This will depend on a number of factors such as the size of the stone, location, symptoms, presence of fever, findings of the urine and blood tests and also patient choice.
In principal stones can be treated by:
- Observation – Small stones will often without treatment and if symptoms are manageable it is often safe to leave them for up to 2 weeks. Your urologist may start you on medication to help stones pass.
- Shock wave lithotripsy – The procedure works like ultrasound and uses shock waves to break your kidney stones into small sand-like particles that can then pass out of your body through your urine. It is performed as a day procedure and avoids the need for a general anaesthetic. During the procedure, you lie on the machine and x-rays are used to find and target your stone. Shocks are then delivered to the stone. The treatment lasts about 40 minutes and delivers around 3,000 shock waves, which pass through your body to break the stone into fragments. It is not suitable for all stones and your urologist will advise you on this. Success rates vary depending on stone size, composition and location.
- Ureteroscopy – This is a procedure that involves a fine telescope being passed through the bladder (via your urethra) and up the ureter to the kidney. It is performed under general anaesthetic. Once the stone is found a laser is used to fragment and vaporise the stone into tiny pieces. Usually the holmium laser is used which is able to break all types of stone. This procedure is generally suitable for stones up to 1.5cm in size and usually takes 60 minutes to complete. Commonly a plastic tube (known as a JJ stent) is inserted afterwards – this runs from the kidney to the bladder and allows the urine to drain and protects the ureter.
- Percutaneous surgery (PCNL) – This is used for larger stone burdens in the kidney which are generally not suitable for lithotripsy or ureteroscopy. A telescope is placed through the back using x-ray guidance with the aim of removing large volumes of stone. It is performed under general anaesthesia and usually requires 2-4 days in hospital.
Your urologist will discuss with you in detail the above treatments to ensure that the correct treatment is tailored to your needs and your stone burden/ location.