Surgical Procedures for Kidney Stones


Story at-a-glance

  • If natural home remedies cannot eliminate kidney stones from the body, then surgery may be your best option. There are four types of kidney stone removal surgeries that patients can undergo
  • Make sure you exhaust all natural options before opting for surgery, and make sure that you’re familiar with the potential effects of these procedures

If natural home remedies cannot eliminate kidney stones from the body, then surgery may be your best option. There are four types of kidney stone removal surgeries that patients can undergo. The method that your physician recommends will depend on:1

Size and type of stone

Medications the patient is taking

Other medical problems

Patient preference

Shockwave Lithotripsy (SWL)

SWL can be used to treat small- to medium-sized kidney stones, especially those that measure less than 2 centimeters in diameter. Also called Extracorporeal Shock Wave Lithotripsy (EWSL), this is an outpatient procedure where the patient is placed under general anesthesia.2,3

SWL involves focusing around 1,000 to 2,000 intense ultrasound or high-frequency shockwaves onto the stones, shattering them into small pieces while reducing the effect on the surrounding tissue.

The pieces are eliminated from the kidneys and body via normal urine flow. This kidney stone removal surgery takes around 45 to 60 minutes.4,5

Certain medications may lead to unwanted bleeding during a surgery, and should be avoided seven to 10 days before SWL:6 There is little or no discomfort after SWL, and it does not require hospitalization. However, it’s not recommended for:7

People with a history of cysteine, monohydrate or uric acid stones

Pregnant women8

People with bleeding disorders, infections and/or skeletal abnormalities

Morbidly obese people

Moreover, SWL might be difficult if there are:9

Kidney stones that might be hard and resistant to breakage caused by the shockwaves

Kidney stones that are invisible on the X-ray and cannot be targeted for treatment

Larger stones or stones that have traveled to the lower part of the urinary tract (a physician might recommend another course of treatment for these stones)

Complications that could occur from SWL include discomfort at the skin closest to where the kidney stones were, abdominal pain or aching for several days, blood in the urine and severe cramps when the fragments leave the body. Severe bleeding and pain, damage to the area around the kidney stones or blockage to urine flow might also happen, although these are rare.10,11

Recovery time for this type of kidney stone surgery is brief. The patient may already walk after treatment and resume daily activities within one to two days. People who undergo an SWL are expected to release kidney stone fragments for several weeks.

Although no special diets are needed, it’s highly recommended to drink lots of water so the kidney stone pieces will pass easily.12

Ureteroscopy

Small- to medium-sized kidney stones can also be eliminated through ureteroscopy. This is performed as a same-day procedure, alongside a lather lithotripsy. Just like with SWL, the patient is under general anesthesia.13 Ureteroscopy is ideal for people with hard kidney stones that don’t respond to SWL, stones that aren’t visible in the X-ray or stones that reside low in the urinary tract and in the region approaching the bladder.

During a ureteroscopy, a urologist passes a long and thin telescope called a ureteroscope14 through the urinary opening, into the bladder and up to the ureter. A laser breaks stones in this area into smaller pieces, which are then extracted or released from the body during normal urine flow.15 A ureteroscopy lasts for one-and-a-half hours, with subsequent post-operative recovery.16

After the operation, a small tube called a stent might be temporarily placed in the ureter to help the kidneys drain. This stent is completely internal, and is removed after three to 10 days in a quick procedure that does not require anesthesia.17,18

Seven to 10 days before the operation, it is advisable that you stop intake of certain medications, as they can change your body’s platelet function or ability to clot, and result in unwanted bleeding during or after surgery.19 However, a ureteroscopy isn’t for people with large kidney stones, since these can produce stone fragments that make complete removal impractical or impossible. The same goes for patients with a history of urinary tract reconstructions.

