Stenting, another option to allow stone fragments to pass, can be uncomfortable, and it requires anesthesia; however, its use is associated with minimal damage to the ureter.2 Percutaneous nephrolithotomy, with or without a basket or a nephrostomy tube, can also be used.12 This method is often needed in patients with a large “stone burden.”2 Open procedures to remove stones, though the gold standard in the early 1980s, are rarely required today.
Recurrence rates for stones can be as high as 50%.13 Depending on the type of stone, certain interventions are essential to reduce recurrence. The ROKS stone calculator can be used to identify patients at increased risk for stone recurrence.14
REFERENCES
1. Norris RD, Norris JM, Lorenz RD, et al. Sliding rocks on racetrack playa, Death Valley National Park: first observation of rocks in motion. PLoS One. 2014;9(8):e105948.
2. Curhan G. Nephrolithiasis. In: Gilbert SJ, Weiner DE, eds. National Kidney Foundation’s Primer on Kidney Diseases. 6th ed. Philadelphia, PA: Elsevier; 2013:405-411.
3. Trinchieri A. Epidemiology of urolithiasis: an update. Clin Cases Miner Bone Metab. 2008;5(2):101-106.
4. Worcester EM, Coe FL. Clinical practice: calcium kidney stones. N Engl J Med. 2010;363(10):954-963.
5. Saigal CS, Joyce G, Timilsina AR; Urologic Diseases in America Project. Direct and indirect costs of nephrolithiasis in an employed population: opportunity for disease management? Kidney Int. 2005;68(4):1808-1814.
6. Segura JW, Patterson DE, LeRoy AJ, et al. Percutaneous removal of kidney stones: review of 1,000 cases. J Urol. 1985;134(6):1077-1081.
7. Wells CG, Chandrashekar KB, Jyothirmayi GN, et al. Kidney stones: current diagnosis and management. Clinician Reviews. 2012;22(2):31-37.
8. Coll DM, Varanelli MJ, Smith RC. Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR Am J Roentgenol. 2002;178(1):101-103.
9. Campschroer T, Zhu Y, Duijvesz D, et al. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Database Syst Rev. 2014;4:CD008509.
10. Erturhan S, Erbagci A, Yagci F, et al. Comparative evaluation of efficacy of use of tamsulosin and/or tolterodine for medical treatment of distal ureteral stones. Urology. 2007;69(4):633-636.
11. Mezentsev VA. Extracorporeal shock wave lithotripsy in the treatment of renal pelvicalyceal stones in morbidly obese patients. Int Braz J Urol. 2005;31(2):105-110.
12. Amer T, Ahmed K, Bultitude M, et al. Standard versus tubeless percutaneous nephrolithotomy: a systematic review. Urol Int. 2012;88(4):373-82.
13. Ljunghall S. Incidence of upper urinary tract stones. Miner Electrolyte Metab. 1987;13(4):220-227.
14. Rule AD, Lieske JC, Li X, et al. The ROKS Nomogram for Predicting a Second Symptomatic Stone Episode. J Am Soc Nephrol. 2014 Aug 7. [Epub ahead of print]