Kidney stone has become a fairly common problem in India and roughly around 10 to 15% of the population suffers from kidney stone once in lifetime. 50 to 70% of these kidney stone patients will form a stone repeatedly. So, it is a common and a very natural question, that if we are suffering from kidney stone, is it always required to undergo a surgery ? We would be interested in knowing if there is any way in which we can avoid surgery to treat kidney stones. International guidelines mention that not all kidney stones will need surgical therapy for treatment. It has been found in the researches that small kidney stones will pass on their own with the urine flow. Sometimes adding a medicine helps in the expulsion of this stone in certain circumstances. Let us find out if it is possible to treat a kidney stone or a stone which has moved down from the kidney into the urine pipe, the ureters, without any surgical treatment.
Does Your Kidney Stone Qualify Non-Surgical Removal?
It is necessary to understand that the first priority of kidney stone treatment is to save kidney function. Further down this article we will understand what are the special types of kidney stones and what are the clinical circumstances when it is safe to wait and take a trial of medical therapy. It is advisable to first observe a kidney stone before straightaway going for a surgery. This is true even if a stone is in the ureter for a few days or a few weeks, provided the stone is not causing substantial obstruction and infection. As per the national and international guidelines the kidney stones or the ureteric stones which have the following characteristics can be observed or can be considered for medical treatment instead of going for the surgical therapy as the first option:
1. Size of the stone
It has been found that the stones which are larger than 6 mm in the maximum diameter are less likely to pass without surgical assistance. A stone which has moved down into the ureter and is less than 6 mm in size has got more than 70% chances of passing out in the urine without surgical therapy.
2. Location of the stone
A stone which has come down to the level of lower ureter, which is the lower part of the urine pipe and has been detected in that position has got better chances of of coming out in the urine without surgical therapy as compared to a stone which got stuck in the upper part of the ureter and got detected in that position.
3. Stage of detection
A stone which has been detected recently within last week for 10 days, because longer the stone stays in the ureter, more is the damage caused by it and the chances of its subsequent passage will be less.
Also read: Kidney Stone Prognosis: Know Everything About The Diagnosis And Its After Care
4. Related Complications
A stone in the ureter which is having above-mentioned characteristics and is not associated with any kind of complication like swelling of kidneys and other such danger signs which we will be discussing in the following section.
5. A small stone
A small stone which is lying in a corner in the kidney without causing any obstruction or any serious symptoms can be observed with or without medications.
When Does A Surgery For Kidney Stone Removal Become Necessary?
- The kidney stone is causing severe obstruction leading to unmanageable symptoms like severe pain and vomiting.
- A kidney stone or a ureteric stone leading to obstruction of the urine flow and causing swelling of the kidney which is likely to compromise the function of that kidney.
- Any kidney stone which is associated with urinary tract infection and specially if the patient has fever as presenting symptom.
- Kidney stone or ureteric stone which is found to be in the only functioning kidney of the patient. This happens if the patient has got a single kidney by birth or the other kidney has been removed or is not functioning for some other reason.
- If kidney stones or the ureteric stones are present in both the kidneys or both the ureters, leading to obstruction in the flow of urine on both the sides. Stones obstructing the urinary passage from the single functioning kidney or obstructing the urinary passage on both sides can be very dangerous and are a true emergency for surgical intervention. If the urine flow from both the kidneys or the only functioning kidney is obstructed the patient can end up with complete renal failure ending up in the emergency room and requiring dialysis to stabilise renal function before any surgical intervention can be done to relieve the obstruction.
- A stone which has been under observation or medical treatment for more than a couple of weeks will probably be better managed with surgical intervention because the longer the stone stays inside the urine pipe more it damages the tissues.
There are certain situations in which observation or medical treatment is not advisable for the kidney or the ureteric stone. These are the situations when the stone is creating some sort of complex clinical scenario and is leading towards a complication and observation or medical treatment alone might not be the best treatment for the patient to save the function of the kidney and sometimes the life of the patient. Observation or only medical management is not advisable if the stone has got following characteristics:
· The kidney stone is causing severe obstruction leading to unmanageable symptoms like severe pain and vomiting.
· A kidney stone or a ureteric stone leading to obstruction of the urine flow and causing swelling of the kidney which is likely to compromise the function of that kidney.
· Any kidney stone which is associated with urinary tract infection and specially if the patient has fever as presenting symptom.
· Kidney stone or ureteric stone which is found to be in the only functioning kidney of the patient. This happens if the patient has got a single kidney by birth or the other kidney has been removed or is not functioning for some other reason.
· If kidney stones or the ureteric stones are present in both the kidneys or both the ureters, leading to obstruction in the flow of urine on both the sides. Stones obstructing the urinary passage from the single functioning kidney or obstructing the urinary passage on both sides can be very dangerous and are a true emergency for surgical intervention. If the urine flow from both the kidneys or the only functioning kidney is obstructed the patient can end up with complete renal failure ending up in the emergency room and requiring dialysis to stabilise renal function before any surgical intervention can be done to relieve the obstruction.
· A stone which has been under observation or medical treatment for more than a couple of weeks will probably be better managed with surgical intervention because the longer the stone stays inside the urine pipe more it damages the tissues.
Also read: 4 Kinds Of Kidney Stones You Need To Know About And Treatment Options For Cure
Speak To Your Urologist About Options
This is a rough guide for the management of kidney stones and this should not be taken as a rule, because every patient has got a different set of clinical situations and the treatment plan has to be tailor-made for every individual. For example if a patient has got a small ureteric stone causing minimal symptoms but he has a baseline poor kidney function or has a poorly controlled diabetes then probably the threshold for going for a surgical intervention would be less and doctor might advise to remove the stones surgically earlier than he would for a patient who has got normal kidney functions and who is not diabetic.
So in a nutshell, the kidney stones or ureteric stones which are small in size particularly less than 6 mm and are found in the lower urinary pipe or the lower ureter have got a fairly good chance of passing out on their own or with medical help. You must speak to your Urologist and discuss all your reports and past history in details and find out if your small stone is safe to be observed for a few days or weeks. Always speak to a qualified urologist before taking a decision for avoiding or going in for a surgery as the topic of kidney stone management is a fairly complex topic and the patient has to be seen and treated as a whole.
Read more articles on Other Diseases
Image credits: aaurology
