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Welcome to NMC Urocare

Stones – Treatments

Conservative Treatment

Conservative treatment options for kidney stones include:

  • Hydration: Drinking fluids can help to flush small stones out of the urinary tract.
  • Medication: Your doctor may prescribe medication depending on the type of kidney stone or if infection is present. Pain medications may also be prescribed.
  • Diet: Dietary changes may be suggested by your doctor depending on the type of kidney stone present.

Surgical Overview

Surgery may be needed to remove a kidney stone if it

  • Does not pass after a reasonable period of time and causes constant pain
  • Is too large to pass on its own or is caught in a difficult place
  • Blocks the flow of urine
  • Causes an ongoing urinary tract infection
  • Damages kidney tissue or causes constant bleeding
  • Has grown larger, as seen on follow-up x rays

Until 20 years ago, open surgery was necessary to remove a stone. The surgery required a recovery time of 4 to 6 weeks. Today, treatment for these stones is greatly improved, and many options do not require major open surgery and can be performed in an outpatient setting.

Surgical Treatments

Extracorporeal Shock Wave Lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) is the most frequently used procedure for the treatment of kidney stones. It is usually performed on an outpatient basis with the patient under IV sedation or general anesthesia. In ESWL, shock waves that are created outside the body travel through the skin and body tissues until they hit the denser stones. The stones break down into small particles and are easily passed through the urinary tract in the urine. Most ESWL devices use either x rays or ultrasound to help the surgeon pinpoint the stone during treatment.

Ureteroscopic Stone Removal

Although some stones in the ureters can be treated with ESWL, ureteroscopy may be needed for mid- and lower-ureter stones. This procedure is usually performed on an outpatient basis with the patient under general anesthesia. No incision is made in this procedure. Instead, the surgeon passes a small fiber optic instrument called a ureteroscope through the urethra and bladder into the ureter. The surgeon then locates the stone and either removes it with a cage-like device or shatters it with a special instrument that produces a form of shock wave. A small tube or stent may be left in the ureter for a few days to help urine flow.

Percutaneous Nephrolithotomy or Tunnel Surgery

This surgery requires a hospital stay and is performed with the patient under general anesthesia. In Tunnel surgery, the surgeon makes a tiny incision in the back and creates a tunnel directly into the kidney.

Using an instrument called a nephroscope; the surgeon locates and removes the stone. For large stones, some type of energy probe—ultrasonic or electrohydraulic—may be needed to break the stone into small pieces.

Often, patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the healing process. This treatment is often used when the stone is quite large or in a location that does not allow effective use of ESWL. One advantage of percutaneous nephrolithotomy is that the surgeon can remove some of the stone fragments directly instead of relying solely on their natural passage from the kidney.

Postoperative Precautions

Your surgeon will give you guidelines to follow depending on the type of procedure performed. General guidelines include the following:

If your surgery was performed as outpatient surgery, you will require a driver to take you home due to the drowsy effects of anesthesia.

Your surgeon may give you activity restrictions such as no heavy lifting and when you can return to work. It is very important that you follow your surgeon’s instructions for a successful recovery.

You may feel soreness around the incision area. Your surgeon may give you a prescription pain medicine or recommend NSAID’s (non-steroidal anti-inflammatory drugs) for the first few days to keep you comfortable.

Contact your doctor immediately if you have a fever, chills, increased pain, bleeding or fluid leakage from the incision, chest pain, shortness of breath, leg pain, or dizziness.

Risks and Complications

As with any surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place. Most patients do not have complications after Kidney Stone surgery; however complications can occur and depend on which type of surgery your doctor performs as well as the patient’s health status. (Obese, diabetic, smoker, etc.) Complications can be medical (general) or specific to your surgery. Medical complications include those of the anesthesia and your general wellbeing.

Almost any medical condition can occur so this list is not complete. Complications include:

  • Allergic reaction to medications
  • Blood loss requiring transfusion with its low risk of disease transmission
  • Heart attack, strokes, kidney failure, pneumonia, bladder infections
  • Complications from nerve blocks such as infection or nerve damage
  • Serious medical problems can lead to ongoing health concerns, prolonged hospitalization, or rarely death.

Specific Complications of ESWL can include:

  • Blood in the urine which usually resolves in a few days
  • Bruising and minor discomfort in the back or abdomen
  • Additional treatments may be needed if stone still present
  • Pain while passing the stone particles

Specific Complications of Ureteroscopy can include:

  • Urinary Infection
  • Bleeding
  • Damage to the ureter

Specific Complications of Percutaneous Nephrolithotomy or Tunnel surgery include:

  • Infection
  • Bleeding
  • Urinary fistulas
  • Perforation of adjacent organs