Last updated: 02/17/2009

Patients with kidney stones may be treated with one or more of the following procedures in addition to PCNL, depending on the size of their renal calculi and possible complications. One frequently used combination, known as sandwich therapy, is extracorporeal...

shock wave lithotripsy for smaller stones followed by PCNL to remove larger calculi.

Conservative approaches

Conservative forms of treatment include the following:

• Watchful waiting.
• Hydration. Increasing the patient's fluid intake (to seven or more glasses of fluid each day) is a major component of treatment intended to prevent the formation of kidney stones. At least half of the fluid should be water.
• Dietary modification. Depending on the type of stone that has formed, the patient may benefit from eating less animal protein, avoiding vegetables with high oxalate content, cutting down on table salt and vitamin C intake, etc.
• Medications. Patients who tend to form uric acid stones may be given allopurinol, which decreases the formation of uric acid; those who form calcium oxalate stones may be given thiazide diuretics; and those who develop infection stones can be treated with oral antibiotics.

Open surgery

Open surgery is the most invasive form of treatment for urolithiasis. As of 2003, it is performed primarily to remove very large and complex staghorn calculi or extremely hard stones that cannot be broken down by lithotripsy. Other indications for open surgery are extreme obesity, an anatomically abnormal kidney, or an infected and nonfunctioning kidney requiring complete removal. Patients are usually hospitalized for a week after open kidney surgery and take about six weeks to recover at home.

Extracorporeal shock wave lithotripsy (ESWL)

ESWL is a noninvasive procedure that was developed in the 1980s as a less invasive alternative to PCNL. It is presently used more often than PCNL to treat smaller renal calculi. In ESWL, the patient is given a local anesthetic and placed in a water bath or on a soft cushion while shock waves are transmitted through the tissues of the back to the stones inside the kidney. The shock waves cause the calculi to break up into smaller pieces that can be passed easily in the urine.

Although patients need less time to recuperate from ESWL, it has several disadvantages. It has lower success rates (50–90%) than PCNL. Moreover, it cannot be used to treat cystine calculi or calculi larger than 1.2 in (3 cm). An additional concern with shock wave lithotripsy is its safety in treating small or anatomically abnormal kidneys; it has been reported to cause temporary damage to kidney tubules in smaller-than-average kidneys.

Ureteroscopy

Ureteroscopy refers to removal of calculi that have moved downward into the ureter with the help of a special instrument. A ureteroscope is a small fiberoptic endoscope that can be passed through the patient's urethra and bladder into the ureter. The ureteroscope allows the surgeon to locate and remove stones in the lower urinary tract without the need for an incision.

Complementary and alternative (CAM) approaches

Vegetarian and other low-protein diets have been found helpful in preventing kidney stone formation. In addition, recent ethnobotanical studies of ammi visnaga (toothpick weed), a plant belonging to the parsley family, and Phyllanthus niruri, a traditional Brazilian folk remedy for kidney stones, indicate that extracts from these plants are effective in increasing urinary output and inhibiting the development of calcium oxalate calculi.