From the Guidelines
Treatment for kidney stones should be based on their size, location, and symptoms, with the most recent and highest quality study recommending watchful waiting with increased fluid intake for small stones and medical procedures for larger stones or those causing severe symptoms 1. The treatment approach may vary depending on the specific characteristics of the stone and the patient's overall health.
- For small stones (less than 4mm), watchful waiting with increased fluid intake (2-3 liters of water daily) is often recommended as they may pass naturally.
- Pain management typically includes NSAIDs like ibuprofen (400-800mg every 6-8 hours) or prescription medications such as ketorolac.
- Alpha-blockers like tamsulosin (0.4mg daily) can relax ureter muscles to help stones pass more easily.
- For larger stones or those causing severe symptoms, medical procedures may be necessary, including extracorporeal shock wave lithotripsy (ESWL) to break up stones, ureteroscopy to remove stones directly, or percutaneous nephrolithotomy for very large stones. Prevention strategies include maintaining hydration, limiting sodium and animal protein intake, and sometimes medications like potassium citrate or thiazide diuretics depending on stone composition, as supported by studies such as 1 and 1. Prompt medical attention is essential if you experience severe pain, fever, chills, or difficulty urinating, as these may indicate complications requiring immediate treatment.
From the Research
Treatment Options for Kidney Stones
- Extracorporeal shock wave lithotripsy (ESWL) is a widely used method to treat renal and ureteral stones, which fragments stones into smaller pieces that can pass spontaneously down the ureter and into the bladder 2.
- Medical expulsive therapy (MET) has been investigated as a supplement to observation to improve spontaneous stone passage rates, with alpha-1 blockers being a commonly used medication for this purpose 3, 4, 2, 5, 6.
- Alpha-blockers, such as tamsulosin, silodosin, and alfuzosin, have been shown to increase the efficacy of ESWL in treating renal stones by increasing the expulsion rates of stones, decreasing time to expulsion, and decreasing the need for analgesia during stone passage 3, 4, 2, 5.
Efficacy of Alpha-Blockers
- Alpha-blockers have been found to be beneficial in increasing stone clearance rates after ESWL, with a risk ratio of 1.16 (95% CI 1.09 to 1.23) compared to control 2.
- The use of alpha-blockers has also been associated with a reduced need for auxiliary treatments after ESWL, with a risk ratio of 0.67 (95% CI 0.45 to 1.00) compared to control 2.
- Additionally, alpha-blockers have been found to reduce major adverse events, with a risk ratio of 0.60 (95% CI 0.46 to 0.80) compared to control 2.
Subgroup Analysis
- Subgroup analysis suggests that the effects of alpha-blockers may vary with stone size, with a risk ratio of 1.06 (95% CI 0.98 to 1.15) for stones 5 mm or smaller versus 1.45 (95% CI 1.22 to 1.72) for stones larger than 5 mm 6.
- The type of alpha-blocker used may also affect the outcome, with tamsulosin being the most widely used and studied alpha-blocker for this purpose 4, 2, 5.