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
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
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
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
- Does not pass after a reasonable period of time and causes
- 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.
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
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.