Kidney Stone Prevention and Treatment FAQ

Are there lifestyle changes I can make that will help with kidney stone prevention?

The simplest and most important lifestyle change to prevent stones is to drink more liquids - bottled water is best. Anyone who forms recurrent stones should try to drink enough liquids throughout the day to produce at least two quarts of urine in every 24-hour period. If you have too much calcium or oxalate in the urine you may need to eat fewer foods containing calcium and oxalate. Not everyone, however, will benefit from a low-calcium diet. Some patients who have high levels of oxalate in their urine may benefit from extra calcium in their diet. You may be told to avoid food with added vitamin D and certain types of antacids that have a calcium base. Patients who have a very acid urine may need to eat less meat, fish, poultry and vitamin C. These foods increase the amount of acid in the urine.

To prevent cystine stones, patients should drink enough water each day to reduce the amount of cystine that escapes into the urine. This is difficult because more than a gallon of water may be needed every 24 hours, a third of which must be taken in during the night.

What medical therapies can be used to prevent kidney stones?

Certain medications may be prescribed to prevent calcium and uric acid stones. These drugs control the amount of acid or alkali in the urine, which are key factors in crystal formation. The drug allopurinol may also be useful in some cases of hypercalciuria and hyperuricosuria.

Another way hypercalciuria may be controlled (and thus, prevent calcium stones) is by prescribing certain diuretics, such as hydrochlorothiazide. These drugs decrease the amount of calcium released by the kidneys into the urine.

Some patients with absorptive hypercalciuria may be given the drug sodium cellulose phosphate. This drug binds calcium in the intestine and prevents it from leaking into the urine.

If drinking more fluids cannot control cystine stones, the drug Thiola may be prescribed. This medication helps reduce the amount of cystine in the urine.

For struvite stones that have been totally removed, the first line of prevention is to keep the urine free of bacteria that can cause infection. Your urine will be tested on a regular basis to be sure that bacteria are not present. If struvite stones cannot be removed, a new drug called aetohydroamic acid (AHA) may be prescribed. AHA is used along with long-term antibiotic drugs to prevent the infection that leads to stone growth.

To prevent calcium stones that form in hyperparathyroid patients, the parathyroid glands (located in the neck) may be removed. This is usually the treatment for hyperparathyroidism as well. In most cases, only one of the glands is enlarged. Gland removal halts further kidney stone production.

What surgical treatments can be used to prevent kidney stones?

Some type of surgery may be needed to remove a kidney stone if the stone:

  • Does not pass after a reasonable period of time and causes constant pain.
  • Is too large to pass on its own.
  • Blocks the urine flow.
  • Causes ongoing urinary tract infection.
  • Damages the kidney tissue or causes constant bleeding.
  • Has grown larger (as seen on follow-up X-ray studies).

Until recently, surgery to remove a stone was very painful and required a lengthy recovery time (four to six weeks). Today, treatment for these stones is greatly improved. Many options exist that do not require major surgery.

Extracorporeal shock wave lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) is the most frequently used surgical procedure for the treatment of kidney stones. ESWL uses shock waves that are created outside the body to travel through the skin and body tissues until the waves hit the dense stones. The stones become sand-like and are then easily passed through the urinary tract in the urine.

There are several types of ESWL devices. One device positions the patient in a water bath while the shock waves are transmitted. Other devices have a soft cushion or membrane on which the patient lies. Most devices use either X-rays or ultrasound to help pinpoint the stone during treatment. For most types of ESWL procedures, some type of anesthesia is needed.

ESWL may be done on an outpatient basis. Recovery time is short, and most people can resume normal activities in a few days.

Complications may occur with ESWL. Most patients have blood in the urine for a few days after treatment. Bruising and minor discomfort on the back or abdomen due to the shock waves are also common. To reduce the chances of complications, it is usually advised to avoid taking aspirin and other drugs that affect blood clotting for several weeks before treatment.

In addition, the shattered stone fragments may cause discomfort as they pass through the urinary tract in the urine. In some cases, the doctor will insert a small tube called a stent through the bladder into the ureter to help the fragments pass. Sometimes the stone is not completely shattered with one treatment and additional treatments may be required.

Percutaneous nephrolithotomy

Sometimes a procedure called percutaneous nephrolithotomy is recommended to remove a stone. This treatment is often used when the stone is quite large or in a location that does not allow effective use of EWSL.

In this procedure, a tiny incision is made in the back and a tunnel is created directly into the kidney. Using an instrument called a nephroscope, the stone is located and removed. For large stones, some type of energy probe (ultrasonic or electrohydraulic) may be needed to break the stone into small pieces. Generally, patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the healing process.

One advantage of percutaneous nephrolithotomy over ESWL is that the surgeon removes the stone fragments instead of relying on their natural passage from the kidney.

Ureteroscopic stone removal

Although some ureteral stones can be treated with ESWL, ureteroscopy may be needed for mid- and lower-ureter stones. No incision is made in this procedure. Instead, the surgeon passes a small fiberoptic instrument called a ureteroscope through the urethra and bladder into the ureter. The surgeon then locates the stone and either removes it with a cage-like device or shatters it with a special instrument that produces a form of shock waveshock wave. A small tube (a stent) may be left in the ureter for a few days after treatment to help heal the lining of the ureter.