The treatment goals for kidney stones are to relieve symptoms, remove stones, and prevent recurrence. Treatment plans 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 interventions, with physicians selecting the most appropriate strategy based on individual cases.
The treatment process is typically divided into three phases: acute pain relief, stone removal, and long-term preventive measures. The acute phase focuses on pain management and alleviating urinary obstruction, while stone removal may require a combination of medications and medical procedures. Preventive measures emphasize dietary adjustments and monitoring urine composition to reduce future risks.
Stones smaller than 5 millimeters have a high likelihood of passing on their own. Physicians often recommend that patients drink plenty of water, aiming for 2-3 liters per day to facilitate stone movement. Additionally, alpha-blockers (such as tamsulosin) can relax the smooth muscles of the urinary tract, accelerating stone passage. This medication can be used in conjunction with pain relievers to help patients safely wait at home for the stones to pass naturally.
Extracorporeal shock wave lithotripsy (ESWL) is another common option, utilizing high-frequency sound waves to break stones into smaller fragments that can be passed naturally. This therapy is suitable for stones located in the upper part of the kidney, but it may cause pain or hematuria during stone passage, requiring evaluation by a professional team for indications.
When stones obstruct the urinary tract or cause infection, endoscopic surgery may be necessary. Percutaneous nephrolithotomy (PCNL) is suitable for stones larger than 2 centimeters, where the physician makes a small incision in the back to directly access the kidney and remove the stones. This surgery requires general anesthesia but has a clearance rate of over 90%.
Ureteroscopy (URS) involves inserting an endoscope through the urethra to break stones using lasers or mechanical lithotripters. This method is suitable for stones in the lower urinary tract or the lower pole of the kidney, with a short hospital stay and fewer complications.
Medication treatment 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. Dissolution medications must target the composition of the stones; for example, patients with uric acid stones may take potassium citrate to adjust urine pH.
Physicians may prescribe specific stone dissolution medications, such as cystine therapy for cystine stones, but these require long-term use and effectiveness may vary by individual. Medication treatment should be accompanied by regular urine tests to assess efficacy and adjust the medication plan.
After shock wave lithotripsy, extracorporeal ultrasound treatment is often combined to promote the passage of small fragments. Some medical centers offer specialized vibrating beds or catheters to assist, using mechanical vibrations to increase the likelihood of stone movement. These techniques are typically used in conjunction with increased fluid intake to enhance the natural passage rate.
Acute pain management combines pharmacological 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 a hospital setting, patient-controlled analgesia (PCA) may be used to precisely control the dosage of pain medication.
A low-calcium diet was once recommended, but recent studies indicate that a balanced intake of calcium while reducing high-oxalate foods (such as spinach and chocolate) is more effective. Physicians often recommend a daily intake of 2.5-3 liters of water 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 for calcium, uric acid, oxalate, and other indicators. Using home urine pH test strips daily, they should record urination frequency and pain levels. This data can assist physicians in timely adjusting treatment plans.
Emerging extracorporeal shock wave technologies are being developed, combining imaging guidance for more precise stone localization. Nanotechnology may be used in the future to create targeted medications that directly break down minerals on the surface of stones. Artificial intelligence systems are under development to automatically generate personalized dietary recommendations based on stone composition.
The field of bioengineering is attempting to use gene therapy to repair metabolic disorders, such as in patients with hereditary stones due to renal tubular reabsorption abnormalities. Minimally invasive surgical instruments are also continuously being improved, such as foldable laser probes that can handle more complex renal anatomical structures.
Immediate medical attention should be sought when experiencing severe flank pain, hematuria, or fever. If stones exceed 1 centimeter, obstruct the urinary tract, or are associated with renal dysfunction, evaluation by a urologist is necessary to assess the need for surgery. Patients who continue to form new stones annually despite dietary control should undergo metabolic evaluation to develop a personalized prevention plan.
Special populations, such as those who have undergone kidney transplants or have a family history of hereditary stone disease, should undergo urine and blood tests every six months. Physicians may recommend stone composition analysis, which helps in developing long-term prevention strategies, such as specific mineral supplementation or medication prophylaxis.
After treatment, dietary adjustments should be made based on stone composition; for example, patients with calcium oxalate stones should reduce intake of spinach and nuts, while those with uric acid stones should limit high-purine foods such as organ meats and rich broths. A daily intake of 2.5-3 liters of water is recommended, and consulting a nutritionist to create a personalized dietary plan can help reduce the risk of recurrence.
What are the differences between extracorporeal shock wave lithotripsy and ureteroscopy?Extracorporeal shock wave lithotripsy (ESWL) uses sound waves to break stones from outside the body, suitable for smaller and higher-positioned stones; ureteroscopy requires inserting an endoscope through the urethra to directly remove or fragment stones, suitable for larger or uniquely positioned stones. The recovery time and complication risks differ between the two, requiring physician evaluation for selection.
What should I do if pain worsens during non-invasive treatment?If pain becomes unbearable or is accompanied by fever or hematuria during extracorporeal shock wave therapy or medication passage, immediate medical attention should be sought. Physicians may adjust pain medication dosages or switch to other treatment methods; do not delay seeking medical care to avoid worsening complications.
What regular checks do kidney stone patients need after surgery?After treatment, it is recommended to conduct urine analysis and abdominal X-rays or ultrasounds every 6-12 months to track residual or new stone formation. If there have been recurrent episodes, a 24-hour urine analysis may be necessary to evaluate metabolic factors and adjust prevention strategies.
Is it reliable that "herbal teas can naturally dissolve stones"?Currently, there is no scientific evidence that specific herbal teas can safely dissolve stones; some folk remedies may increase the burden on the kidneys or interact with medications. Treatment should rely on medical methods, such as extracorporeal shock wave therapy or surgery, and dietary adjustments should be made under physician guidance.
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