Initial treatment will focus on relief of pain. After this, the next step will be to facilitate either passage or removal of the stone itself. 80-90% of all stones less than 5 mm will pass out on their own. If the stone is smooth, even stones of 7- 8 mm may pass out on their own. A combination of drugs called the medical expulsive therapy promotes stone expulsion with far less pain. This is the first line of therapy now. Stones larger than this will invariably need to be removed by one of the many methods available. If there is an anatomical abnormality, the priority will be to correct that abnormality while removing the stone. 1-2 cm solitary stones in the kidney can be treated preferably by ESWL (Extracorporeal Shock Wave Lithotripsy). This is the method by which pressure waves from the machine are focussed on to the stone and the stone is powdered. The stone fragments will pass out in the urine over a period of 1 to 12 weeks. Larger stones in the kidney are preferably removed by PCNL (Percutaneous Nephrolithotomy)
. In this method the patient needs to be admitted, a small puncture is made from the back directly into the kidney; the stone is visualized, fragmented and removed completely.
Stones lower down in the urinary tract may be treated either by ESWL or by endoscopic methods. In this, an endoscope is passed into the urinary tract from external meatus, the stone visualized, and fragmented.
Open surgery for stones in the ureter is used only in complicated cases.
Uric acid stones are generally seen only on the ultrasound, and not on x-rays film. If they are around 1 cm in size, they can be the dissolved by simple alkalinisation of the urine.