From the Guidelines
Pericalyceal lithiasis treatment should prioritize increased fluid intake to achieve at least 2 L of urine per day to prevent recurrent nephrolithiasis, as recommended by the American College of Physicians 1.
Treatment Options
The primary treatment options for pericalyceal lithiasis depend on stone size, location, and patient factors. For small stones less than 5mm, watchful waiting with increased fluid intake and medical expulsive therapy using alpha-blockers may facilitate spontaneous passage.
- Increased fluid intake: at least 2 L of urine per day to prevent recurrent nephrolithiasis 1
- Medical expulsive therapy: alpha-blockers like tamsulosin 0.4mg daily for 4-6 weeks
- Extracorporeal shock wave lithotripsy (ESWL): for larger stones or those causing obstruction
- Percutaneous nephrolithotomy (PCNL): for stones larger than 2cm or complex stones
- Flexible ureteroscopy with laser lithotripsy: for lower pole stones
Prevention Strategies
Prevention strategies include dietary modifications, maintaining adequate hydration, and sometimes medications like thiazide diuretics, potassium citrate, or allopurinol depending on stone composition.
- Dietary modifications: reduced sodium and animal protein
- Maintaining adequate hydration: at least 2 L of urine per day
- Medications: thiazide diuretics, potassium citrate, or allopurinol depending on stone composition 1
Pain Management
Pain management during episodes typically includes NSAIDs like ketorolac 30mg IV or oral analgesics.
- NSAIDs: ketorolac 30mg IV or oral analgesics Regular follow-up imaging is essential to monitor stone clearance and prevent recurrence. The American College of Physicians recommends pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol to prevent recurrent nephrolithiasis in patients with active disease in which increased fluid intake fails to reduce the formation of stones 1.
From the Research
Pericalyceal Lithiasis Treatment Options
- The treatment of pericalyceal lithiasis, or kidney stones, can vary depending on the size and location of the stone, as well as the patient's overall health 2, 3, 4, 5, 6.
- Several treatment options are available, including extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS) 2, 4, 6.
Comparison of Treatment Options
- ESWL is a non-invasive procedure that uses shock waves to break up the stone, while PCNL is a more invasive procedure that involves making a small incision in the back to remove the stone 2, 4, 5.
- RIRS is a minimally invasive procedure that involves using a small scope to remove the stone through the urethra 4, 6.
- Studies have shown that PCNL may have a higher success rate than ESWL for larger stones, but ESWL may be a better option for smaller stones 2, 4, 6.
- RIRS has been shown to have similar success rates to PCNL, but with fewer complications 4, 6.
Considerations for Treatment
- The choice of treatment will depend on the individual patient's needs and circumstances, including the size and location of the stone, as well as their overall health 3, 5.
- Patients with smaller stones (<10 mm) may be good candidates for ESWL or RIRS, while those with larger stones may require PCNL 6.
- The patient's quality of life and potential for complications should also be taken into consideration when choosing a treatment option 4.