How to treat a 23mm kidney stone in elderly patients with high blood pressure?

Dear Monika m maru ji,

We understand your concern about a 74-year-old woman who has a 23 mm kidney stone and high blood pressure (BP). The good news is that treatment options are available, even for older patients. However, the safest treatment depends on the stone's location, kidney function, BP control, and overall health.

Which treatment is suitable for a 23 mm kidney stone?

A 23 mm kidney stone is considered large and is unlikely to pass naturally. A urologist will review her scan reports and recommend the most suitable treatment.

• PCNL (Percutaneous Nephrolithotomy): This is often the preferred treatment for kidney stones larger than 20 mm. The doctor makes a small cut in the back and uses a special instrument to break the stone into smaller pieces and remove them.
• RIRS (Retrograde Intrarenal Surgery): A thin, flexible instrument is passed through the urinary passage to reach the kidney. A laser breaks the stone into smaller pieces. Depending on the stone's size and location, more than one session may be needed.
• Other treatment options: In selected cases, the urologist may consider alternative procedures depending on the stone's location, her medical condition, and the risks of anaesthesia.

Is kidney stone surgery safe at the age of 74 with high BP?

Age and high BP do not automatically prevent surgery. However, her BP should be assessed and appropriately controlled before a planned procedure. The doctor may also check her kidney function, blood count, urine test, and signs of infection. An anaesthetist will assess her fitness for the procedure and help reduce the risks.

What precautions should she take?

• Consult a urologist promptly and carry her CT scan or ultrasound reports.
• Give the doctor a list of all BP medicines and other medications she takes.
• Do not stop or change her BP medicines without medical advice.
• Drink adequate water if her doctor has not restricted fluids because of kidney or heart problems.
• Avoid taking painkillers or herbal remedies without medical advice, as some may affect BP or kidney function.

If she develops fever or chills, severe pain, repeated vomiting, very little or no urine, or becomes unusually drowsy or confused, take her to the hospital immediately. A kidney stone causing a blockage along with infection can be dangerous and may require urgent treatment.

To help guide you more accurately, please share:

• Is the 23 mm stone in the right kidney, left kidney, or both kidneys?
• What is her usual BP reading?
• Does she have pain, fever, difficulty passing urine, or any other symptoms?
• What is your city and state?

These details can help guide you towards the appropriate next steps. Please do not delay medical assessment, as a stone of this size needs evaluation by a urologist.

Wishing you and your family good health always.
Warm regards,
Team HexaHealth