Kidney

Kidney and Ureteral Stones

Treatment of Kidney and Ureteral Stones

You have been diagnosed with a kidney or ureteral stone. This section describes the different treatment options which you can discuss with your doctor. Together you can decide which approach is right for you.

Factors that influence the decision include:

  • Your symptoms
  • Stone characteristics
  • Your medical history
  • The kind of treatment available at your hospital and the expertise of your doctor
  • Your personal preferences and values

Not all stones require treatment. You need treatment if your stone causes discomfort and does not pass naturally with urine. Your doctor may also advise treatment if you have pre-existing medical conditions.

If you have a kidney or ureteral stone which does not cause discomfort, you will generally not receive treatment. Your doctor will give you a time schedule for regular control visits to make sure your condition does not get worse.

If your stone is likely to pass with urine, your doctor can prescribe drugs to ease this process. This is called conservative treatment.

If your stone continues to grow or causes frequent and severe pain, you will get active treatment.

Conservative stone treatment

Most kidney or ureteral stones will leave your body while you urinate. However, depending on the size and location of the stone, it will take you some time to pass the stone. You may suffer from renal colic when the stone moves. If you have a very small stone there is a 95% chance of passing this stone within 6 weeks.

In general you can keep this in mind:

  • The closer the stone is to the bladder, the higher the chance of passing it
  • The bigger the stone, the smaller the chance of passing it

There are 2 common conservative treatment options: Medical Expulsive Therapy (MET)  and dissolving uric acid stones. In both cases you get medication.

Active stone treatment

Kidney or ureteral stones should be treated if they cause symptoms. There are 3 common ways to remove stones: shock-wave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PNL).

Which active treatment option is best for you depends on many aspects. The most important factor is the symptoms the stone causes. Based on whether the stone is in your kidney or your ureter, the doctor may recommend different treatment options.

If you don’t have symptoms you may still get treatment in case:

  • The stone continues to grow
  • You are at high risk of forming another stone
  • You have an infection
  • Your stone is very large
  • You prefer active treatment

Your doctor will recommend to remove a stone in the ureter if:

  • It seems too big to pass with urine
  • You continue to suffer from pain while you take medication
  • Your kidneys have stopped or may stop to function properly
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Asymptomatic stones

Stones that do not cause any symptoms. They are usually found during imaging tests done for another condition.

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Bladder

Organ which collects urine from the kidneys.

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Calculi

Stones.

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Computed tomography (CT)

Imaging technique that makes a series of x-ray images of the body.

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Conservative treatment

Monitoring the progress of the stone disease or treatment with medication to ease the natural passing of stones.

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Contraindication

A symptom or condition that makes a certain treatment option undesirable.

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Decompression

Relieving pressure in the kidneys. A nephrostomy tube is placed directly in the kidney through the skin so that urine can leave the body.

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Endoscope

A tube-like instrument to examine the inside of the body. Can be flexible or rigid.

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Fragments

Pieces of the stone broken during a procedure.

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Intravenous urography

An imaging technique where x-ray contrast agent is injected into the vein, usually in the arm.

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JJ-stent

A tube that is temporarily placed in the ureter to make sure urine can flow from the kidney to the bladder.

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Kidneys

Two bean-shaped organs in the back of the abdomen that filter the blood and produce urine.

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Medical Expulsive Therapy (MET)

Medication that makes the natural passing of stones easier and less painful.

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Metabolic evaluation

Series of blood and urine tests for patients who have a high risk of forming stones.

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Nephrostomy tube

A tube placed directly into the kidney through the skin. This allows the urine to leave the body.

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Non-contrast-enhanced CT

Type of CT scan with low radiation exposure.

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NSAIDs

A group of medicines used to relieve pain. It is often used to relieve renal colic.

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Oxalate

A component found in many kinds of food which may be related to forming kidney or ureteral stones.

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Percutaneous

Through the skin.

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Percutaneous nephrolithotomy (PNL)

Treatment option to remove stones directly from the kidney by placing a tube through the skin.

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PH-value

A measure between 0.0 and 14.0 to describe if a fluid is acidic or alkaline. pH values close to 7.0 are neutral, anything above is alkaline, anything below is acidic.

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Renal colic

Severe pain in flank, loin, groin, or thigh caused by a stone blocking the normal flow of urine.

