Kidney stones is a composed of mineral salts formed in
the kidneys. Men account for the 80% of those with kidney stones and
are at risk of the formings between 30 and 40 years of age. About 75% of
kidney stones are calcium stones.
Treatment
A. In conventional medicine perspective
Most kidney with diameter less than 5 mm (0.20 in) may pass through the
urinary tract through urination within days of the onset of symptoms
A.1. Medications
The aims of medication is to manage pain or assist the speed up the spontaneous passage of ureteral calculi
1. Analgesia
Medication used to relieve pain.
2. Expulsion therapy
a. In the study to evaluate the efficacy of alfuzosin as medical expulsive therapy
for distal ureteral stone passage od a total of 76 patients with a
distal ureteral calculus, showed that the overall spontaneous stone
passage rate was 75%, including 77.1% for
placebo and 73.5% for alfuzosin (p = 0.83). Mean +/- SD time needed to
pass the stone was 8.54 +/- 6.99 days for placebo vs 5.19 +/- 4.82 days
for alfuzosin. (p = 0.003). There was no difference in the size or
volume of stones
that passed spontaneously between the placebo and alfuzosin arms, as
measured on baseline computerized tomography (4.08 +/- 1.17 and 3.83 +/-
0.95 mm, p = 0.46) and by a digital caliper after stone expulsion
(3.86 +/- 1.76 and 3.91 +/- 1.06 mm, respectively, p = 0.57). When
comparing the improvement from the baseline pain score, the alfuzosin
arm experienced a greater decrease in pain score in the days after the
initial emergency department visit to the date of stone passage (p =
0.0005)(18).
A.2. Non invasive treatment and surgery
Extracorporeal shockwave lithotripsy does not require anaesthesia and requires little analgesia
so that treatment can be given on an outpatient basis, and there is no
wound to heal. Only a small puncture site is needed for percutaneous
endoscopic lithotomy, and with the advent of prophylactic antibiotics
there are few complications. Of renal stones, about 85% can now be
successfully treated by extracorporeal lithotripsy alone, and almost all
of the stones too large or hard for lithotripsy can be treated
endoscopically, with ultrasonic or electrohydraulic probes being used to
fragment the stone(19).
A.3. Recurrent treatments
2.1. Recurrent cystine renal stones
In the report of using ureterorenoscopy (URS) for the treatment of recurrent renal cystine stones. From 2003 to 2007, 10 patients (4 males and 6 females) with one or multiple recurrent renal cystine stones underwent URS. Overall, 21 procedures have been performed. Mean maximum diameter of stones was 11.2 mm (range 5-30 mm). Either 8-9.5 F semirigid or 7.9 F flexible ureteroscopes were used. In 6 cases, stones were removed using a basket; in 9 procedures laser lithotripsy with flexible scope was performed; in 6 cases renal calculi
were pulled down in the ureter using flexible instrument and then
shattered with laser introduced by semirigid instrument. Stone-free
status was defined as the absence of any residual fragment. A complete
stone clearance was obtained in 15 out of 21 procedures (71%). In 5
cases (24%) significant residual fragments occurred; in the remaining
case (5%) URS was ineffective. In 5 out of these unsuccessful
procedures, stone clearance was obtained with auxiliary treatments. The
last patient has not been treated yet(20).
2.2. In general
Patients with kidney stones are highly motivated to prevent
recurrence and were more amenable to fluid intake change than to
another dietary or pharmaceutical intervention. Barriers preventing
fluid intake success aligned into 3 progressive stages.
a. Stage 1 barriers included not knowing the benefits of fluid or not
remembering to drink.
b. Stage 2 barriers included disliking the taste of
water, lack of thirst and lack of availability.
c. Stage 3 barriers
included the need to void frequently and related workplace disruptions.
Tailoring fluid
intake counseling based on patient stage may improve fluid intake
behavior(21).
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Sources
(18) http://www.ncbi.nlm.nih.gov/pubmed/18423747
(19) http://www.ncbi.nlm.nih.gov/pubmed/8274898
(20) http://www.ncbi.nlm.nih.gov/pubmed/21193905
(21) http://www.ncbi.nlm.nih.gov/pubmed/22341296
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