The basic treatment is established according to the results of the various medical tests that the doctor suggests:

• urinalysis to check for blood and crystals in the urine, and to determine its pH;
• analyzing a recovered stone to determine its type;
• a blood test to check the state of kidney function or to detect a metabolic abnormality;
• a CT scan of the kidneys, ureters and bladder, which shows most stones.

A good hydration is the basic prevention of stones, but only when the pain is less severe. Indeed, when the pain is very intense, during the renal colic attack, you should not drink. This is because the stone can get stuck in a ureter, preventing urine from passing. So drinking would increase the pressure in the ureter, and therefore the pain.

The majority of stones (especially if their diameter is less than 7 mm or 80% of stones) are eliminated by themselves within 6 weeks following their training, especially if the person consumes a lot of water. During this time, doctors usually recommend drink about 3 liters of water or other types of drinks per day.

La renal colic is extremely painful. Pain relief may be necessary if pain persists for several hours. Nonsteroidal anti-inflammatory drugs, or opioids, can be given intravenously in the hospital when the attack is very severe.

If the condition is less painful, the person can stay home under medical supervision. She can relieve her pain by taking a analgesic paracetamol type or acetaminophen (Tylenol®, Doliprane®), until the stone is cleared. The heat also helps relieve pain (hot baths, hot and wet compresses).

If you have a struvite calculations, it is important to treat UTI. It is also necessary to discover and eliminate as much as possible the factors that predispose to infections.

interventions

In the event of an infectious sign or pain not calmed by analgesics, an internal probe called a double J probe or a JJ probe must be fitted as a matter of urgency. This is a small tube that the doctor enters through the urethra, passes into the bladder, and then places it between the bladder and the kidney in each of the ureters. This JJ probe allows urine to pass around the stone, or it pushes the stone back up into the kidney, where it can later be broken up.

In case of infection, it is urgent: it is necessary to drain the urine urgently, so as not to leave these infected urine in the kidney because this would damage it or could cause septic shock (septicemia).

If there is no infection, or after the placement of a JJ probe if the stone is not evacuated, it will have to be fragmented, that is to say reduced into small pieces or extracted surgically using one of the following techniques:

Ureteroscopy : It is the most frequent intervention thanks to new technologies, the flexible ureteroscope, the laser and the surgical equipment (forceps or small baskets) allowing to recover the fragments of the calculus or to take it out all at once. Ureteroscopy is performed under general anesthesia.

It consists of introducing a tube fitted with a mini camera (called a ureteroscope) through the urethra to the bladder, up to the ureter. The calculations are then fragmented or taken intact. The ureter is sometimes injured either by technique or by calculus if it is irregular and sharp. In this case, the JJ catheter can be left in place after the procedure to allow the ureter to heal. The use of analgesics or antispasmodics helps relieve pain.

Various lifestyle habits and other treatments can be used to prevent stone formation in the future. See the Prevention section.

Extracorporeal shock wave lithotripsy.

This is an external technique that does not require opening the body or entering inside our body, the shock waves diffusing through the skin. During this procedure, ultrasound is directed directly to the stone. They break it up, and the small pieces can be eliminated through the urinary system. This intervention can be performed on an outpatient basis, so without hospitalization. The risk of the shock wave method is to cause a hematoma, the shocks being relatively violent, not succeeding in fragmenting it entirely, and requiring fairly long sessions.

The choice of method depends on the calculations, their location, the type of calculation, its size, etc.

Percutaneous nephrolithotomy. This technique has been a revolution, but it is less and less practiced in favor of flexible uteroscopy. It is used if the stone is very large or if it is positioned in such a way that it cannot be fragmented by extracorporeal lithotripsy. The doctor makes an incision in the back and places an observation tube and an instrument called a nephroscope in the kidney to remove the stone. If the stone is too large, it can be split using a laser or electric power. Usually, the person having this procedure stays in the hospital for several days.