If you are in extreme pain from what may be a kidney stone, contact your doctor or seek help at a hospital emergency room. The doctor will order imaging tests such as an intravenous pyelogram or a spiral CT to check for stones. Blood and urine tests will also be performed.
An IVP is a special x-ray exam of your kidneys and other parts of your urinary system. This includes the tubes leading from the kidneys (ureters) and your bladder. A special dye is injected into your bloodstream through an IV so that the x-ray machine can pick up images of your kidneys and other parts of your urinary tract. The exam takes about an hour and should not be painful.
A spiral CT exam is another special type of x-ray. The spiral CT scan is a painless procedure that involves a highly advanced imaging machine. The machine rotates rapidly around the body taking over one hundred pictures in sequence. The scan is so sensitive that it can spot stones that are too small to be seen on a conventional x-ray.
You may be able to pass a stone through your urinary system without seeking medical treatment. Drink two to three quarts of water a day and stay physically active. You may take pain medication as needed. If you think you are about to pass a stone, urinate through a strainer or into a cup so that you can save the stone and give it to your doctor for testing.
Your doctor is the best source of information on the drug treatment choices available to you.
Surgical procedures are used to treat kidney stones that are too large to pass through the body on their own or are causing bleeding, kidney damage, or chronic urinary infections. The most commonly used procedure is shock wave lithotripsy (SWL), a process that breaks kidney stones into tiny fragments. Other procedures include percutaneous nephrolithotomy and ureteroscopic stone removal. Both of these procedures use miniature telescopes to look inside the kidney or ureter to remove stones.
SWL relies on shock waves to break kidney stones into fragments or crystals that can pass out of the body in the urine. It is most effective on stones located in the kidney or upper urinary tract that are no larger than about three-quarters of an inch or one centimeter across. A machine called a lithotripter is used to focus shock waves from outside the body onto the stone.
During SWL, you will be positioned in a water bath or asked to lie on a soft cushion while the shock waves are administered. You may be given a sedative just before the procedure to help you relax. Depending on patient and physician preferences, you may be given anesthesia instead. You will not feel the shock waves or experience pain from them; however, you will be given earphones to protect your ears from the noise they generate. Because several hundred shock waves will be needed to break up the stone, the procedure may last from half an hour to about two hours.
The success rate of SWL is 60% to 90%, depending on the location of the stone. Complications may include bruising on the back or abdomen, blood in the urine, and discomfort as the shattered fragments of the stone move through your urinary tract. You should be able to resume a normal schedule within a few days.
If an SWL procedure does not completely break up the kidney stone, you may need to undergo additional treatments. Your doctor also may perform ureteroscopic stone removal. In this procedure, a surgeon will insert a small telescope called a uretoscope into the ureter. The stone is then grasped with forceps and removed. A large stone may be shattered first with one of several different techniques. In addition to being used as a follow-up procedure to SWL, ureteroscopic stone removal is often used as a primary treatment to remove stones lodged in the ureter.
Percutaneous nephrolithotomy is used when SWL is not effective or the stone is exceptionally large or inaccessible. In this procedure, the surgeon makes a tiny incision in your back, then inserts a larger telescope called a nephroscope. The stone is then located and removed. Large stones are generally broken into smaller pieces before removal.
The prognosis depends on the cause of your kidney stone and your willingness to take medication, if prescribed, or follow other steps your doctor has recommended, such as diet and lifestyle changes. If you do not adhere to treatment recommendations, you may develop a new stone every two to three years. However, if you follow the prescribed recommendations, the medications and/or dietary changes can reduce your chance of forming another stone by 90% to 95%.
If you have had treatment for a kidney stone, such as SWL, but continue to experience pain, contact your physician. Some pieces of the stone may still be stuck in your urinary tract and will require additional treatment. Otherwise, follow the doctor’s recommendations for prevention of additional stones and routine check-ups.
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