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Surgical procedures for kidney stones

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Doctor performing a surgery

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  • Surgery may be considered to address kidney stones, provided that you have exhausted other safer holistic treatment options
  • There are four types of surgical procedures your doctor could suggest if you’re dealing with kidney stones
  • A shockwave lithotripsy and a ureteroscopy are outpatient treatments that won’t require hospitalization

If natural home remedies no longer work for your kidney stones, surgery may be considered as a last resort. There are four types of kidney stone removal surgeries, and the type of procedure you'll need to undergo will depend on factors like:1

  • Stone size and type
  • Medications you're currently taking
  • Other health issues you're dealing with
  • Personal preference

Shockwave lithotripsy (SWL)

SWL can address small to medium stones,2 especially those with diameters less than 2 centimeters (0.78 inch).3 The University of Michigan notes that this surgery, also called extracorporeal shock wave lithotripsy (EWSL), is an outpatient procedure that doesn't require hospitalization.4

If you'll undergo an SWL, you'll need to be placed under general anesthesia.5 SWL mainly involves focusing around 1,000 to 2,0006 ultrasound or high-frequency waves toward the stones, which shatters them into little pieces that can be released when you urinate.7 This kidney stone removal surgery takes around 45 to 60 minutes.8

Seven to 10 days before undergoing this surgery, it's recommended that you avoid medicines like aspirin, ibuprofen, motrin, Advil, Coumadin, vioxx and Plavix. According to the University of Florida's Department of Urology, these drugs disrupt your body's platelet function and raise your risk for unwanted bleeding during the procedure.9 However, SWL is not recommended for people who are:10

  • Morbidly obese11
  • Pregnant
  • Struggling with obstructions in their ureter or have scar tissue in this body area
  • Dealing with kidney stones that are made of cystine and certain types of calcium
  • Taking blood thinners
  • Diagnosed with bleeding disorders, infections of the kidney or urinary tract, or kidney cancer
  • Dealing with kidneys that are abnormally structured or do not function properly12
  • Struggling with a chronic kidney infection, since some stone pieces are unable to pass through, causing bacteria to not fully be eliminated from the kidneys
  • In need of speedy or complete removal of substances that can trigger kidney stones

Moreover, the Division of Urologic Surgery at the Washington University School of Medicine in St. Louis also highlights that SWL can be difficult if the kidney stones are:13

  • Hard and are unable to be broken by the shockwaves in this procedure
  • Not seen on the X-ray and cannot be targeted for treatment
  • Larger or are already in the lower part of your urinary tract, since they may be addressed by other more effective methods

Complications that can occur because of SWL include:

  • Skin discomfort in the area where the stones were closest to
  • Presence of blood in the urine
  • Back or abdominal bruises14
  • Bleeding and extreme pain (albeit rare)15
  • Abdominal pain or ache that lasts several days
  • Severe cramps due to stone pieces being released from the body16
  • Disrupted flow of urine17

People who undergo a SWL could experience a short recovery period. According to the National Kidney Foundation, walking after treatment and performing daily activities may be done in one to two days. After the procedure, you'll be advised to drink lots of water, so the kidney stone pieces will pass — sometimes this could take several weeks.18

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Small- to medium-sized kidney stones can also be eliminated through ureteroscopy, a procedure that takes one-and-a-half hours.19 This is done alongside a lather lithotripsy, and you'll need to be placed under general anesthesia. You can be recommended for an ureteroscopy as an alternative to SWL, or if your kidney stones cannot be seen in an X-ray or are located in the lower portion of urinary tract, in an area near your bladder.20

During an ureteroscopy, a long and thin ureteroscope is inserted21 through your urethra, and into the bladder and ureter, particularly in the area where the kidney stone is.22 The kidney stones in the said location are then broken down into little fragments using a laser. These small pieces can be extracted or released from the body when you pee.23

After the operation, a small tube called the ureteral stent is temporarily placed in your ureter to help the kidneys properly drain your urine.24 This internal stent can be removed after three to 10 days in a quick procedure that doesn't require anesthesia.25

If your doctor suggests that you undergo an ureteroscopy, stop taking drugs like aspirin, ibuprofen, motrin, Advil, Coumadin and Plavix. Changes in your body's platelet function could develop because of them and raise your risk for unwanted bleeding during the procedure.26

Johns Hopkins Medicine notes that not everyone is eligible for an ureteroscopy. If you belong to any of these two groups, try searching for other more effective options to address kidney stones:27

  • People with large kidney stones — They could produce excessive amounts of stone fragments that may be difficult or impossible to extract from the body.
  • People who have a history of urinary tract reconstruction — It can be difficult for the ureteroscope to pass through the urinary opening if you underwent ureteral or bladder reconstruction.

You may also deal with complications linked to your stents, such as mild pain, bladder discomfort, increased tendency to urinate and traces of blood in urine. Severe bleeding is also possible, although it's rare.28

According to the Guy's and St. Thomas' NHS Foundation Trust, you can feel sick 24 hours after an ureteroscopy because of the anesthesia. After two to three days, you should be able to eat and drink normally. However, it's still advisable that you refrain from driving cars, operating machinery, cooking, using sharp utensils, signing contracts or making crucial decisions 48 hours after this surgery since your thinking and decision skills could be affected.29

Percutaneous nephrolithotomy (PCNL)

A PCNL can be suggested if you exhibit large or complex kidney stones or have many small stones in one of your kidneys. A urologist and an interventional radiologist will conduct the PCNL. A small, dime-sized incision is made on your back so they can access your kidney's drainage system. Special equipment is used by the urologist to break the stones into smaller pieces and extract them from your kidney.30

You can be discharged 24 hours after the surgery,31 although it's possible that you'll be hospitalized for one to two days.32 Just like with the first two procedures, avoid taking drugs like aspirin, ibuprofen, motrin, Advil, Coumadin, vioxx and Plavix seven to 10 days before a PCNL to prevent changes to your body's platelet function and unwanted bleeding during the procedure.33

Take note that a PCNL could be time-consuming since more than one procedure may be required to completely remove stones or fragments. It's also not recommended if you're already taking blood-thinning medications.34

Side effects of PCNL include discomfort linked to the incision, presence of blood in the urine and the potential need to use a stent to deliver drainage to your kidneys.35 There is also a possibility for blood loss, development of infections or injuries to multiple tissues and organs. Some stones may not be completely removed or be difficult to extract due to their location. Your doctor could decide to do an open surgery instead if certain difficulties arise.36

After the operation, light activities like walking are recommended, but heavy lifting and driving shouldn't be done within two weeks.37 Sexual activity is prohibited within this period too.38 Wait for at least one to two weeks after the procedure before going back to work.39

Open surgery

Open surgery is not as common as the first three surgeries. In fact, it's rarely done.40 According to the University of Wisconsin School of Medicine and Public Health, an open surgery should only be considered if other procedures were unable to address the kidney stones, staghorn calculi (large stones that arise due to infections) are present or if you have abnormalities in your urinary tract disrupt urine flow in your kidneys, ureter or bladder.41

During this procedure, the surgeon will make an incision on your abdomen or side to be able to access your kidney and remove the stones. Afterward, a catheter is placed near your kidney so urine properly drains until the mentioned organ heals. People who undergo an open surgery are hospitalized for six to nine days, and could go back to performing daily routines after four to six weeks.42


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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