Patients who have undergone ureteral or bladder reconstruction may also experience problems with this surgery, as their bodies may inhibit the ureteroscope’s smooth passage. There are also rare instances wherein scopes cannot reach the kidney stones despite the machine’s small size and flexibility.20

Complications are often associated with stents, such as mild discomfort or back pain, bladder irritation, frequent urges to urinate and blood in the urine. Severe blooding could also happen, although this is rare.21

It’s normal to feel or be sick 24 hours after the operation, since it’s an after effect of the anesthetic. But after two to three days, the patient should be eating and drinking normally. Although the patient might feel fine after the procedure, reasoning, reflexes, judgment, coordination and skill can be affected, so he or she should refrain from doing these activities 48 hours after the surgery:22

Driving vehicles, including bicycles

Operating machinery

Attempting to cook

Using sharp utensils

Pouring hot or boiling liquids

Making important decisions or signing contracts

Percutaneous Nephrolithotomy (PCNL)

Percutaneous nephrolithotomy (PCNL) is recommended for patients with exceptionally large or complex kidney stones, or a large amount of small stones in one kidney. Unlike SWL and ureteroscopy, PCNL is an inpatient procedure that requires hospitalization.23

PCNL is done by an urologist and assisted by an interventional radiologist. They work together to create a small (no larger than a dime) incision in the back to make a direct channel into the kidney’s draining system. The urologist uses specialized equipment to shatter stones which are then vacuumed or plucked out of the kidney.

After PCNL, most patients can be discharged within 24 hours, although some can be hospitalized for one to two days.24,25 Make sure to avoid medicines that can alter platelet function or the body’s clotting ability, and that may trigger unwanted bleeding seven to 10 days before a PCNL.26

PCNL is time-consuming, especially if there are large and more complex stones, since more than one procedure might be required to completely remove everything. It is not ideal for people taking blood-thinning medications.27

Side effects of PCNL include pain in the incision site, presence of blood in the urine, need for a stent or tube for temporary kidney damage and stent discomfort. Some also experience fatigue, constipation or nausea, which are related to the anesthesia.28 There is also a possibility for severe bleeding, injuries to the kidney and adjacent structures and infections.29 Even worse, some stones may not be removed, resulting to open surgery.30

After the operation, light activities like walking are recommended, but heavy lifting, driving or other potentially tiring activities must be limited for two weeks. Sexual activity is prohibited, too.31,32 As for returning to work, patients must wait for at least one to two weeks following surgery, or as advised by the physician.33

Open Surgery

Open surgery is not as common as the first three procedures. In fact, this is rare, with only less than 1 percent of patients requiring it. An open surgery should be considered if there’s a very large stone or abnormal anatomy. During the procedure, the surgeon will make an incision on the back to be able to access the ureter and the kidney, and then remove the kidney stone.34

MORE ABOUT KIDNEY STONES

Kidney Stones: Introduction

What Are Kidney Stones?

Kidney Stones Types

Kidney Stones Causes

Kidney Stones Symptoms

Kidney Stones Prevention

Kidney Stones Duration

Kidney Stones Treatment

Kidney Stones Surgery

Kidney Stones Diet

Kidney Stones FAQ

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[+]Sources and References [-]Sources and References

  • 1, 2, 7, 9, 10, 13, 15, 18, 21, 23, 25, 27 “Surgery for Kidney Stones,” Washington University School of Medicine in St. Louis Urologic Surgery
  • 3, 5, 8, 11, 12 “Kidney Stone Treatment: Shock Wave Lithotripsy,” National Kidney Foundation, September 2009
  • 4, 34 “Treating Kidney Stones,” NHS Choices, June 15, 2016
  • 6 “Extracorporeal Shock Wave Lithotripsy (ESWL),” UF Department of Urology
  • 14 “Treating Kidney Stones,” NHS Choices, June 15, 2016
  • 16 “Ureteroscopy,” UC San Diego Health
  • 17 “Frequently Asked Questions About Ureteral Stents,” UMHS Department of Urology
  • 19 “Ureteroscopy and Laser Lithotripsy,” UF Department of Urology
  • 20 “Ureteroscopy,” Johns Hopkins Medicine Health Library
  • 22 “Having a Ureteroscopy,” Guy’s and St Thomas’ NHS Foundation Trust
  • 24, 26, 28, 33 “Percutaneous Nephrolithotomy (PCNL),” UF Department of Urology
  • 30 “Percutaneous Nephrolithonomy (PCNL),” Johns Hopkins Medicine Health Library
  • 31 “Percutaneous Nephrolithotomy (PCNL) Information for Patients,” Royal United Hospital Bath NHS Trust, March 21, 2012
  • 32 “After PNL (Percutaneous Nephrolithotomy) Surgery,” Vancouver Coastal Health, October 2015