Top Ways to Break and Remove Lower Pole Kidney Stones: What You Need to Know
Dr. Alex Shteynshlyuger is a board certified urologist in NYC who specializes in treating men and women with kidney stones and ureteral stones.
Lower Pole Kidney Stones: Kidney Stones in the Lower Pole of the Kidney are More Challenging to Treat
In general, stones in the lower pole of the kidney are more difficult to treat than stones in other areas of the kidney. Because of gravity, they don’t float away as easily. Treatment options are based on stone size. ESWL or ureteroscopy is recommended for stones that are smaller than 1 cm in size. PCNL is needed for larger stones, but larger stones 1-2 cm in size can still be treated with ureteroscopy in certain situations.
Often, I am able to reposition a stone from the lower pole of the kidney using a stone basket to a more favorable location.
A new therapy uses ultrasound energy to reposition kidney stones. Focused ultrasonic propulsion of kidney stones seems to be promising and may become available in the next few years.
The repositioned stone can then be fragmented with laser and fragments can be removed with a stone basket for biochemical analysis. More than one procedure may be necessary in the lower pole to render a patient stone-free.
The choice of procedure for breaking lower poke stones is determined by stone size, stone density as measured by Hounsfield units on CT scan, patient characteristics and whether there are additional stones in the kidney or in the ureter.
Lower Pole Stone with Additional Stones in the Kidney or Ureter
In general if there are additional stones in the kidney or the ureter and if there is only 1-2 additional stone less than 1 cm each, ureteroscopy may be a reasonable option. If the stones are multiple and large, PCNL is usually the procedure of choice.
If stones are not dense and only 1-2 relatively small stones (<1 cm) are in the kidney, lithotripsy with ESWL can be tried.
Small Lower Pole Stones
Lower Pole kidney stones less than 7-8 mm can often be broken with shockwave lithotripsy with success rate similar to ureteroscopy with laser with fewer side effects.
For medium size stones 0.9 cm to 1 cm, shockwave may be tried but may require more than one treatment. Ureteroscopy is a good treatment option especially if additional small kidney stones are present.
Large Lower Pole stones
Large lower pole stones are unlikely to be broken down with ESWL lithotripsy in one setting. As a result, for stones greater than 1 cm, the choice is between ureteroscopy and PCNL. For stones that are 10 mm to 15 mm, ureteroscopy may be reasonable to try but PCNL is usually preferred especially if there are additional large stones in the kidney or at the UPJ or if the stone is hard.
For large lower pole stones that are 1.5 cm or larger and certainly if a stone is larger than 2 cm, PCNL is usually the preferred approach.
Dr. Alex Shteynshlyuger is a board certified urologist in NYC who specializes in treating men and women with kidney stones and ureteral stones. He has treated hundreds of men and women with large kidney stones.