The goal of kidney stone treatment is to alleviate symptoms, remove the stones, and prevent recurrence. The treatment plan should be tailored based on the size, location, composition of the stones, and the overall health status of the patient. Modern medical technology offers a variety of treatment options, ranging from non-invasive therapies to surgical procedures, with physicians selecting the most appropriate strategy based on individual cases.
The treatment process typically involves three stages: acute pain relief, stone removal, and long-term prevention measures. The acute phase focuses on pain management and relieving urinary obstruction, while stone removal may involve medications and medical procedures. Prevention emphasizes dietary adjustments and urine component monitoring to reduce future risks.
Small stones less than 5 millimeters have a high likelihood of passing spontaneously. Physicians often recommend increased water intake, with a daily consumption of 2-3 liters to promote stone movement. Additionally, alpha-blockers (such as tamsulosin) can relax the smooth muscles of the urinary tract, accelerating stone expulsion. These medications can be combined with pain relievers, allowing patients to safely wait at home for natural stone passage.
Extracorporeal Shock Wave Lithotripsy (ESWL) is another common option, using high-frequency sound waves to break stones into smaller fragments for spontaneous passage. This method is suitable for stones in the upper part of the kidney but may cause pain or hematuria during stone passage, requiring assessment by a specialized team to determine suitability.
When stones obstruct the urinary tract or cause infections, endoscopic surgery may be necessary. Percutaneous Nephrolithotomy (PCNL) is suitable for stones larger than 2 centimeters. The surgeon makes a small incision in the back to directly access the kidney and remove the stones. This procedure requires general anesthesia but has a removal success rate exceeding 90%.
Ureteroscopy (URS) involves inserting an endoscope through the urethra to fragment the stones using laser or mechanical lithotripters. This method is suitable for stones in the lower urinary tract or lower pole of the kidney, with shorter hospital stays and fewer complications.
Medication therapy is divided into acute relief and stone dissolution. Non-steroidal anti-inflammatory drugs (NSAIDs) or opioids are used to control severe pain, while muscle relaxants can alleviate muscle spasms caused by stone movement. Drugs for stone dissolution should target the stone's composition; for example, uric acid stones can be treated with potassium citrate to regulate urine pH.
Physicians may prescribe specific stone-dissolving medications, such as cystamine for cystine stones, which require long-term use with variable effectiveness. Regular urine tests are necessary to evaluate treatment efficacy and adjust medication plans accordingly.
After ESWL, it is common to combine with extracorporeal ultrasound therapy to promote the expulsion of small fragments. Some medical centers offer special vibrating beds or catheter-assisted methods to increase the likelihood of stone movement through mechanical vibration. These techniques are usually combined with increased water intake to enhance natural expulsion rates.
Acute pain management combines medication and non-pharmacological methods. Applying heat to the lower abdomen can temporarily relieve muscle tension, while breathing exercises and relaxation techniques can reduce pain perception. In hospital settings, patient-controlled analgesia (PCA) systems may be used to precisely control pain medication dosages.
Low-calcium diets were once recommended, but recent studies suggest that a balanced intake of calcium and reduction of high-oxalate foods (such as spinach and chocolate) are more effective. Physicians often advise drinking 2.5-3 liters of water daily and limiting high-purine foods (such as organ meats and sardines) to reduce the risk of uric acid stones.
Patients should regularly collect 24-hour urine samples to test calcium, uric acid, oxalate, and other indicators. Using home urine pH test strips daily and recording urination frequency and pain levels can help physicians adjust treatment plans in a timely manner.
Emerging extracorporeal shock wave technologies are being developed, with image-guided systems for more precise stone localization. Nanotechnology may be used in the future to create targeted drugs that directly dissolve mineral deposits on the stone surface. Artificial intelligence systems are under development to generate personalized dietary recommendations based on stone composition.
In the field of bioengineering, efforts are underway to use gene therapy to repair metabolic abnormalities, such as hereditary stones caused by renal tubular reabsorption defects. Minimally invasive surgical devices are also being improved, such as foldable laser probes capable of handling more complex renal anatomies.
If severe back pain, hematuria, or fever occurs, immediate medical attention is necessary. For stones larger than 1 centimeter, obstructing the urinary tract, or associated with renal dysfunction, evaluation by a urologist for surgical intervention is recommended. Patients who continue to form new stones annually despite dietary control should undergo metabolic assessment to develop a personalized prevention plan.
Special populations, such as those with kidney transplants or a family history of hereditary stones, should have urine and blood tests every six months. Physicians may recommend stone component analysis to help formulate long-term prevention strategies, including specific mineral supplementation or medication.
Post-treatment, dietary adjustments should be based on stone composition. For calcium oxalate stones, reduce intake of spinach and nuts; for uric acid stones, limit high-purine foods such as organ meats and rich broths. It is recommended to drink 2.5-3 liters of water daily and consult a nutritionist to develop a personalized diet plan to reduce recurrence risk.
What are the differences between extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy?ESWL uses sound waves from outside the body to fragment stones and is suitable for smaller, higher-positioned stones. Ureteroscopy involves inserting an endoscope through the urethra to directly remove or break stones, suitable for larger or specially located stones. The recovery times and complication risks differ between the two, and should be evaluated by a physician for appropriate selection.
What should be done if pain worsens during non-invasive treatment?If pain becomes unbearable or is accompanied by fever or hematuria during ESWL or medication therapy, immediate medical attention is required. The physician may adjust pain medication or switch to alternative treatments. Do not delay seeking medical care to prevent complications from worsening.
What follow-up examinations are recommended after kidney stone treatment?It is advised to undergo urine analysis and abdominal X-ray or ultrasound every 6-12 months to monitor for residual or new stones. For recurrent cases, 24-hour urine analysis may be necessary to evaluate metabolic factors and adjust prevention strategies.
Is the folk belief that herbal teas can naturally dissolve stones reliable?There is currently no scientific evidence supporting that specific herbal teas can safely dissolve stones. Some folk remedies may increase kidney burden or interact with medications. Treatment should rely on medical methods such as ESWL or surgery, complemented by dietary adjustments under medical supervision.
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