"Silent" stones (those that are not causing any problem for the patient) normally do not require treatment. Acute attacks, on the other hand, may require an emergency room visit or hospitalization, because the pain is so severe. In most cases, the stone is small and the individual needs only pain relief and instructions concerning retrieval of the stone. Sometimes the stone becomes stuck in the ureter. In this event, the physician may recommend medication to help the stone pass (medical expulsive therapy-MET). About 90% of stones pass spontaneously, without intervention.
Indications for surgery to treat kidney stones immediately include severe pain not controlled with oral analgesics, intractable nausea or vomiting, infection or kidney damage if the stone blocks the kidney for too long.
Percutaneous nephrolithotomy (PCNL): This procedure is typically used for larger stones located within the kidney. A small incision is made in the back and a telescope with a camera is introduced into the kidney. Lasers or other devices are placed through the scope to break up the stones and the fragments removed directly from the kidney.
Ureteroscopy: This procedure is often used when a stone becomes lodged in the ureter. A small telescope is inserted into the bladder and ureter (tube draining the kidney). A laser fiber is passed through the scope to break up the stone. A small basket can be used to retrieve the fragments and/or the patient may pass these on their own.
Extracorporeal shock wave lithotripsy (ESWL): This procedure uses high-energy shock waves to break stones into small pieces that then travel down the ureter and out of the body in the urine. It is a non-invasive procedure that allows precise localization of the stone and removal without the need for surgery. Before treatment, the individual is placed under anesthesia and positioned in a water bath or specially designed table so that the stone can be targeted to receive the highest energy of the shock wave. The blast does not typically harm surrounding skin or nearby tissues. The duration of the procedure is approximately one hour.