Kidney stone removal treatment is a medical procedure targeting stones in the kidneys or urinary tract, primarily aimed at relieving obstruction, alleviating pain, and preventing complications. This treatment is suitable for stones that cannot be passed spontaneously and may cause renal impairment or recurrent infections. Based on the size, location of the stones, and the patient's health status, the physician will select the most appropriate treatment method.
The main treatment options include Extracorporeal Shock Wave Lithotripsy (ESWL), endoscopic stone removal, and surgical extraction. ESWL uses high-frequency sound waves to break stones into small fragments for expulsion with urine; endoscopic removal involves inserting a scope through the urethra or ureter, combined with laser or grasping tools to remove stones; surgical removal is suitable for large or multiple stones.
Other non-invasive methods such as chemical dissolution or combined ESWL and medication are applicable for stones with specific chemical compositions (e.g., uric acid stones). The treatment mechanism should be adjusted based on stone composition analysis to improve success rates.
This treatment is indicated for stones larger than 0.6 cm in diameter, or cases with severe pain, urinary obstruction, or recurrent infections. If the stones cause abnormal kidney function or ureteral strictures, removal is prioritized. Patients with specific conditions such as hypercalciuria or metabolic abnormalities may require combined treatment and medication control.
ESWL is usually performed in radiology departments, requiring localization of the stone followed by setting shock wave frequency and energy levels. Endoscopic treatment requires local or general anesthesia, with an operation time of approximately 1 to 2 hours. Medication treatments such as diuretics or specific acid-base regulators should be adjusted according to the chemical composition of the stones.
New technologies like minimally invasive endoscopy can reduce incisions and lower infection risks, suitable for elderly or frail patients.
ESWL may cause hematuria, back pain, or residual fragments requiring secondary treatment. Endoscopic procedures may lead to urethral mucosal injury or infection. Risks associated with general anesthesia include airway obstruction or allergic reactions. About 5-10% of patients may experience short-term hematuria or increased pain during stone passage.
Contraindications include:
Pre-treatment imaging examinations are necessary to confirm the location of the stones and assess whether kidney function permits shock wave therapy.
Patients on anticoagulants (such as warfarin) should temporarily discontinue medication and switch to low-molecular-weight heparin. When combined with analgesics, kidney function should be monitored to prevent drug interactions that could worsen renal damage.
ESWL has a success rate of 70-90% for kidney stones less than 2 cm in diameter, but the recurrence rate is approximately 10-20%. Endoscopic treatment can achieve a stone clearance rate of over 95% for lower urinary tract stones. Long-term follow-up shows that combining medication for prevention can reduce the five-year recurrence rate by 40%.
Medical treatments such as allopurinol for uric acid stones can dissolve stones, or diuretics can promote the passage of small stones. Patients unsuitable for ESWL may opt for percutaneous nephrolithotomy (PCNL), though it involves greater trauma. Conservative treatments like high fluid intake and positional drainage are only suitable for stones smaller than 0.5 cm in diameter.
Before kidney stone removal surgery, urine analysis, abdominal X-ray or computed tomography scans are usually performed to confirm the size, location, and shape of the stones. The doctor may ask the patient to stop anticoagulant medications and arrange for kidney function tests. Fasting and water restriction for 8 hours before surgery are necessary to reduce anesthesia risks.
How can pain be relieved during recovery?Pain after surgery can typically be controlled with prescribed analgesics, such as non-steroidal anti-inflammatory drugs or mild opioids. For ESWL, cold compresses on the waist may help reduce swelling. Patients should avoid heavy lifting or vigorous activities and follow the doctor’s instructions for pain medication use.
What dietary precautions should be taken after kidney stone removal?Dietary adjustments are key to preventing recurrence. It is recommended to drink 2-3 liters of water daily, reduce high-oxalate foods (such as chocolate and spinach), and control animal protein intake. Patients with high uric acid should avoid organ meats and high-purine foods, and increase fiber intake to promote metabolism.
How do recurrence rates differ between treatment methods?Short-term recurrence rates for ESWL and endoscopic stone removal are about 5-10%, but long-term risk can be reduced with dietary control after stone removal. If stones are related to metabolic abnormalities (e.g., hypercalciuria), long-term medication such as thiazide diuretics may be necessary to lower recurrence risk.
How long after surgery can normal activities be resumed?Recovery time varies by treatment: after ESWL, light activities can resume in 2-3 days, with gradual increase over a week. After endoscopic or percutaneous nephrolithotomy, rest for 1-2 weeks is recommended. Patients should avoid strenuous exercise within 4 weeks post-operation and follow medical advice to gradually restore physical activity.
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