Lithiasis and Renal Colic Treatment

What does Lithiasis and Renal Colic Treatment Involve?

After diagnosing renal colic, it must be ascertained whether an obstruction and/or infection exists so that suitable measures can be taken.

In the acute and intensely painful stage, the immediate aim is to relieve the pain. Evidence of complications must be sought, such as infection, bilateral obstruction or a single functioning kidney, or the presence of pus in the urinary tract. These are grounds for urgent/emergency surgery.

It cannot be over-emphasised that urgent surgery can save lives if there is evidence of obstruction and infection. Other criteria for surgery at this stage are the presence of vomit, fever or general physical decline. If the pain continues or the stone is not eliminated after around 2 weeks, urgent surgery is also necessary.

After treatment of this acute stage, the main aim is to eliminate the stones causing the pain and, afterwards, to avoid the formation or growth of new ones.

The stone may be dissolved by alkalinising the urine. The alkalinisation of the urine is effective at dissolving uric acid stones even when they are large, provided patients stick to the treatment. In other types of stones, the treatment is not as effective and may even be dangerous (alkalinisation of the urine may facilitate infection).

Many patients try alternative treatments (with teas or other products – the classic “quebra-piedras” bought in pharmacies, health shops or ordered from Spain).

The definitive treatment for stones involves lithotripsy (fragmentation of the stone). This can be external – extra corporal shockwave lithotripsy (SWL) – or internal, by endoscopy and laser technology to fragment and eliminate the stones (ureterorenoscopy or retrograde intrarenal surgery with intracorporeal lithotripsy).

What is the Procedure?

After a complete diagnosis, a personal treatment plan must be created for the patient.

Dissolving Non-Calcium Stones

Currently, there is no treatment to dissolve predominantly calcium-based stones. However, chemoprophylaxis can avoid the growth or formation of new stones.

The prophylactic therapy includes food restrictions, supplements and, more importantly, an increase in water intake to ensure urine expulsion of around two litres per day.

Dissolving Uric Acid and Cystine Stones

Bicarbonate of soda can be used to alkalinise urine, though the preferred solution is potassium citrate, as it is available in time-release tablets and avoids ingestion of sodium.

Urine alkalinisation is very effective in dissolving large uric acid stones.

In patients with pure uric acid stones (a minority) and hyperuricemia, treatment with alopurinol (300 mg per day) is recommended, as it cuts the excretion of uric acid.

Preventive Measures

Lithiasis is a chronic illness that necessitates behavioural changes.

The measures most important in urolithiasis prophylaxis are:

Higher water consumption (at least 1.5l per day in addition to other water-based liquids and foods – ensuring the production of 2 litres of urine every 24 hours);
Low salt intake;
Reduced protein (red meat) consumption.

An empirical restriction on consuming calcium (not based on 24 hour urine doses) can affect bone mineralisation and contribute to osteoporosis, mainly in women. It is therefore not recommended.

In cases of infection associated with lithiasic obstructive uropathy, the patient must be treated urgently or there is a risk of urosepsis or even death.

At the Instituto da Próstata, the most common methods are extracorporeal lithotripsy and endoscopic surgery (ureterorenoscopy or retrograde intrarenal surgery).

Extracorporeal Lithotripsy for Kidney Stones

This is an effective, non-invasive and low risk treatment for lithiasis of the kidneys or ureter.

See Treatment

Endoscopic Surgery for Kidney Stones

Ureterorenoscopy and retrograde intrarenal surgery are endoscopic surgeries used to treat lithiasis in the urinary tract. They are performed through the urethra, bladder and ureter.

See Treatment

What is the Post-Treatment Patient Care?

Renal lithiasis is a chronic pathology so there is a great probability of recurrence.

The patient must receive a care plan from the medical team that includes control tests, usually performed every 12 months. The most common test in patients’ follow-up is ultrasound, as it does not involve radiation, but tests like renovesical radiography or a simple x-ray of the urinary organs and computed tomography (CT scan) may be necessary.

When pharmacological treatment is begun, a 24-hour urine test must be requested 1–3 months later to assess their metabolic efficiency and whether the patient is following the treatment.

The metabolic parameters must be assayed, as changes may occur after treatment.

After establishing a stable therapeutic plan, annual follow-up is recommended with an ultrasound scan and urine tests, which may occasionally last 24 hours.

Want to know more about “kidney stone” treatments?

The most suitable procedure depends on each patient’s diagnosis. If you suffer from renal lithiasis, book an appointment at the Instituto da Próstata.

Book an Appointment

Dr. José Santos Dias

Clinical Director of the Instituto da Próstata

Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
Specialist in Urology
Fellow of the European Board of Urology
Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"

See Biography