Hospital Treatment For Kidney Stones: What To Expect

Kidney stones are a common and painful condition that affects millions of people each year. While kidney stones can often be treated at home, there are times when a trip to the emergency room is necessary. Treatment for kidney stones depends on the size and type of kidney stone. In some cases, surgery may be required to remove the stone, either through a non-invasive shockwave treatment procedure (lithotripsy) or a ureteroscopy, where a small scope is used to remove the stone. After surgery, a tube or stent may be left in the kidney or ureter to help drain urine. Other treatments include medication, drinking enough liquids, changing one's diet, and in the case of calcium stones, surgery to remove the abnormal parathyroid gland.

Emergency room procedures

If you are experiencing any of the following symptoms, you should go to an emergency room immediately:

• Intolerable kidney stone pain despite taking prescription painkillers
• Fever, chills, nausea, and vomiting, which can be signs of infection
• A burning sensation when urinating, difficulty urinating, or inability to urinate, which could be symptoms of a blockage
• Cloudy, pink, or foul-smelling urine, indicating the presence of blood or bacteria
• Certain medical conditions, such as diabetes or decreased kidney function, that increase the risk associated with passing a kidney stone

Once at the emergency room, the ER provider will typically start by taking blood and urine samples to confirm the presence of kidney stones and look for signs of infection. They may also perform imaging tests, such as X-rays and CT scans, to determine the size and location of the kidney stone and assess any potential obstructions or blockages.

Based on the findings, the ER doctor will decide if a urology consultation is required immediately or if it can wait. In the meantime, intravenous medications, such as ketorolac (Toradol) and opioids or narcotics, may be administered to manage pain.

Non-invasive treatments

Increasing fluid intake

Drinking enough liquids, primarily water, is a simple yet effective way to prevent kidney stones. Water helps to flush out the kidneys and prevent the buildup of minerals and salts that can form stones. The recommended amount is six to eight 8-ounce glasses of water per day, but this may vary depending on climate, activity level, and individual health considerations. Other fluids such as citrus drinks, particularly lemonade and orange juice, are also beneficial due to their citrate content, which inhibits the formation of stones.

Medication

Intravenous medications are often used to manage kidney stone pain. The most common medication is ketorolac (Toradol), a strong NSAID that is more effective than opioids for pain relief. Opioids or narcotics like hydrocodone, oxycodone, and morphine are sometimes used in conjunction with NSAIDs but can cause side effects such as nausea, vomiting, and constipation.

Shockwave Lithotripsy (SWL)

SWL is a non-invasive procedure that uses ultrasound to locate the kidney stone and then break it into smaller pieces with shock waves. This allows the stone to be passed naturally in the urine. SWL may require multiple sessions and is usually performed after administering pain medication, as it can be uncomfortable.

Ureteroscopy

This procedure involves inserting a thin telescope called a ureteroscope through the urethra, bladder, and into the ureter. The surgeon then attempts to remove the stone directly or break it into smaller pieces using laser energy, allowing it to be passed out in the urine. Ureteroscopy is considered a minimally invasive procedure and is often used for stones located in the lower ureter.

Prevention and Lifestyle Changes

Making certain lifestyle changes can help prevent kidney stones from forming or recurring. These include increasing fluid intake, modifying diet to reduce salt intake and promote a healthy weight, and taking prescribed medications. For those with hyperparathyroidism, surgery to remove the abnormal parathyroid gland may be recommended to prevent calcium stones.

