Kidney Stone Treatments

Surgical options for treating large kidney stones

In most instances small kidney stones are naturally passed in your pee. Where stones are too large to pass naturally, then surgery may be required.

There are three surgical options available and choice is based on size and location of your kidney stone.

1. Shock-wave lithotripsy (SWL)

Shock-wave treatment involves targeting stones within the kidney or within the ureter (tube connecting kidney to bladder). Targeted shock waves fragment the stone into very small pieces that can pass naturally. Targeting is done using ultrasound and X-ray guidance, takes approximately 30 mins and is well tolerated. Painkillers are given before the treatment and the treatment is performed awake. Up to 2 to 3 treatments may be given if the stone is not fully fragmented during the first session.

2.  Ureteroscopy

This treatment is performed under a general anaesthetic and involves passing a small endoscopic camera into the tube that connects the kidney with the bladder (ureter). A laser is used to fragment the stone into small pieces that can either pass naturally or be removed via the endoscope. Sometimes a small plastic drainage tube (stent) is placed within the ureter to aid recovery. This will need to be removed at some point via a flexible cystoscopy.

3. Percutaneous Nephrolithotomy (PCNL)

This treatment is performed under a general anaesthetic and involves a keyhole operation to directly fragment and remove stone from the kidney. A tube is placed directly through the skin into the kidney, and stone is fragmented within the kidney, and removed. Often a small plastic drainage tube (stent) is placed within the ureter to aid recovery. This will need to be removed at some point after the operation via a flexible cystoscopy.

4.  Stent

A stent is a plastic tube which is placed in the ureter and runs between the kidney and the bladder.  Occasionally it can be placed as an emergency if there is a stone blocking the kidney leading to infection within the kidney.

A stent can also be placed following surgery to allow the kidney to drain and protects it from any swelling.

A stent can be uncomfortable and common stent symptoms include:

• Needing to pass urine more frequently and urgently (this is a consequence of the end of the stent irritating the lining of the bladder where it is resting).
• Blood in the urine.
• Pain in the side.

These symptoms all subside once the stent is removed.

The stent can be left on a string which is taped to the penis or inner thigh and removed by pulling the string. Alternatively it can be removed under a local anaesthetic flexible cystoscopy if no string has been left.