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Shock-wave lithotripsy (SWL)

Treatment option to break stones into smaller pieces using high energy sound waves. Stone fragments pass with urine after the procedure.

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Ultrasonography

Imaging technique that uses high-frequency sounds to make an image of the inside of the body (ultrasound).

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Ureter

One of the two tubes through which urine flows from the kidneys to the bladder.

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Ureteroscope (rigid or flexible)

An endoscope used for the urinary tract. It is inserted into the urethra and can move through the bladder, up the ureter, and even into the kidney.

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Ureteroscopy (URS)

Treatment option to remove kidney or ureteral stones. A ureteroscope is inserted into the urinary tract via the urethra to pull out the stone.

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Urethra

The tube which carries urine from the bladder and out of the body.

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Uric acid

A chemical that is created when the body breaks down substances called purines.

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Urinary tract

The organ system which produces and transports urine through and out of the body. It includes two kidneys, two ureters, the bladder and the urethra. The urinary tract is similar in men and women, only men have a longer urethra.

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Urolithiasis

Stone disease.

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Urologist

A doctor specialized in health and diseases of the urinary tract and the genitals.

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LUTS

Lower urinary tract symptoms. A term used for the symptoms caused by BPE which can also point to other diseases affecting the urinary tract (see also Urinary tract).

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Active treatment

Procedures to remove a kidney or ureteral stone.

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Adenoma

The enlarged part of the prostate.

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Anaesthesia (general, spinal, or local)

Before a procedure you will get medication to make sure that you don’t feel pain. Under general anaesthesia you are unconscious and unaware of what is happening to you. Under spinal or local anaesthesia you will not feel pain in the part of your body where the procedure is done. Anaesthesia wears off gradually after the procedure.

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Benign enlargement

Cell growth in the body which is not cancerous.

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Cystoscope

A type of endoscope which is used in the urethra (see also Endoscope, Urethra).

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Erectile dysfunction

The inability to get or keep an erection.

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Indwelling catheter

A tube placed in the urethra and bladder to help you urinate.

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Micturition

Urination.

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Minimally invasive procedure

A surgical procedure where there is no need to make an incision in the body. An endoscope is used to reach the part of the body that needs to be treated through the urethra (see also Endoscope).

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Nocturia

Waking up one or more times during the night because of the need to urinate.

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Physical

Having to do with or affecting the body.

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Post void residual urine (PVR)

The amount of urine left in the bladder after urination.

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Prostate

The gland which produces the fluid which carries semen. It is located in the male lower urinary tract, under the bladder and around the urethra.

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PSA (prostate-specific antigen)

A protein produced by the prostate which may increase in men with a benign prostatic enlargement, prostatic inflammation, or prostate cancer.

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Psychological

Having to do with or affecting the mind.

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Resectoscope

A type of endoscope used for minimally invasive treatment of BPE.

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Retrograde ejaculation

A condition when semen can no longer go through the urethra during orgasm but goes into the bladder instead. The semen later leaves the body during urination.

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Urgency

The sudden need to urinate which is difficult to postpone.

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Urinary incontinence

Involuntary loss of urine.

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Urinary retention

When you are unable to urinate. This condition can be chronic.

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Nocturnal polyuria

When the kidneys overproduce urine at night.

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Peripheral oedema

Oedema means swelling. Peripheral oedema refers specifically to swelling of the ankles and legs.

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Primary polydipsia

The sensation that your mouth is dry which leads you to drink too much.

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Obstructive sleep apnoea

Repetitive pauses in breathing during sleep, despite the effort to breathe, commonly paired with snoring.

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Benign Prostate Enlargement (BPE)

An enlargement of the prostate related to hormonal changes with age.

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Overactive Bladder Symptoms

A collection of urinary storage symptoms, including urgency, incontinence, frequency and nocturia.

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Transurethral resection of the prostate (TURP)

TURP is a standard surgery to treat benign prostatic enlargement (BPE). A part of the prostate is removed to improve the symptoms without making an incision in your lower abdomen. This type of surgery is known as minimally invasive treatment.

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Catheter

A hollow flexible tube to insert or drain fluids from the body. In urology, catheters are generally used to drain urine from the bladder.

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Urinary frequency

The need to urinate more often than usual, generally more than 8 times a day.

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