The first step is to identify any emergency cases, which require medical attention immediately. Such cases would include the presence of pathogenic organisms or their toxins in the blood or tissues along with an obstructing stone, anuria and acute renal failure. In addition, patients unable to continue with regular oral intake, those suffering through severe pain, and old patients must be hospitalized soon after kidney stones are detected as a cause behind their discomfort.



For those patients who are not bedridden, early management of kidney stones would include adequate analgesia, timely urologic consultation and close follow-up. As far as analgesia is concerned, it works to numb the sense of pain while retaining consciousness. Narcotics such as codeine, morphine and meperidine (Demerol) are effective in suppressing pain, they do nothing to treat its underlying cause, and they have the side effects of dependence and disorientation. However, aspirin, diclofenac and ibuprofen effectively manage the pain of kidney stones.

After all emergencies have been taken care of, and the pain has been subdued with the help of medication, it is time to manage the stone itself. Kidney Stone management involves two main factors, which are the stone size and its location.

The size of a kidney stone determines whether it can be passed out of the body without any kind of intervention or not. Any stones smaller than 5mm can easily pass out of the body within one or two weeks. In fact, in 80% of the patients, kidney stones pass out on their own, without any other treatment. If electing for this conservative treatment, it is recommended to have regular follow-ups to check for any signs of sepsis and the size of the stone. It is also advisable to collect the stone while urinating, using a kidney stone sieve. This stone can be treated in the laboratory to discover its composition, which in turn provides important information for the prevention of future stones. Medical surveillance must be continued until stone passage is documented.

In case the size of the stone is larger than 5mm, it is not advisable to wait for treatment for more than three weeks. You must discuss the various possible treatments for your stone and choose the one that is most suitable.

Stones that do not cause nor exhibit any symptoms of disease may be treated conventionally. However, it must be understood that about 50 percent of small kidney stones become symptomatic within five years of detection. Stag horn kidney stones, especially, must be treated as soon as they are detected in order to avoid any kind of infection, which is associated with these stones. Treatments available are extracorporeal shock wave lithotripsy and Percutaneous Nephrolithotomy. The best thing is to arrive at the best possible treatment as advised by the urologist’s judgment and experience in combination with due thought given to the patients preferences.