Kidney Stones (cont.)
What Is the Treatment for Kidney Stones?
- In the emergency department, intravenous fluids may be provided to help with hydration and to allow the administration of medications to control pain and nausea. Ketorolac (Toradol), an injectable anti-inflammatory drug, and narcotics may be used for pain control, with the goal being to relieve suffering and not necessarily to make the patient pain free. Nausea and/or vomiting may be treated with anti-emetic medications like ondansetron (Zofran), promethazine (Phenergan), or droperidol (Inapsine).
- The decision to send a patient home will depend upon the response to medication. If the pain is intractable (hard to control) or if vomiting persists, then admission to the hospital may be necessary. Also, if an infection is associated with the stone, then admission to the hospital will be considered.
- Pain control at home follows the lead of the hospital treatment. Over-the-counter (OTC) ibuprofen (Advil) is used as an anti-inflammatory medication, and narcotic pain pills may be provided. Antinausea medication may be prescribed either by mouth or by suppository. Tamsulosin (Flomax, a drug used to help urination in men with an enlarged prostate gland) may be used to help the stone pass from the ureter into the bladder.
- Because of their size or location, some stones may not be able to be passed without help. If the stone does not pass, then a urologist may need to consider using lithotripsy, or shock wave therapy (ESWL), to break the stone up into smaller fragments to allow those small pieces to pass more easily into the bladder. Shock waves are a type of ultrasound that fragments stones.
- If the stone is located in a place where lithotripsy cannot be used, or if there is a need to relieve the obstruction emergently (an example would include the presence of an infection), the urologist may perform ureteroscopy, in which instruments are threaded into the ureter and can allow the physician to use a laser to fragment the stone. Occasionally, the urologist may be able to use instruments to grab the stone and remove it.
What Are Possible Complications of Kidney Stones?
- Since most patients have two kidneys, a temporary obstruction of one is not of great significance. For those patients with only one kidney, an obstructing stone can be a true emergency, and the need to relieve the obstruction becomes greater. A kidney that remains completely obstructed for a prolonged period of time may stop working.
- Infection associated with an obstructing stone is another emergent situation. When urine is infected and cannot drain, the situation is like an abscess that can spread the infection throughout the body (sepsis). Fever is a major sign of this complication, but urinalysis may show an infection and cause the urologist to consider placing a stent, nephrostomy tube, or removing the stone to relieve the obstruction. Antibiotics use may be considered.
Last Reviewed 11/21/2017
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