Medical and Surgical Management of Urinary Stones

The modality of treatment for a stone would depend upon its characteristics, physical symptoms, overall health condition of the patient and the treatment options available.

The location of the stone is also important. Is it in the kidney, the ureter or the bladder? U/S is done to make assessments.

Small Stones but No Symptoms

Not all stones require treatment. Some small and rounded stones that are not producing any symptoms may be left as such.

There are chances that they passe along with urine in a natural way.

Small Stone With Presence of Colic

Stones produce pain, called colic, when they move along the urinary tract. The pain is sharp and transient.

Small round stones have chances of passing out with urine. So they may be managed medically, even though they produce a colicky attack.

There are certain group of medicines that can make the stone move faster along the urinary tract. These medicines may also reduce pain as the stone moves through the passage.

They are called alpha-blockers, like nefidipine etc. These may be prescribed by your doctor. This mode of treatment is called medical expulsion therapy (MET).

You are required to visit the doctor on a regular basis to check if the stone is moving slowly down the passage.

Uric acid stones may be dissolved. This is done by making your urine alkaline, that is, increasing its pH.

Sodium bicarbonate or alkaline citrate may be used for this purpose. As the urinary pH reaches a pH of 7 or more, the stone starts getting smaller in size to get dissolved completely with time.

Larger Irregular Stones

Large-sized stones, or irregular shaped ones which give painful colics have to be removed surgically. Some stones having sharp edges, which tend to injure the urinary tract also fall into this category.

There are many ways to handle this. They include-

Shock-wave Lithotripsy

Lithotripsy is breaking up of the stone.

High energy sound waves are focused on the stone. These waves break the stone into smaller fragment, when still inside the ureter.

These smaller fragment are able to pass out along with urine.

Removal by Ureteroscopy

Done under the hands of a highly skilled nephrologist. An urteroscope is gently inserted into the bladder without making any incision on the skin. It is gently inserted upwards into the urinary tract to reach the stone.

The stone is captured into a basket like trap and gently pulled out.

The whole procedure is carried out under anesthesia.

Percutaneous Nephrolithotomy

The procedure is quite invasive. An incision is made in the abdomen to approach the stone and take it out directly.

Larger stones, especially those present inside the kidney are taken out this way.

Complications if not Treated

• The stone may grow is size and injure the inner walls of the ureter.
• May get infected
• Get pushed upwards.