- For pain management, nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids can be used, with NSAIDs forming the core of most opioid-sparing pathways 4.
- A study comparing the effects of suppository diclofenac (an NSAID) and oral administration of a combination of oxycodone (an opioid) and acetaminophen found that both treatments provided effective pain relief after extracorporeal shock wave lithotripsy (SWL) 5.
- Surgical removal of non-obstructing renal stones can also be an effective treatment option, with studies showing significant reduction in pain and improvement in quality of life after ureteroscopy 2, 3.
Medical Expulsion Therapy
- Medical expulsion therapy (MET) using alpha-1 blockers, such as alfuzosin, can be used as an adjunctive therapy to increase the efficacy of SWL in treating renal stones 6.
- A study found that patients receiving alfuzosin after SWL had higher clinical success rates and required less analgesia compared to those receiving conventional treatment alone 6.
Ureteroscopic Treatment
- Ureteroscopic treatment can be an effective option for patients with small, painful, non-obstructing renal stones, with studies showing complete or partial resolution of pain in most patients 3.
- A retrospective chart review found that 85% of patients reported complete resolution of pain and 67% had improved quality of life after ureteroscopic treatment 3.