How are Kidney Stones treated?
Anyone who has had a kidney stone will tell you that it can be one of the most painful experiences. The good news is that kidney stones are very treatable. Many small stones pass on their own with the right care at home, while larger stones can be removed or broken up using safe, well-established procedures, often without any large cuts.
Your doctor will recommend the approach that best suits the size and location of your stone, as well as your overall health.
Understanding Kidney Stones
Your kidneys are located in the abdomen on either side of the spine. They filter waste from your blood and make urine. Kidney stones form when minerals and salts in the urine build up and clump together into hard deposits, often because of a change in the chemical balance (the pH) of the urine, or because the urine becomes too concentrated. Stones can be as small as a grain of sand or, in some cases, as large as a golf ball.
There are different types of stones, and knowing which type you have helps to guide treatment and prevention:
- Calcium stones: The most common type, usually made of calcium oxalate. They can also be among the hardest to break down.
- Uric acid stones: Linked to a diet high in animal protein, gout, and urine that is persistently acidic.
- Struvite stones: Associated with repeated urinary tract infections, and can grow quickly to become large.
- Cystine stones: A rare type caused by an inherited condition.
A small stone may cause no symptoms while it stays in the kidney. Pain usually begins when a stone moves into the ureter, the narrow tube that carries urine from the kidney to the bladder. This can cause severe cramping pain in the side or back that comes and goes in waves, sometimes spreading to the groin, along with blood in the urine, nausea, or an urge to urinate more often.
Kidney stones are common in Singapore. Our warm, humid climate means that many of us lose a lot of fluid through sweat, and it is easy to become dehydrated without realising it, which makes urine more concentrated and stones more likely to form.
How Your Treatment is Planned
Treatment for kidney stones depends on the size of the stones, as well as where they are, what they are made of, whether they are causing blockage or infection, and your overall health. To work this out, your doctor will usually ask about your symptoms and medical history, and may arrange urine and blood tests and imaging such as an ultrasound, X-ray, or CT scan. These tests show the size and position of your stones and check how your kidneys are working.
Treating Small Stones
Small stones can often pass naturally through the urinary tract in your urine. During this time, your doctor may advise a few simple measures to help the stone along and keep you comfortable:
- Drink plenty of water: You might be advised to drink up to 3 litres of water throughout the day, every day, until the stones have cleared. Please check with your doctor first if you have heart or kidney problems or have been told to limit your fluids.
- Avoid carbonated drinks: Fizzy drinks may contribute to stone formation, so it is best to avoid them.
- Reduce your salt intake: A high-salt diet raises the amount of calcium in the urine, which makes stones more likely to form.
- Check the colour of your urine: Your urine should be pale in colour. Darker urine can be a sign that you are not drinking enough water.
- Pain relief: You will be prescribed pain relief medication to help you feel more comfortable while the stone passes. In some cases, your doctor may also prescribe medication that relaxes the ureter to make passing the stone easier.
- Antibiotics: If an infection is present, you will be prescribed antibiotics. An infection in the urinary tract along with a stone can be serious and needs to be treated promptly.
Treating Large Stones
Kidney stones that are too large to be passed naturally are removed by a procedure. The type of procedure depends on the size and location of your stones. The three main options are shock wave lithotripsy, percutaneous nephrolithotomy, and ureteroscopy.
- Shock Wave Lithotripsy (SWL)
Shock wave lithotripsy uses high-frequency sound waves to break large kidney stones into smaller pieces. These smaller fragments can then pass through the ureters into your bladder and out of your body in your urine. Because the sound waves are directed from outside the body, no incision is needed.
SWL can be an uncomfortable form of treatment, and light anaesthesia may be given before the procedure to keep you comfortable. It can cause bruising on the abdomen and back, and bleeding around the kidney and nearby organs. As the fragments pass, you may notice blood in your urine and some cramping pain. More than one session of SWL is usually needed to treat your kidney stones successfully.
- Percutaneous nephrolithotomy (PCNL)
Percutaneous nephrolithotomy is a procedure carried out under general anaesthesia, in which stones are removed through a small incision in your back. It may be performed in cases where the stone causes obstruction and infection, is damaging the kidneys, or has grown too large to pass and the pain cannot be managed.
During the procedure, a thin telescopic instrument called a nephroscope is passed through the incision in your back and into your kidney. The stone is either pulled out, or it may be broken into smaller pieces using laser energy. Because PCNL involves entering the kidney directly, it usually requires a short stay in hospital for monitoring, and a small tube may be left in place for a short time to drain the kidney while it heals.
- Ureteroscopy
A ureteroscope may be used when a stone is stuck in the ureter or bladder. Ureteroscopy is carried out under general anaesthesia and involves passing a long, thin telescope called a ureteroscope through the urethra and into your bladder, and up into the ureter. Because it goes through the body’s natural passages, no external incision is needed.
The stone may be removed, or laser energy may be used to break it into smaller pieces so that it can be passed naturally in your urine. The stone is sent to the laboratory for analysis, which helps your doctor to identify what it is made of and to advise on preventing future stones. Sometimes a thin, soft tube called a stent is left in the ureter for a short time to keep it open while it heals.
Recovery and Aftercare
Recovery depends on the procedure, but most people find that they are able to return to normal activities within days to a couple of weeks. Here are some things that are commonly experienced and helpful to know:
- Blood in the urine: It is common to see pink or red urine for a few days after a procedure, and this usually clears up on its own. Drinking plenty of water helps.
- Mild discomfort: You may have some soreness or cramping, especially as stone fragments pass. Your doctor will prescribe pain relief to keep you comfortable.
- Stent symptoms: If a stent has been placed, you may feel an urge to urinate more often, a burning sensation, or an ache in the side, particularly when you pass urine. These are temporary and stop once the stent is removed.
- Straining your urine: Your doctor may ask you to catch any stone fragments so that they can be analysed.
- Follow-up: You will have a follow-up appointment, often with a scan, to confirm that the stones have been cleared and to plan how to prevent new ones.
- Maintain a healthy weight and stay active: Excess weight and a sedentary lifestyle are linked to a higher risk of stones.
- Follow your doctor’s advice: If your stone analysis or urine tests show a particular cause, you may be given medication or specific dietary guidance. Our Dietetics and Nutrition service can offer personalised advice.
