Surgical

If the stone is unlikely to pass by itself or is causing too many problems then intervention may be required.

Most patients who have treatment will have planned surgery for stones and have a full explanation of the treatments given to them by their consultant at their clinic appointment. In summary surgical removal can be achieved by the following means;

Ureteroscopy


Ureteroscopy involves the insertion of a very small telescope up through the water pipe (urethra) to the bladder and then up the ureter.  This is performed under general anaesthetic.  A straight or semi-rigid telescope is normally used for stones in the ureter.  A flexible telescope with a movable tip is used to access stones in the kidney.  A laser fibre can be inserted down the middle of the telescope to allow the stone to be broken.  A tiny wire basket may then be used to remove the stone fragments.  Very small fragments may be left to pass out on their own.  

Ureteroscopy is the most successful way of treating stones of 15mm or less, but does require a general anaesthetic. 

 

Extracorporeal Shock Wave Lithotripsy (ESWL)

Shock wave lithotripsy involves treating a stone in the kidney or ureter without the need for a general anaesthetic.  The patient lies on a bed in a small pool of warm water.  A water filled cushion is then pressed up against the kidney and a shock wave is fired directed at the stone.  This fragments the stone allowing the patient to pass the fragments.  

This is done without the need for general anaesthetic as an outpatient procedure.  However, the stone fragments need to pass down the ureter pipe and may cause renal colic as they come down.  The success rate from lithotripsy is also slightly lower than ureteroscopy and lasering the stone.  

 

Percutaneous Nephrolithotomy (PCNL)


PCNL is the surgical removal of stones from the kidney.  This is reserved for larger stones or stones that cannot be treated with either ureteroscopy or shock wave lithotripsy.  A general anaesthetic is required and a small (1cm) incision is made in the skin overlying the kidney.  A telescope is then introduced through this incision into the kidney.  The stone is broken and removed.  At the end of the procedure a small tube is left in the kidney, which drains out through the skin.  This is normally removed after 48 hours.