Kidney Stones: When do you need surgery ?

We recently covered the medical treatments available for small kidney stones in our previous post, but you may be wondering what the treatment options are for more severe kidney stones. In this post, we’ll analyze the four most common surgical treatments for kidney stones and what each procedure entails.

Let’s first discuss the most common treatment option:

Shockwave Lithotripsy (SWL)

For small to medium-sized kidney stones, physicians will utilize high-energy shock waves to break up the stones while they’re still in the body. Doctors will use ultrasound or x-rays beforehand to determine the location and size of the stones before proceeding with this option.

The physician will send the shockwaves externally, and the waves travel through the skin to efficiently break the stones up into more manageable pieces which are then passed naturally. Doctors may also use a stent inserted into the ureter to provide a broader opening for the stones to exit.

There are a few side effects to consider with this procedure including:

• Bleeding around the kidney from the shockwaves
• Infection
• Stones blocking the flow of urine

Ureteroscopy 

This is a more invasive procedure for larger stones inside of the kidney and ureter. The doctor will insert a thin and flexible scope through the bladder and ureter, eventually reaching the kidney where a small basket on the end will collect and remove the stones. If stones are bigger than average, doctors will actually use laser technology to break them up. While this procedure sounds scary, patients are under anesthesia during the entire treatment and are usually able to go home the same day.

As with SWL, the doctor may insert a stent into the ureter to help urine drain from the kidney and clear up any tiny stones.

Some side effects to consider:

• Infection
• Ureter narrowing
• Bleeding

Percutaneous Nephrolithotomy and Percutaneous Nephrolithotripsy (PCNL)

Both of these treatments are similar to the two previous and combine the use of a tube inserted into the body along with soundwave technologies.

During the procedure, a doctor will make a small incision in the patient’s back or side and insert a small tube in the area of the kidney stones. Once the tube is inside the doctor will either remove the kidney stones (Nephrolithotomy) or will send powerful shockwaves near the stones to break them up (Nephrolithotripsy).

The entire procedure will generally take under an hour; however, patients will have to stay in the hospital for at least a day while they recover.

A few risks with these surgeries:

• Infection
• Bleeding
• Bladder, bowel, ureter, kidney, or liver damage

Open Surgery

While open surgery is not as commonly used for kidney stones as before, it is still an option for those in exceptional circumstances such as a stone stuck in the ureter, blockage of the urine flow, tremendous pain, or infection.

In this procedure, the patient is unconscious while the doctor makes an incision into the side and kidney, removing any of the stones. This method, like any open surgery, requires the patient to recover in the hospital for a little while.

If you think you may have kidney stones, be sure to seek medical attention and ask your doctor about the different treatment options available for your specific case.

Resources:

• https://www.auanet.org