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.
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.
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.
The patient who, whether for business or otherwise, travels to locales where medical care is not reliable may wish to consider preventive treatment.
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.