During Treatment How Kidney Stones Are Found People with kidney stones usually see their doctors because of back pain or blood in their urine. If your doctor thinks that you have a stone, its location, size, and type need to be determined for proper treatment to occur. Your doctor will start by asking you questions about your medical and family history and by doing a physical examination. Analyses of your blood and urine will help determine whether there is an infection or whether high levels of stone-forming substances are present. Kidney stones can become stuck in any part of the urinary system. To begin to locate a stone, doctors may perform an x-ray or ultrasound study. This gives a good idea of the stone's size and where it is located. Many patients also receive an intravenous pyelogram (IVP) . For an IVP, a special dye is injected into the patient's vein. The dye eventually collects in the urinary system. There, it produces a white contrast when an x-ray is taken. The dye allows the doctor to precisely locate the stone and to determine the condition of the kidneys, ureters, and bladder. It is very important that the stone, if passed, be saved, so that it can be sent to a laboratory for evaluation. Long-term treatment and prevention plans depend on the type of stone. Between 70% and 80% of stones pass on their own in the urine, usually within 48 hours of the start of the symptoms. To catch a stone, patients are asked to urinate into a strainer, a cup with mesh in the bottom. All pieces of stone, no matter how small, should be collected and given to the doctor. If one stone is analyzed, more may not be needed, since most people develop just one type of stone. What are the treatment choices? How a particular stone is treated depends on its size, location and composition. Although kidney stones, especially calcium stones, are very hard, most of the 20% to 30% that do not pass out of the body on their own can be eliminated without surgery. A process called lithotripsy (from the Greek word for "stone crushing") breaks into tiny fragments most stones that are less than three-quarters of an inch across. (Lithotripsy is also called extra-corporeal shock wave lithotripsy.) Lithotripsy has been used in the U.S. since 1984. A urologist performs the treatment using a machine called a lithotripter. It is the most common method of treating stones in the US. There are different types of lithotripters, but all focus shock waves from outside the body on the kidney stone. Repeated shock waves cause the kidney stone to disintegrate into tiny particles. These particles pass easily out of the body in the urine. Lithotripsy alone doesn't work for all patients or for all kidney stones. Other treatment options include medication therapy, ureteral stent, ureteroscopy, percutaneous lithotripsy or open surgery. Please discuss these options with your urologist to determine which is best for you. What are the advantages of Lithotripsy? Lithotripsy offers many advantages over stone removal through surgery. Some of those advantages include: 1. Reduction in complications 2. Reduction in pain 3. Reduced recuperation time 4. Performed on outpatient basis 95% of the time 5. Able to resume normal activities much sooner 6. Reduced cost 7. No incision Risks of Lithotripsy There are risks to the procedure. Chief among them is possible bruising or damage to the kidney. As a result, some blood usually appears in the urine following the procedure. Healing of the kidney is usually rapid, bleeding stops within 24 hours and no lasting problems are observed. However, in 0.4% of reported cases, the bleeding may be more significant causing a collection of blood around the kidney (perinephric hematoma) which may take weeks to resolve. Rarely, transfusion is required. Patients who are taking aspirin or NSAIDs, or those with untreated kidney infection or poorly controlled hypertension are at particular risk. Loss of the kidney can occur. Even minor damage to the kidney may result in permanent elevation of blood pressure through mechanisms that are poorly understood. Several studies have shown that the incidence of hypertension (high blood pressure) is no greater with lithotripsy than with other modalities of stone treatment. Other complications relate to the obstruction of the kidney by passing stone fragments. This condition can easily be treated, but may require an additional procedure for temporary insertion of a stent or percutaneous nephrostomy into the kidney for drainage. Sepsis can occur if this condition is untreated. Damage to adjacent organs such as lung, spleen, pancreas, bowel, liver, etc. is also reported, but these complications are VERY rare. Bruising of the skin at the shockwave entry site is common and usually requires no treatment. Transient alteration of the heart rhythm occasionally occurs during treatment. This is usually of no clinical significance, can be treated with medication administered by the anesthesiologist and stops with cessation of the procedure.