Drug treatment for kidney and ureteral stones

Drug-based stone therapy can refer to various treatments. Almost every patient asks whether kidney stones can be dissolved with medication. Although this would of course be highly desirable, "dissolving" is unfortunately only possible for a small proportion of stones. These are uric acid stones; the therapy is referred to as chemolitholysis.

If a stone is already in the ureter, medication can help to promote the passage of the stone by natural means. This option exists for small stones, provided the pain is tolerable and the laboratory and urine parameters are within certain limits. This is referred to as conservative stone therapy.

For patients who repeatedly form stones, taking medication may be useful, depending on the composition of the stones. Medication is always combined with other measures such as increasing fluid intake or changing lifestyle. This type of prevention is known as stone metaphylaxis and can extend the time until urinary stones recur or prevent the formation of new stones altogether. This requires close coordination with the treating urologist.

What does chemolitholysis mean?

Chemolitholysis refers to the drug-based "dissolving" of urinary stones. This therapy is only effective for uric acid stones. Taking a medication increases the pH value of the urine; this is called urine alkalinisation. If the urine is less acidic, uric acid stones can dissolve again. The pH value can be determined by the patients themselves using test strips. Depending on the value, the dose of the medication is adjusted until the pH value is between 7.0 and 7.2. This value must be maintained for a few weeks.
To prevent the formation of new uric acid stones, urine-alkalinising medication can also be taken permanently. The target pH value should be constantly between 6.2 and 6.8. It is also advisable to lower uric acid levels in the blood. In addition to deacidification, weight loss and a reduction in purine-rich food have a positive effect. If this is not sufficient, the uric acid level in the blood can also be lowered with medication. This is done as part of the treatment of gout, which is also the result of elevated uric acid levels.