Conditions and Treatments

Urinary Stones (Kidney Stones) - Treatments

Once diagnosed, the size and location of the stone are important in guiding the options for treatment.

Small stones - Conservative

Most small stones do not require surgical treatment. Conservative treatment include:

Drinking water: Drink as much 2-3 litres of water a day to keep your urine diluted and clear unless your doctor tells you otherwise.
Pain relief: You may be prescribed pain medications to minimise discomfort during stone passage.
Medical therapy: An alpha blocker, such as tamsulosin, may be prescribed to relax to muscles in your ureter, facilitating passage of stone with less pain.

Large stones – Surgical Management

Stones that are too large to pass on their own or cause bleeding, persistent severe pain that cannot be controlled, renal impairment and infection of the urinary tract may require invasive treatment. These are the option:

Extracorporeal shockwave therapy (ESWL): ESWL uses sound waves delivered by an external device that resembles an X-ray machine that break stones into smaller pieces that can be passed out in your urine. You will be given painkillers to make you more comfortable.

ESWL may cause blood in urine, pain or bruising of your back or abdomen, bleeding around the kidney. Sometimes you may require more than one session to completely fragment the stones. Very rarely, the small fragments may be stuck in the ureter and cause obstruction of urine flow, which will require surgical management.
Ureteroscopy: A small telescope can be passed through your urethra and bladder to your ureter. Tools can be used to break stones into pieces that will be removed with a small basket or pass out in your urine. You will require general anaesthesia during this procedure. Your doctor may then place a stent (small plastic tube) in the ureter to prevent swelling and obstruction of the ureter and to promote healing.

You may require more than one procedure to completely remove larger stones. If your ureter is too tight to pass the ureteroscope or instruments through, your doctor may choose to insert a stent in your ureter to allow muscles in your ureter to relax and you will come back another day (~1-2 weeks) to complete the procedure.
Percutaneous nephrolithotomy (PCNL): This procedure involves a small incision over your back and inserting a telescope and instruments into the kidney to break the stones into smaller pieces. This procedure requires general anaesthesia. You may wake up with a tube behind your back to help drain the urine and stone fragments. This will be removed in 1-2 days before you are discharged home.

Potential complications of PCNL include bleeding, urinary tract infection, injury to adjacent organs and retained stones.