So, you have a kidney stone. Ouch! First off, we’re sorry, believe us, we know it’s painful. But there are ways to treat them. Here’s how we decide what to do, based on where in the urinary tract the stone is, how big it is and how much pain it’s causing.
Let’s start with the really miserable ones — the stones that have dropped out of the kidney and into the ureter (the small tube linking the kidney to the bladder). “Passing” a stone (moving it through the ureter from kidney to bladder) can be excruciating, but that pain is generally over once it’s passed. While the stone is in the ureter, however, it obstructs the flow of urine to the bladder, causing it to accumulate in the kidney and causes stretching of the kidney. This causes not only pain but also nausea.
So what do you do if you have a stone in the ureter?
If the stone is small (less than 5mm or so), there’s a good chance that it will successfully pass, but the process can be rough, and you’ll likely need medication to help with pain and nausea, as well as medicines to dilate the ureter. If the process becomes unbearable or if the stone is so large it is unlikely to pass, we can intervene with surgery.
For ureteral stones, there are two types of procedures to either break up or pull out the stone. The first way is the less invasive by far, but also the more unpredictable in terms of outcome. It is called extracorporeal shockwave lithotripsy (ESWL). ESWL entails no cuts, scopes, or other invasive elements, but instead uses waves of energy transmitted through the body from the outside to pulverize the stone into small fragments, which can easily be passed. In most cases this is successful, although very dense stones may not fragment as well.
The second option, called ureteroscopy, uses a small telescope, passed up the urethra, into the bladder, then through the ureter until the stone is encountered. At that time the stone can either be pulled out whole using a special type of basket device, or if it is larger we can use a laser to fragment it before pulling out the fragments. Because this is done by directly visualizing the stone with a scope, it is slightly more likely to be successful than ESWL. However, ureteroscopy is of course also slightly more invasive than ESWL, making recovery just a bit more extensive.
At the Kidney Stone Center of Charleston, we can help you during a painful kidney stone event by relieving your pain and nausea with IV medications and by a board certified urologist reviewing your CT or X-ray with you and counseling you on your options. If you choose to have your stone treated surgically, we will do everything possible to do so promptly and effectively. There is no need to wait for an appointment or go to the ER. Walk-ins are welcome.
By Dr. Dennis Kubinski, a board certified urologist with Charleston Urology Associates and a Roper St. Francis Physician Partner
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