When a kidney stone causes pain to the extent that the pain
cannot be controlled with oral pain medication, the stone should
be treated. Similarly, stones that are associated with severe nausea
or vomiting should be treated. Some stones are associated with infection
or fever – such situations can be life-threatening and demand
prompt attention. Stones that are associated with a solitary kidney,
poor overall kidney function, or complete blockage of urine flow
should also all be treated.
Sometimes, when a stone is associated with bothersome symptoms,
it may be appropriate to wait and see if the stone will pass on
its own. If the stone is small, this is a very reasonable course
of action. However, stones larger than 5 mm in size are unlikely
to pass on their own, and should be considered for treatment.
There are some instances when it is okay to leave a kidney stone
untreated. If the stone is small (less than 5 mm) and not causing
any pain, there is a good chance that it will pass on its own after
it falls into the ureter. Such stones may be followed with "watchful
waiting". This means that the stone is not actively treated,
but instead your doctor keeps a check on the stone to be sure that
it is not growing or changing. This can be done with periodic x-rays.
There are a number of reasons to treat a kidney stone even
if it is not causing any painful symptoms.
Recurring urinary tract infections
Some kidney stones may be infected, and in many cases, despite proper
antibiotic treatment, the infection cannot be cleared from the stone.
In such cases, the only way to remove the infection completely is
to remove the stone completely.
Staghorn stones
These are extremely large stones that grow to fill the inside of
the kidney. There are serious health risks associated with these
stones, and left untreated they are associated with an increased
risk of kidney failure.
Occupational requirements
For example, the Federal Aviation Administration will not allow
a pilot to fly until all stones have been cleared from his or her
kidney. Other occupations, too, do not allow for the unplanned passage
of a kidney stone.
Extensive travel
The patient who, whether for business or otherwise, travels to locales
where medical care is not reliable may wish to consider preventive
treatment.
Patient preference
After thorough consideration of all options available to them, many
patients elect to remove their stones at a time when it is convenient
for them.
Historically, the treatment of kidney stones required major surgery,
and was associated with long hospitalization and recovery periods.
However, in recent years an improved understanding of kidney stone
disease, along with advances in surgical technology, has led to
the development of minimally invasive, and even non-invasive, treatments
for persons with kidney stones.
At Johns Hopkins, we believe that the treatment of a patient’s
stones requires an approach that is unique to that individual. We
offer a complete range of state of the art treatment options, including
ESWL, ureteroscopy, and PERC,
and we will discuss with you the advantages and disadvantages of
each therapy as they apply to your situation. Our goal is to provide
each patient with a clear understanding of the nature of their stone
burden as well as the most appropriate course of treatment.
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