There are different methods used for removal of kidney stones, depending on the size of the stone, its position and type:
- Extracorporeal Shock Wave Lithotripsy (ESWL).
- Percutaneous Nephrolithotomy and Percutaneous Nephrolithotripsy (PCNL)
Extracorporeal Shock Wave Lithotripsy (ESWL)
ESWL uses sound waves to create strong vibrations (shock waves) that break the stones into tiny pieces that can be passed in your urine.
Procedure of ESWL
- The complete treatment takes about 45 to 60 minutes.
- A procedure is performed under local or general anesthesia as there is some pain
- The patient is positioned on an operating table so that the stone is targeted precisely with the shock wave, causing the stone to fragment. Stones are broken that are small enough to pass in the urine.
- Sometimes, a stent is inserted via the bladder till the kidney just prior to ESWL.
- Drinking plenty of water helps the stone fragments pass. For several weeks, you may pass stone fragments.
- Following few days asked to strain your urine through a filter to capture the stone pieces for testing
- You may pass blood in your urine
- May experience a severe cramping pain as shattered stone fragments make their way out.
- Oral pain medication and drinking lots of water will help relieve symptoms.
Risks of ESWL procedure
- ESWL can cause blood in the urine
- Bruising on the back or abdomen
- Bleeding around the kidney and other adjacent organs
- Discomfort as the stone fragments passes through the urinary tract
Prognosis of ESWL treatment
About 50-75% patients are found to be free of stones within three months of ESWL treatment. The highest success rates is in those patients with smaller stones ( less than 1 cm).
Removes stones using the help of a scope
Indication for Ureteroscopy:
Used for stones located in the ureter, especially for stones closest to the bladder, most commonly used for the treatment of lower ureteral stones.
Procedure of Ureteroscopy
- It is usually performed as an outpatient procedure and does not require hospitalization
- A small scope is inserted into the bladder and ureter
- It allows the urologist to see into the ureter, find the stone and remove it.
- The surgeon passes a tiny wire basket into the lower ureter via the bladder, grabs the stone and pulls the stone free.
- lf the stone is too large or too tightly stuck in the ureter, it can be fragmented and removed.
- Generally, the patient monitored for few hours and then allowed to return home
- Antibiotics and painkillers prescribed
- A patient told to keep a check on warning signs of infection
Risks of Ureteroscopy
- Injury to the ureter
Percutaneous Nephrolithotomy and Percutaneous Nephrolithotripsy (PCNL)
Surgery to remove very large stones in the kidney through instruments inserted through a small incision in the back.The goal is to take out all of the stones so that none are left to pass through the urinary tract.
Indication for Percutaneous Nephrolithotomy and Percutaneous Nephrolithotripsy
- Used in patients with large or irregularly shaped kidney stones,
- People with infections
- Stones that have not been broken up enough with ESWL
- In cases where ureteroscopy not possible
- Stones bigger than 2 cm
- The procedure takes around 20 to 45 minutes depending on the position of the stone
- Procedure is performed under anesthesia
- Small incision is made on the back to enter the kidney
- A nephroscope and other small instruments are advanced in through the hole
- lf the stone is removed through the tube, it is called nephrolithotomy.
- lf the stone is broken up and then removed, it is called nephrolithotripsy.
- The surgeon, high-frequency sound waves to break up the stone, uses a suction machine to clear up
- Patient is put under observation in hospital for 2-3 days
- Regular monitoring of vitals
- Antibiotics and pain killers prescribed
- Strenuous activity to be avoided initially
Risks of procedure
- Small risk of injury to other nearby organs, such as bowel, ureter, liver or the bladder