In general, minimally invasive lithotripsy requires 5–7 days of hospitalization.

When extracorporeal shock-wave lithotripsy (ESWL) fails to clear the stones, minimally invasive lithotripsy is performed. This involves making a small puncture in the skin to insert a special instrument that delivers holmium laser energy directly onto the stone surface. The success rate is high because the laser effectively fragments most stones, allowing the fragments to pass out naturally.

For ureteral stones, a cystoscope can be passed through the bladder into the ureter to reach the stone, and holmium laser lithotripsy is then performed. Although effective, the procedure may cause minor trauma to surrounding tissues. Therefore, patients are typically hospitalized for 5–7 days post-operatively. During this period:

• Anti-inflammatory and anti-edema medications are administered.
• Urine color is monitored; if red blood cells are present, it indicates possible injury to the kidney or ureter, and the patient is advised to drink plenty of water and rest in bed.

If, after 5–7 days, the patient has no discomfort and urine returns to normal, they can be discharged.

Post-discharge instructions:

• Avoid strenuous exercise
• Drink large amounts of water to help flush out any remaining fragments.

The claim that pumpkin vines can cure stones is false.
Although folk remedies promote pumpkin vine as a stone-dissolving agent, no scientific study has ever validated this effect. Relying solely on such folklore delays proper care.

Therapy must be tailored to stone size, location, shape, and the presence of obstruction or infection. After imaging (KUB film or non-contrast CT) clarifies these features, management options are:

1. High fluid intake – increases urinary flow to flush out small stones.
2. Moderate exercise – stair-climbing or rope-jumping helps propulsion.
3. Drugs – α-blockers (tamsulosin, silodosin) relax the ureter and relieve colic; traditional stone-expelling powders (e.g., Pai-Shi granules, Desmodium compound) may be added.
4. Extracorporeal shock-wave lithotripsy (ESWL) – best for renal and upper-ureteral stones; repeated shock waves fragment the calculus, allowing spontaneous passage.
5. Surgery – whenever severe obstruction or infection coexists, endoscopic or percutaneous minimally invasive procedures are performed promptly to eliminate the stone and prevent systemic sepsis.

Commonly, stones (calculi) form in the urinary system, the biliary system, and on teeth. Less frequent sites include the eyes, stomach, pancreas, and bronchi. The main locations are outlined below.

1. Urinary system
   – Kidney, ureter, bladder, and urethral stones.
   – Exact cause unknown; both external and internal factors raise the concentration of calcium-containing solutes and matrix in urine, promoting crystallization.
   – Small stones: oral medical expulsion therapy.
   – Medium-sized or non-severe obstruction: extracorporeal shock-wave lithotripsy (ESWL).
   – Large or heavily obstructed stones with infection: minimally invasive surgery (ureteroscopy, percutaneous nephrolithotomy, etc.).
2. Biliary system
   a) Gallbladder stones: linked to hormonal changes, obesity, chronic high-fat diet; treated with laparoscopic cholecystectomy when indicated.
   b) Common-bile-duct stones: possibly related to infection, obstruction, or parasites; managed surgically or endoscopically to restore bile flow.
   c) Intrahepatic stones: strongly associated with recurrent cholangitis; environmental and genetic factors implicated; usually require surgical removal.
3. Teeth
   – Dental calculus arises in patients with gingivitis or periodontitis. Soft plaque mineralizes and hardens over time.
   – Prevention: good oral hygiene; routine professional scaling to prevent progressive gum damage.

Tea is not recommended; plain boiled water is preferred.
From the standpoint of stone-forming mechanisms:

1. Excessive excretion of stone-forming substances
   Increased urinary calcium, oxalate or uric acid from prolonged immobilization, hyperthyroidism, idiopathic hypercalciuria, distal renal tubular acidosis, etc.
2. Low urine volume
   Raises the concentration of salts and organic matrix.
3. Reduced urinary inhibitors of crystallization
   Lower levels of citrate, pyrophosphate, magnesium, acidic glycosaminoglycans and trace elements.
4. Anatomical factors & infection
   Urinary-tract obstruction causes stasis and local deposition; infection further promotes struvite or calcium-phosphate stones.
   Uric-acid stones are linked to gout.

Oxalate metabolism
Oxalate is the second major component of calcium-oxalate stones, yet most patients have no inherited oxalate disorder.
Enteric hyperoxaluria (≈ 2 % of stone formers) arises from increased colonic absorption:

• In ileal disease, chronic pancreatitis or biliary disease, fat binds calcium, leaving free oxalate to be absorbed.
• Unabsorbed fatty acids and bile salts also increase mucosal permeability to oxalate.
• Absorptive hypercalciuria can secondarily raise oxalate uptake.

Because all of these mechanisms are aggravated by low urine output and additional oxalate intake, stone patients should drink plenty of plain water and avoid tea.

Stone-forming patients can safely drink yogurt. Its benefits include:

1. Stimulates gastric-juice secretion, improving appetite and digestion.
2. Lactic-acid bacteria lower levels of certain carcinogens, giving anti-cancer potential.
3. Suppresses putrefactive bacteria and the toxins they produce in the gut.
4. Helps reduce blood cholesterol, valuable for people with hyperlipidaemia.

Stone patients should also eat plenty of fresh vegetables and fruit, get adequate rest, and limit spicy, greasy or otherwise irritating foods.