Treatment: How can urinary stones be cured?
The therapy of urolithiasis involves different therapeutic approaches depending on clinical symptoms (symptomatic/asymptomatic patient), size, location and composition of the calculi. In the presence of kidney stones that are <5mm (in most cases asymptomatic), we recommend a periodic clinical monitoring. In the presence of small ureteral stones (<5mm), the initial treatment involves a medical expulsive therapy, consisting of an abundant hydration of the patient associated with drugs designed to relax the smooth muscles along the urinary tract, thus allowing spontaneous passage.
Kidney stones with a size of 6-20 mm and pre-bladder stones can be subjected to ESWL (lithotripsy by means of extra-corporeal shock wave therapy), which allows the crushing of stones from the outside, making them liable to spontaneous expulsion in the urine. Even ureteral stones can be subjected to extracorporeal shock wave lithotripsy; however, it may have a lower percentage of success. For this reason, the treatment of choice for ureteral stones is now represented by ureterorenoscopy (URS) or ascending towards the urinary tract with a special tool until it reaches the calculi and performs subsequent crushing by different energy sources (laser/ultrasonic/pneumatic waves). The intervention includes spinal anaesthesia (or, in special conditions, general anaesthesia), and has an average duration of about 45 min and, in some cases, it is necessary to place a ureteral guardian; this project involves an average hospital stay of about three days.
In the presence of large renal calculi (>25mm), the treatment is called pyelo-nefro-lithotomy (GNP). It is a surgery performed under general anaesthesia, which provides a percutaneous access to the urinary cavity with crushing by means of several possible sources of energy. The operation involves the placement of a ureteral catheter, a urinary catheter and a percutaneous nephrostomy; The average operating time is approximately 90 minutes, while the average hospital stay is about five days; It has very high efficacy (98% of cases), but requires experienced surgeons. In selected cases (e.g. Stones refractory to Extracorporeal lithotripsy treatments), Our Centre offers a therapeutic option of innovative retrograde intrarenal surgery (RIRS), namely the intervention with access to the kidney with a special flexible instrument that extends from the urethra along the urinary tract until it reaches the calculi and performs subsequent crushing.
Learn more about symptoms and diagnosis of urinary stones