Most kidney stones originate as crystals in the kidney, enlarge over time, and then pass through the urinary tract. Prior to 1982, most patients with stones either passed them spontaneously, or underwent open surgical incisions to remove them. Since then however, there have been phenomenal technological advances in both the diagnosis and management of urinary tract stones. Today, it is rare for patients to undergo open stone surgery. With the current use of spiral CT scanning, most stones are now rapidly diagnosed and treated.
Symptomatic bladder and ureteral stones can be treated with minimally invasive endoscopic procedures, either with simple ureteroscopic stone extraction or Holmium laser lithotripsy (stone pulverization). Most complex upper ureteral or renal stones can be managed with the insertion of a very small flexible ureteroscope into the bladder and up the ureter to the kidney and the stone similarly extracted or broken into smaller fragments with laser. There is no incision with this approach. The urologist has precise visualization of the anatomy and the stone using a digital fiberoptic camera. In addition, digital x-rays are available in "real-time" to assist the urologist in complete stone removal.
Many kidney stones and upper ureteral stones can be treated non-invasively with SWL (shock wave lithotripsy) as an outpatient procedure. Since its introduction in the mid 1980's, this technology has been refined and is now an option for managing many upper tract urinary stones. The impressive efficacy and high safety profile make this procedure ideal for patients with low to moderate kidney stone burden.
For larger and more complex kidney stones, percutaneous (literally: "through the skin") stone removal is now the procedure of choice. This technique involves a small ½ inch incision in the back and the creation of a small tunnel into the drainage portion of the kidney. Surgical scopes can then be passed and the stones are either removed intact or broken into smaller pieces that are small enough to extract. Multiple energy sources are utilized to accomplish complete stone removal including Holmium laser, ultrasonic and pneumatic lithotripsy. Recovery from these procedures is short and most patients can resume their normal lifestyle and activity within days.
Medical Management of Urinary Stones
To help determine the cause of kidney stones, laboratory tests may be ordered, including urine and blood tests. The patient's medical history, occupation, and eating habits may be questioned. The oral intake of fluids may be particularly important in the initial cause or recurrence rates of kidney stones. If a stone has been removed, or if the patient has passed a stone and saved it, a stone analysis by the laboratory may help in planning treatment.
A 24-hour urine collection may be instructive in determining the cause of kidney stones. For this collection, the patient is given a large container, which is refrigerated between trips to the bathroom. The collection is used to measure urine volume and levels of acidity, calcium, sodium, uric acid, oxalate, citrate, and creatinine-a product of muscle metabolism. Specific dietary and medication recommendations are then made based on the results of the urinary and blood tests, urinary stone composition and type of urinary stone disease. A second 24-hour urine collection may be needed to determine whether the prescribed treatment is working. The Maine Medical Partners Kidney Stone Prevention Program is New England’s first and only comprehensive center for managing recurrent kidney stones in adults and children. To learn more about how you can prevent kidney stones, click here.