Kidney Stones

Treatment

Based on the type of stone and the cause, Mayo Clinic physicians will recommend an appropriate treatment and prevention plan tailored to each patient.

Waiting and Watching

In about 85 percent of cases, kidney stones are small enough to pass during urination, usually within 72 hours of symptom onset. The best treatment for these stones is to drink plenty of water (as much as 2 to 3 quarts per day), stay physically active and wait. Painkillers may be prescribed to help alleviate the discomfort associated with passing a stone.

For patients who can pass a stone without medical intervention, urinating through a strainer may be recommended so that the stone can be recovered and analyzed. The mineral composition of the kidney stone will dictate appropriate treatment and future preventive measures.

Stones that are too large to pass on their own or that may cause bleeding, kidney damage or ongoing urinary tract infection may need surgical treatment.

Minimally Invasive Treatments

Extracorporeal Shock Wave Lithotripsy (ESWL)

This procedure is the usual treatment to remove stones about 1 centimeter or smaller. Mayo Clinic was among the first medical centers in the United States to use shock waves for treatment of kidney stones.

Patients lie on a cushion during the procedure. In many cases the stone will begin to crumble after 200 to 400 shock waves. The sandlike particles that remain after treatment are easily passed in the urine.

The shock waves are painful, so the procedure is performed with sedatives, local anesthesia or general anesthesia.

Some side effects of extracorporeal shock wave lithotripsy include blood in the urine for a short time after the procedure and minor bruising on the back or abdomen. Some patients may also experience discomfort as the stone fragments pass through the urinary tract. Others may need another treatment if the stone doesn't shatter completely. Most patients resume normal activity in a few days, but it may take months for all stone fragments to pass.

Percutaneous Nephrolithotomy

Mayo surgeon removes large stones with a nephroscope.

When lithotripsy isn't effective, or the kidney stone is very large, a surgeon may remove it through a small incision in the back, using a nephroscope. The procedure, percutaneous nephrolithotomy, is performed using general anesthesia. Patients usually stay in the hospital for one to two days, with additional recovery time of one to two weeks.

After the nephroscope is inserted into the kidney, the urologist threads an ultrasonic probe or laser through the nephroscope to break up the stones and extract them. All stones and fragments are removed through the nephroscope during the procedure; none are left to pass through the urinary tract.

Mayo Clinic doctors performed the first percutaneous ultrasonic stone removal in the United States in 1981, and have treated thousands of patients since then. Experienced Mayo Clinic urologists have a 95 percent success rate in clearing all stones with percutaneous nephrolithotomy. Mayo physicians recommend this procedure for people whose stones are too large for other procedures and who are amenable to this procedure, or for those who need to be stone-free either for health reasons or because of their jobs, such as a heavy-equipment operator or airline pilot. In these professions, sudden pain due to passing stone fragments would endanger the person and others, so removal of all stone pieces is essential.

Ureteroscopic Stone Removal

This procedure is used to remove stones that are lodged in a ureter, and is usually performed on an outpatient basis while the patient is sedated with general or local anesthesia. The surgeon passes a small ureteroscope through the bladder into the ureter to snare the stone. In some cases, the surgeon will shatter the stone using a laser or a technique called electrohydraulic lithotripsy. To relieve swelling and help with healing, the surgeon may then place a small tube (stent) in the ureter for two to three days.

Mayo Clinic physicians were among the first in the world to perform ureteroscopic stone removal, and were also instrumental in refining and improving the procedure. Today, Mayo physicians who specialize in stone removal perform many ureteroscopic stone removals every year.

Parathyroid Surgery

Some calcium stones are caused by overactive parathyroid glands, which are located on the four corners of the thyroid gland. Usually, a small benign growth in one of these glands causes it to be overactive. As a result, the body's level of calcium becomes too high, which can lead to kidney stone formation. Removing the growth on the parathyroid gland will cure the kidney stone problem. This operation is performed by a general surgeon, not a urologist.