Surgical procedures

• Shock Wave Lithotripsy (SWL): This procedure uses ultrasound (high-frequency sound waves) to locate the kidney stone. Ultrasound shock waves are then directed at the stone to break it into smaller fragments that can be passed out in the urine. SWL is often performed after administering painkillers, as it can be uncomfortable. Multiple sessions may be required for complete stone fragmentation.
• Ureteroscopy: This procedure involves inserting a thin, flexible telescope called a ureteroscope into the urethra and advancing it through the bladder and up the ureter to reach the kidney stone. The surgeon then attempts to either retrieve the stone using specialized instruments or break it up with laser energy into manageable pieces that can be naturally eliminated through urination.
• Percutaneous Nephrolithotomy (PCNL): PCNL is a surgical procedure performed under general anaesthesia. It involves making a small incision in the patient's back and inserting a nephroscope into the kidney to locate the stone. The stone is then either extracted or fragmented using a laser or pneumatic energy. PCNL is generally used for larger kidney stones and may result in certain complications, which the surgeon should explain beforehand.
• Nephrectomy and Parathyroidectomy: In some cases, kidney stones may be caused by hyperparathyroidism, a condition characterized by abnormally high calcium levels in the blood. Treatment for this condition involves surgery to remove the affected parathyroid gland, which can cure hyperparathyroidism and prevent future kidney stones.

After surgical procedures, a ureteral stent (a thin, flexible tube) may be left in the urinary tract to aid in urine flow and ensure the passage of any remaining stone fragments. Patients may experience discomfort and notice blood in their urine for a few days as the stone fragments exit their bodies.

Pain management

Kidney stones are a painful condition that affects millions of people each year. While some cases can be treated at home, more severe symptoms may require a visit to the emergency room. The treatment provided by hospitals for kidney stone pain depends on the size and type of kidney stone.

The pain associated with kidney stones occurs when there is a blockage of urine in the ureter, which is the tube connecting the kidney to the bladder. This blockage causes a backflow of pressure that stretches out the plumbing system of the kidneys. The resulting visceral pain is severe because the body is signalling that a vital organ is in trouble.

If over-the-counter pain medication does not provide relief, it is recommended to visit the emergency room. There, intravenous medications are used to manage kidney stone pain. The most commonly used drug is ketorolac (Toradol), a strong NSAID that is more effective than most opioids. Caution must be exercised when administering ketorolac to patients with acid reflux, ulcers, or kidney dysfunction. Opioids or narcotics, such as hydrocodone, oxycodone, morphine, and hydromorphone, are often used in combination with NSAIDs. While these medications provide effective pain relief, they can also cause nausea, vomiting, and constipation.

In cases where the kidney stone has grown too large, surgery may be required to remove it. One non-invasive procedure is shockwave treatment (lithotripsy), which uses ultrasound to break the stone into smaller pieces that can be passed in the urine. This method can be uncomfortable, so it is typically performed after administering painkilling medication. Another surgical option is percutaneous nephrolithotomy (PCNL), which involves making a small incision in the back and passing a nephroscope into the kidney to remove the stone or break it into smaller pieces using a laser or pneumatic energy. PCNL is performed under general anaesthesia, and patients may need to stay in the hospital for several days after the procedure.

Prevention

To prevent kidney stones from forming, it is recommended to make changes to your diet. Doctors advise drinking plenty of fluids, including water, to dilute your urine and prevent kidney stones from forming and growing. Staying well-hydrated is especially important during exercise or activities that cause sweating, as loss of water through sweating leads to reduced urine production, allowing stone-causing minerals to settle and bond in the kidneys and urinary tract.

In addition to staying hydrated, it is recommended to limit your intake of animal-based protein to 6 to 8 ounces per day, as excessive animal protein can contribute to kidney stone development. Eating more fruits and vegetables can also help prevent kidney stones. For those with calcium oxalate kidney stones, it is advisable to reduce your consumption of foods high in oxalate, such as beets, black pepper, black tea, chocolate, nuts, potatoes, rhubarb, soy products, and spinach.

To prevent uric acid stones, it is best to avoid high-purine foods like red meat, organ meats, and shellfish. Instead, opt for a diet rich in fruits and vegetables, whole grains, and low-fat dairy products. It is also important to limit sugar-sweetened foods and drinks, especially those containing high-fructose corn syrup, as well as alcohol, as these can increase uric acid levels.

For chronic kidney stones, urine pH levels can be balanced by taking alkali citrate, which can be prescribed or purchased over-the-counter. Citrus juices contain citrate (citric acid), but large amounts may be needed to achieve the desired effect. Alkali citrate can also be combined with minerals such as sodium, potassium, or magnesium to prevent stone formation.

Frequently asked questions