Dissolving kidney stones

CONDITIONS

Can Kidney Stones Be Dissolved?

Yes, certain kidney stones can be dissolved with a treatment called dissolution therapy. It is a safe and effective non-surgical option, but it only works for uric acid stones. Patients take oral medication that breaks down and dissolves the stones, which can eliminate the need for an operation.

Why Only Uric Acid Stones?

Dissolution therapy is a non-surgical treatment that specifically targets uric acid stones, which account for about 10% of all kidney stones. This method is particularly valuable because uric acid stones have a high chance of recurring.

How It Works: Alkalinisation

The treatment works by making your urine less acidic, a process known as urine alkalinisation. You'll take medication that raises the pH of your urine. This change in chemistry creates an environment where uric acid stones cannot stay solid, causing them to slowly dissolve over time.

How do you know if your stones can be dissolved?

Before starting treatment, your doctor needs to be reasonably sure that your stones are the uric acid type. Since you can't always get a piece of the stone to analyse without surgery, doctors use several diagnostic clues.

Urine and Blood Tests: A key indicator is the acidity of your urine. Uric acid stones form in acidic urine, so a low urine pH (often below 5.5) is a strong sign. Doctors may also check for elevated levels of uric acid in your blood (serum UA levels).
Imaging: A non-contrast Computed Tomography (CT) scan is the most common imaging tool used. Uric acid stones are typically radiolucent, meaning they don't show up well on standard X-rays. On a CT scan, however, they are visible. Doctors can also measure their density in Hounsfield Units (HU). Uric acid stones tend to have a low density (usually less than 500 HU (1)), which helps differentiate them from other, denser stone types like calcium oxalate. Research suggests that a stone larger than 4 mm with an HU measurement of 500 or less and a urine pH of 5.5 or less has a 90% chance of being a uric acid stone (3).

What to Expect from Treatment

Dissolution therapy is primarily administered through oral medication. The most common medications are alkalinising agents like potassium citrate, sodium bicarbonate, or a combination. The goal is to raise your urine pH to a target level, which typically ranges from around 6.0 to 7.5.

In some cases, you may be asked to monitor your own urine pH at home using test strips and adjust your medication dose accordingly to stay within the target range. Treatment duration can vary significantly, from a few weeks to several months, with the average being around half a year in recent studies. Alongside medication, your doctor will likely recommend increasing your daily fluid intake and may suggest a diet low in purines (found in red meat, organ meats, and some seafood). Sometimes, a medication like allopurinol or febuxostat is prescribed to lower the amount of uric acid your body produces.

What Are the Chances of Success?

The results from the comprehensive review are very encouraging. Overall, around 80 % of patients saw either complete or partial dissolution of their uric acid stones (1).

When broken down further:

Around 60% of patients achieved complete dissolution, meaning their stones disappeared entirely on follow-up imaging.
20% of patients experienced partial dissolution, meaning their stones got smaller.

This high success rate means that a large majority of patients can avoid surgery. However, the therapy isn't successful for everyone. Around 15-20% of patients ultimately require surgical intervention (2) to remove their stones. The therapy was generally well-tolerated; only about 10 % of patients stopped the treatment due to side effects, non-compliance, or other reasons. The most common side effect was gastrointestinal disturbance.

In conclusion, for those with uric acid kidney stones, dissolution therapy stands out as a highly effective and safe first-line treatment that can eliminate stones without the need for an invasive procedure. If you have been diagnosed with kidney stones, it's worth discussing with your urologist whether this could be the right approach for you.

Mr Ivo Dukic is a top Consultant Urological Surgeon whose Birmingham-based practice is a leading UK centre for kidney stone removal. As one of the country's highest-volume stone surgeons, he is a primary choice for patients seeking unparalleled expertise and successful outcomes.

Mr Dukic has dedicated his practice to the surgical management of kidney stones, ensuring patients benefit from a depth of experience crucial for complex cases. His reputation is built on his mastery of advanced, minimally invasive techniques. He is a renowned specialist in Percutaneous Nephrolithotomy (PCNL), including ultra-modern mini-PCNL and ultra-mini PCNL procedures. These advanced treatments offer patients significantly faster recovery times and reduced discomfort.

For those throughout the UK seeking a definitive solution from an expert surgeon, Mr. Dukic's practice represents a national centre of excellence, combining high-volume experience with the latest, most effective treatments available.

You can schedule an appointment with him for expert, bespoke advice through his Top Doctors profile or book an appointment through the Harborne Hospital, HCA Healthcare or the Priory Hospital, Edgbaston, Circle Health Group.

Glossary

Alkalinisation: The process of making a substance, like urine, less acidic (raising its pH). This is the core mechanism of dissolution therapy for uric acid stones.
Calculi: The medical term for stones, in this case, those that form in the urinary tract.
Computed Tomography (CT) Scan: An advanced imaging technique that uses X-rays and a computer to create detailed cross-sectional images of the body. It's the most common method for diagnosing uric acid stones.
Dissolution Therapy: A medical treatment that uses oral medications to dissolve kidney stones, serving as a non-surgical alternative.
Hounsfield Units (HU): A measurement of density on a CT scan. Uric acid stones typically have a low HU value, which helps doctors identify them.
Radiolucent: A term for materials that are not easily visible on a standard X-ray. Uric acid stones are radiolucent.
Uric Acid (UA): A waste product found in the blood. When levels are too high, it can crystallize and form stones in the kidneys, especially in acidic urine.
Urolithiasis: The medical term for the condition of having stones in the urinary tract

References

Ong A, Brown G, Tokas T, Hameed BMZ, Philip J, Somani BK. Selection and Outcomes for Dissolution Therapy in Uric Acid Stones: A Systematic Review of Literature. Curr Urol Rep. 2023;24:355-63.
European Association of Urology. Urolithiasis - metabolic evaluation and recurrence prevention [Internet]. Arnhem, The Netherlands: European Association of Urology; 2022 [cited 2025 Aug 30]. Available from: https://uroweb.org/guidelines/urolithiasis/chapter/metabolic-evaluation-and-recurrence-prevention
Spettel S, Shah P, Sekhar K, Herr A, White MD. Using Hounsfield unit measurement and urine parameters to predict uric acid stones. Urology. 2013;82(1):22-6.

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