Kidney Stones: Acute Management Essay

654 words - 3 pages

There are a few different procedures for kidney stones. The procedures depend on there size and location.About 80% of ureteral stones pass spontaneously in the urine, usually within 48 hours of the acute attack. Most patients can be managed as outpatients. Conservative treatment consists of reassurance, adequate pain control, and advice to maintain adequate hydration. A three-day supply of an oral narcotic analgesic such as hydromorphone can be prescribed and the patient told to return immediately if severe, intractable pain, persistent nausea and vomiting, or fever and chills occur. A urine strainer should be prescribed and patients instructed to strain all urine for up to 72 hours after the pain subsides to try to retrieve the stone for analysis. If a patient is unable to pass the stone they may need to have them removed with Laser lithotripsy, Percutaneous nephrolithotomy or Ureteroscopy.Laser lithotripsy (a non-invasive removal technique) has become the method of choice and most widely used approach for removal of Kidney stones. The technique is appropriate for almost all calculi in the renal collecting system and some of those in the upper ureter. Renal calculi of 2 cm or less are the ideal targets. Lithotripsy makes use of shock waves generated by an underwater spark discharge and focused by a hemielliptic reflector. The patient is manipulated into position within a water bath so that the targeted stone visualized on a fluoroscopic monitor is at the focal point of the concentrated shock waves. About 1,000-2,000 shocks are needed to fragment a stone into sand like particles, which can then be passed in the urine. The procedure usually lasts about 60-90 minutes and requires general, epidural, or spinal anesthesia. Most patients can be discharged the same evening and return to work after a few days.Percutaneous nephrolithotomy is used principally in patients with renal or upper ureteral stones that are not suitable for lithotripsy. This procedure is used when the size of the stone is larger than 2 cm, hardness (cystine stones), or complexity (infection...

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