Kidney stones are a common reason to see a urologist – because of sudden, severe pain in the back or as a chance finding on ultrasound. Treatment depends on the size, position and composition of the stone, on the state of the kidney and on your symptoms, so it starts with a careful consultation.
Dr Penev specialises in the endoscopic and laparoscopic treatment of stones in the kidneys and ureters, and since 2017 he has been part of the team at the Department of Urology at Kaspela University Hospital (UMBAL Kaspela), Plovdiv. From the first consultation to the removal of the stone, you are looked after by the same doctor.
When it is recommended
- wave-like pain in the back spreading towards the groin – typical renal colic;
- blood in the urine, nausea or vomiting with the pain;
- burning and frequent urges to pass urine when the stone has moved low down in the ureter;
- a stone or a dilated kidney (hydronephrosis) found by chance;
- a past attack, a stone you have passed or recurrent stones – to find out the cause.
Do not wait for a scheduled appointment – go to an emergency department or call 112 (the European emergency number) if you have a fever and shivering during the attack, if you are not passing urine, if you are vomiting and cannot keep down fluids and painkillers, or if you have only one kidney. A blocked and infected kidney is a life-threatening condition and needs to be drained immediately. What to do in the first few hours is covered in the advice on first aid for renal colic.
How it is done
- Conversation. Dr Penev asks about the nature of the pain, previous episodes, family history, diet, medicines and other conditions.
- Physical examination of the abdomen and the kidney areas.
- Ultrasound. It shows stones in the kidney and bladder, dilatation of the renal pelvis and residual urine. Small stones in the middle part of the ureter are not always visible, so the findings are interpreted together with your symptoms.
- Tests. Urine for blood, infection and acidity; blood for kidney function, calcium and uric acid. If needed, a low-dose CT scan without contrast is arranged, which precisely determines the size, density and position of the stone.
The consultation takes about 30 minutes, is painless and does not require anaesthesia.
Preparation
- Come with a moderately full bladder so that an ultrasound can be done.
- Bring previous test results, including CT scan discs.
- If you have passed a stone, keep it in a small clean bottle – chemical analysis guides prevention.
- Write down the medicines and supplements you take.
After the consultation: choosing treatment
The plan is individual; the main options are as follows.
- Watchful waiting. Stones in the ureter up to about 5–6 mm often pass on their own within a few weeks – with painkillers, a medicine that relaxes the ureter and a follow-up ultrasound. If the stone has not moved on within 4–6 weeks or the kidney remains blocked, active treatment follows.
- Shock wave lithotripsy (ESWL). Shock waves from outside the body break the stone into fragments that are passed in the urine – for smaller, not very dense stones in the kidney or upper ureter, depending on the equipment available and an individual assessment. More about shock wave lithotripsy.
- Endoscopic laser treatment (URS). A thin instrument passed through the urethra reaches the stone and breaks it up with a laser, without any incisions – suitable for most stones in the ureter and for kidney stones up to about 2 cm.
- Percutaneous nephrolithotomy (PCNL). For large or staghorn stones, access is through a small opening in the back, with a short hospital stay.
Dr Penev performs the operations at Kaspela University Hospital under anaesthesia – details on the page about endoscopic and laser stone treatment. After the procedure a temporary internal stent is often left in place and removed after a few weeks. With a blocked and infected kidney, the kidney is drained and the infection brought under control first, and the stone is treated afterwards.
Prevention follows: about 2–3 litres of fluid a day, a diet tailored to the type of stone and, with recurrent stones, a metabolic assessment. More in the advice on diet and fluids for kidney stones.
Where it is done
The consultation and follow-up take place at Dr Penev’s practice in Plovdiv (5 Anri Barbyus St) and at Vita Med Medical Centre, Karlovo, by appointment; an ultrasound is part of the consultation in Plovdiv, and whether one is possible in Karlovo is confirmed when you book. CT scans, stone fragmentation and operations are arranged through the Department of Urology at Kaspela University Hospital, Plovdiv, 64 Sofia St.
Price
Initial consultation €50, follow-up consultation €30. The price of the ultrasound and of any procedures is confirmed at the consultation.
The earlier a stone is found, the gentler the treatment usually is – book an appointment with Dr Penev and discuss the right approach for you.
Frequently asked questions
Should I drink lots of water during an attack of renal colic?
During the attack itself – in moderation. Large amounts of fluid with a blocked ureter raise the pressure in the kidney and make the pain worse. Once the pain has passed, drinking enough fluids helps the stone to pass.
Is a kidney stone that does not hurt dangerous?
It can be. Stones without symptoms sometimes grow or suddenly block the ureter, so they are monitored with ultrasound, usually once a year, and treatment is recommended if they grow, cause infections or are in a risky position.
Should I cut out calcium so that I do not form new stones?
No. Restricting calcium increases the risk of calcium oxalate stones, because more oxalate is absorbed in the gut. Calcium from food should be normal, while salt and animal protein should be moderate.
Are kidney stones hereditary?
The tendency often runs in families, but whether a stone forms depends largely on fluids, diet and weight. If you have relatives with stones, it is worth starting prevention earlier.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.