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Ask the Expert: Kidney Stones

September 14, 2018

Q&A with Matthew Hall, MD

Q: My doctor told me I have a kidney stone. How can I prevent and treat stones in the future?

A: If you suspect you have kidney stones, it is important to see your urologist. Larger kidney stones and stones in the ureter (the tube that drains the urine from the kidney to the bladder) need to be assessed for removal, as do stones causing pain, infection or obstruction.

Treatment Options

Once it has been determined that the stone will not pass or needs to be treated based on size, usually 5 millimeters (mm) or larger, there are three minimally invasive options for stone removal: percutaneous nephrolithotomy or PNL, which involves putting a scope through a small opening in the back and into the kidney to remove stones via ultrasound; ureteroscopy, where a small camera is placed up the ureter, then a laser is used to break the stones; and extracorporeal shock wave lithotripsy (ESWL), where ultrasound waves are used to break up stones from outside the body.

ESWL or ureteroscopy are good options for managing stones in the ureter. ESWL is the treatment of choice for most small kidney stones, while PNL is the preferred method of stone removal for larger renal stones.

Preventing Stones

A variety of medical treatments may help to prevent future stones. Dehydration is linked to 90 percent of stones. A patient’s goal should be 100 oz. water daily as long as he or she has no medical contraindication. Your urologist will send you for a study to discover why you are forming stones. Some patients have elevated calcium in urine which may be treated with diuretics; low citrate in urine is treated with potassium citrate; and low urine pH is treated with sodium bicarbonate.

With medical treatment, more than 75 percent of stones can be prevented, however, medications do not dissolve preexisting calcium stones.