KIDNEY STONE TREATMENT

Treating kidney stones 

Most kidney stones will be small enough (no more than 4mm or 0.2in in diameter) to be passed out in your urine. It may be possible to treat these at home.

However, small kidney stones may still cause pain. The pain from smaller kidney stones usually lasts a couple of days and disappears when the stone has been passed.

Medication

If you have severe pain, your GP may inject you with a painkiller. A second dose can be given after half an hour if you are still experiencing pain.

Medication can also be injected to treat the symptoms of nausea (feeling sick) and vomiting. This is called an anti-emetic (anti-sickness) medication.

You may also be given a prescription for painkillers, anti-emetics, or both, to take at home.

Self-care

If you are sent home to wait for your kidney stone to pass, you may be advised to try to collect the stone from your urine.

You can do this by filtering your urine through gauze or a stocking. The stone can be given to your GP to help them determine any further treatment you may need.

You should drink enough water to make your urine colourless. If your urine is yellow or brown, you are not drinking enough.

Admission to hospital

If your kidney stone has moved into your ureter and it is causing severe pain, your GP may admit you to hospital for treatment.

This may be necessary if:

• you are at an increased risk of your kidneys failing (for example, because you only have one kidney)
• your symptoms do not improve within an hour of being given painkillers or anti-sickness medication
• you are dehydrated and you are vomiting too much to keep fluids down
• you are pregnant
• you are over 60 years of age

Treating large kidney stones

If a kidney stone is too big to be passed naturally (6-7mm in diameter or larger), you may need to have treatment to remove it another way.

This could include:

• extracorporeal shock wave lithotripsy (ESWL)
• ureteroscopy
• percutaneous nephrolithotomy (PCNL)
• open surgery

These procedures are explained in more detail below. The type of treatment you have will depend on the size and location of your stones. 

Extracorporeal shock wave lithotripsy (ESWL)

ESWL is the most common way of treating kidney stones that cannot be passed in the urine.

It involves using X-rays (high-energy radiation) or ultrasound (high-frequency sound waves) to pinpoint where a kidney stone is. A machine then sends shock waves of energy to the stone to break it into smaller pieces so it can be passed in your urine.

ESWL can be an uncomfortable form of treatment, so it is usually performed after giving painkilling medication.

You may need more than one session of ESWL to treat your kidney stones successfully. ESWL is up to 99% effective for stones that are up to 20mm (0.8in) in diameter. 

Ureterorenoscopy 

If a kidney stone is stuck in your ureter (tube that carries waste products from your kidneys to your bladder), you may need to have ureterorenoscopy. Ureterorenoscopy is also sometimes known as retrograde intrarenal surgery (RIRS).

It involves passing a long, thin telescope called a ureteroscope through your urethra (the tube urine passes through out of the body) and into your bladder. It is then passed up into your ureter to where the stone is stuck.

The surgeon may either try to gently remove the stone using another instrument, or they may use laser energy to break the stone up into small pieces so that it can be passed naturally in your urine.

Ureterorenoscopy is performed under general anaesthetic, so you should not drive or operate machinery for up to 48 hours after the procedure.

For stones up to 15mm (0.6in), an ureterorenoscopy is effective in 50-80% of cases.

You may need a plastic tube called a stent to be inserted inside you temporarily to allow the stone fragments to drain into the bladder.

Percutaneous nephrolithotomy (PCNL)

PCNL is an alternative procedure that may be used for larger stones. It may also be used if ESWL is not suitable (for example, because the person being treated is obese). 

PCNL involves using a thin telescopic instrument called a nephroscope. An incision (cut) is made in your back. The nephroscope is passed through the incision and into your kidney. The stone is either pulled out or broken into smaller pieces using a laser or pneumatic energy.

It is always performed under general anaesthetic (you are put to sleep), which means that you should not drive or operate machinery for up to 48 hours after the procedure.

PCNL is 86% effective for stones that are 21-30mm (0.8-1.2in) in diameter.  

Open surgery

Nowadays, it is rare for people to have open surgery for kidney stones (less than 1% of cases require this type of surgery). It is usually used if there is a very large stone or abnormal anatomy. 

It involves making an incision in your back to gain access to both your ureter and your kidney. The kidney stone can then be removed. 

Treating uric acid stones

If you have a uric acid stone, you may be advised to drink around three litres of water each day to try to dissolve it.

Uric acid stones are much softer than other types of kidney stone, and they can be made smaller if they are exposed to alkaline fluids.

You may need to take some medication to make your urine more alkaline before the uric acid stone starts to dissolve.

When to seek urgent medical attention

You should seek urgent medical attention if:

• you have a high temperature (fever) of 38°C (100.4°F) or over
• you have an episode of shivering or shaking
• the pain gets worse, particularly if it is a sudden, severe pain

If you experience any of the above symptoms, contact your GP immediately for advice. If this is not possible, telephone NHS 111 or your local out-of-hours service.