Kidney Stones prevention and treatment

[Rhys]

Aloha TV, 

 

Ok.. what are some of the local medical options non-surgical options for large kidney stones...

[mogandave]

Mine were shattered using a sonic blasting device at BKK hospital.


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[Rhys]

5 hours ago, mogandave said:

Mine were shattered using a sonic blasting device at BKK hospital.


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Was this painful?  Did it get the stone, what was the size, and medication follow up.... How about the cost?  Cheers mate..

[mogandave]

There was no pain, it felt a like a light finger thumping, but inside. A little odd, but not painful.

It was 5-10 years ago, so I don't remember what it cost. I don't think there was any medication with or after the treatment, but (I think) they used a contrasting agent to locate the stone.

I don't remember how big it was, but once it was shattered it passed without any discomfort.




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[Rhys]

According the medical research and reports, they indicate a 50% probability of the stones reforming, did it return in your case?   As far as follow up drinking 2-3 liter of water is a bit of a challenge, even drinking a liter is a challenge, even to spread it out through the day.  The other preventions are food restrictions but that is all subjective it seems because there is always another report to contract the findings...  Thanks for the insights....

 

[mogandave]

As far as I know, mine has not come back.

In any event, even if it came back every few months I would keep basting it, as the pain is pretty unbearable when they get stuck.

I don't remember having to drink that much water.

All in all, from the time I got to the emergency room until I was discharged it was a good experience. I had to drive 180km in misery, but my wife had called ahead and I was on a nice opiate minutes after I got there.



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[Sheryl]

Non-surgical treatment of kidney and bladder stones depends on the size of the stone(s).

 

With small stones,  heavy hydration (drinking a lot of water or even IV fluids in a hospital) plus pain medication can be sufficient to help you pass the stones naturally.

 

 With larger stones, the options which cane be used separately or in combination are:

 

1 -  extracorporeal shock wave lithotripsy (ESWL). This is a non-surgical procedure that uses shock waves to break up the stone(s) into smaller pieces which can then be passed naturally. Will still need to be well hydrated (force a  lot of fluids or have IVs) and may or may not still need some medication for pain.

 

Lithotripsy does not always work. In particular, even after being broken up into smaller stones, they may still be too large to pass. You may need repeat treatments and/or to go on to:

 

3- removal by an instrument (ureteroscope) passed through your urtethra   into your bladder and up into the ureters to the kidney – the instrument has a camera so that the doctor can see, and then attachments that can be used to manually break up stones and remove them.  This procedure will require sedation or anesthesia to perform but there are no incisions. It is sometimes combined with lithotripsy i.e. might do lithotripsy first and then this to remove any stones still not passed. It too does not always succeed.

 

An experienced doctor can tell you, based on the size and positioning of the stones, what the odds are of success with either of the above approaches or the two combined, but there is never 100% certainty.  The more skilled and experienced the doctor, the better his judgment will be as to the what approach has best chance of success in an individual case.

 

The last resort is surgical removal through a small incision in your back. It is laparascopic surgery, called a percutaneous nephrolithotomy.

 

Any really large hospital will have the machine required for lithotripsy. It is not cheap as the machines are expensive, but will cost less in a government hospital. However only the top ones like Chulalongkhorn, Siriraj and major teaching hospitals like Srinigarind (KKU), CMU etc. will have it.

 

Any competent urologist can do # 2 and #3. Cost will vary depending on where you go and be least at a government hospital. 

 

As to exact costs it will depend on where you go and what is required – lithotripsy alone vs. multiple lithotripsy or lithotripsy + surgery etc.  You will certainly be likely to be >100K at a private hospital and could be over 200 K if multiple procedures prove necessary.

 

Regarding recurrence it is not that the same stones re-form, but that you form new ones for the same reason that you formed the ones already removed. Staying well hydrated is the single best preventive measure.

 

Depending on the type of stone you had, which they will not know until you pass them or they remove them to be analyzed, there may be some dietary measures as well that will help – but regardless, drinking plenty of fluids on a regular basis is key.