Treating renal (kidney) stones
17 Jun 2021
It is more common in men than in women, however each individual has a lifetime risk of 10-15 per cent for experiencing renal stone disease, with peak incidence occurring between the ages of 30 to 50 years old.
Many stones will pass spontaneously. However in some cases, particularly where there is ongoing pain, renal impairment or infection, emergency intervention will be required.
Risk factors
- Males (M:F ratio 2:1)
- Caucasians, Asians
- Hot and dry climate
- Family history
- Medical conditions, including; hyperparathyroidism, gout, sarcoidosis, renal tubular acidosis, primary hyperoxaluria, cystinuria, malabsorption (Crohn’s disease, jejunoileal bypass, intestinal resection)
- Anatomical, including; horseshoe kidney, medullary sponge kidney, PUJ obstruction, stricture
Treatment options
There are a number of treatment options for renal stone disease, depending on different factors that can be assessed by an urologist. Some factors include the size, site and type of the stone and any associated infections or pain for the patient.
Conservative treatment
A conservative approach can include using simple analgesia and trial of passage.
Dissolution therapy
For uric acid stones, sodibic or potassium citrate can be used to reduce their size, allowing them to be passed through urination.
Surgery
If stones are unable to be passed spontaneously, surgical interventions can remove obstruction from the renal system for pain relief and function recovery, and clear calculi to prevent further recurrence of obstruction.
Surgical procedures can be:
- Percutaneous nephrolithototomy (for larger stones)
- Ureteroscopy/pyeloscopy and laser with stent insertion
A stent is frequently included as part of surgical management of stones to keep the ureter patent whilst the ureteric oedema, caused by the obstruction, improves. It also facilitates passage of tiny stone fragments following a laser procedure.
Management of common post-operative stent irritations
Irritation symptoms are very common after a stent has been inserted, with 95 per cent of patients experiencing symptoms.
Symptoms can include:
- Flank and suprapubic discomfort
- Bladder irritation (frequency and/or urgency)
- Haematuria
After ruling out infection by testing urine for nitrites and culture sensitivities, recommended management of stent irritation is as follows:
- Regular paracetamol and nonsteroidal anti-inflammatory drugs (Nurofen or Indomethacin)
- Opiates (as needed for a short duration)
- Oxybutynin, 2.5 to 5mg twice daily for symptoms of bladder irritation ie; frequency, urgency.
- Ural, 1 to 2 sachets three times daily for symptoms of bladder irritation ie; frequency, urgency.
Emergency intervention
It should be noted that emergency intervention will be required if patients present with the following:
- Clinically suspected infected, obstructed kidney
- Bilateral renal obstruction/obstruction of single kidney
- Renal failure
- Pain refractory to analgesia
In these circumstances, patients should be referred to a urological surgeon without delay.
Author:
Dr Ivan Aw - urologist at St John of God Midland Public and Private Hospitals
Dr Ivan Aw is a specialist urological surgeon with special interests in simple and complex renal stone disease, as well as benign and malignant conditions of the kidney, bladder and prostate. He treats public and private patients at St John of god Midland Public and Private Hospitals.