The treatment depends on the size, location, type and number of stones.
If the stone is small enough, it may pass when the child urinates. It is helpful to increase the amount of fluids the child drinks. This will help "flush out" the stone. Occasionally, the doctor may admit your child to the hospital and give IV fluids to assist with the passing of the stone.
The child may need to take pain medication and an antibiotic during this time. Until the stone passes, the urine must be strained at home with a special straining device. Then, the stone will be sent off to a lab to be studied.
- ESWL (Extracorporeal Shock Wave Lithotripsy) - ESWL is a procedure which uses energy to break up the stone. No incision (cut in the skin) is needed. Before the procedure, a moving x-ray locates the stone, and then the energy waves crush the stone into very small pieces. The small stone pieces pass when the child urinates.
Patients usually go home the same day of the procedure and return to normal activities in 2-3 days. Your child should not be involved in vigorous physical activity if a ureteral stent is placed to help the stone fragments pass.
- Ureteroscopy - This treatment involves use of a small telescope (ureteroscope) to access stones in the ureter (tube that goes from the bladder to the kidney) or kidney. No cut in the skin is needed since the scope enters at the urethra (opening which allows urine to exit body), proceeds to the bladder and the ureter. When the stone is seen it can be removed with a basket-like tool. If the stone is large, a laser can be used to break it into very small pieces.
- Ureteral Stent Placement - A ureteral stent may be placed after the ESWL or Ureteroscopy procedures. It may also be placed without any other procedure, to assist the stone to pass down the ureter.
The stent is a thin, flexible tube which extends from the kidney to the bladder. It prevents blockage of urine due to swelling or buildup of stone fragments. The stent cannot be seen from outside the body. Contact sports and physically strenuous activities must be avoided. The child may feel some discomfort, and feel the urge to urinate often. The urine may appear pink or red. These symptoms will disappear when the stent is removed, several weeks later. Antibiotics and a medication to stop bladder spasms (from irritation of the bladder wall by the stent) will be prescribed.
- Percutaneous Nephrolithotomy - This procedure is used when a very large stone is located in the kidney or when other treatments fail. A small cut is made in the lower back and a small telescope is inserted into the kidney. Once seen, the stone can be broken into smaller pieces and removed.
The doctor may place a small flexible tube called a nephrostomy tube directly into the kidney through a small opening in the back. The tube will extend from the kidney to the outside of the child's lower back and will temporarily drain urine from that kidney into a bag. The nephrostomy tube is usually removed after 2-3 days.
Call the office if the child has any of the following:
• Lower back pain
• Fever >101°
• Severe nausea and vomiting
• Leakage from around the nephrostomy tube
• Heavy bleeding through the tube
• No urine drainage for 1-2 hours
- Open Surgery - Open surgery is very rare and used only for very large stones or oddly located ones. The doctor would make an incision in the child's side and remove the stone. A drain is placed near the opening in order to keep urine away from it. Later the doctor will remove the drain.