Kidney stones can be treated with surgery
Surgical treatment of kidney stones comes in several forms, all of which are generally well tolerated. It is rare to have to actually make a large incision to remove a stone in the urinary tract. Reasons that surgery may be advised include continued pain, risk of continued damage due to a blocked kidney, bleeding or infection.
- Ureteral Stent Placement is a plastic hollow tube that is placed in the ureter to allow urine to pass from the kidney past the blockage, caused by a stone or swelling, to allow drainage of the kidney. There are times when a stent is placed without another procedure such as when there is an infection or if a patient is in severe pain and other forms of therapy are not available. Ureteral stents are commonly placed during other forms of treatment to prevent post-operative kidney blockage to help in healing of the urinary tract.
- Extracorporeal shock wave lithotripsy (ESWL) uses shock waves to break kidney stones into tiny pieces that are then passed in the urine. Physicians often use this procedure to remove stones about 1 centimeter in size or smaller. During ESWL, patients are either lie on a cushioned bed, are placed under a general anesthetic and the kidney stone is located using X-ray. High powered sound waves are then passed through the body and crush the kidney stone. The procedure takes about one hour and may need to be repeated for multiple stones or very large stones. The small fragments of the stone are usually passed as sand-like particles. Some stones may not be appropriate for ESWL especially if they are very low in the urinary tract, if you are pregnant, if the stone cannot be seen on X-ray or are too hard.
- Percutaneous nephrolithotomy (PCNL) is a procedure that is generally performed for very large stones in the kidney. After these stones are not causing pain but there is a concern for ongoing infection or blockage. In this procedure, a tube is placed through the back into the kidney through which a camera can be placed to visualize the stone. A variety of instruments, including lasers, high frequency ultrasound and jackhammer like devices, are then used to break apart the stone and remove them from the body. This procedure is performed under general anesthesia and patients usually stay in the hospital for one to two days.
- Ureteroscopic stone removal or ureteroscopy is one of the most common ways to treat a stone emergently. This procedure involves passing a small rigid or flexible camera into the ureter (the tube that connects the kidney to the bladder) and using a laser to break the stone and/or a basket to extract the fragments. Urologists perform this procedure to remove stones lodged in the ureter or in the kidney. A stent is routinely placed after the procedure to prevent swelling of the tissues from blocking the kidney and causing pain. There are times when the anatomy of a patient’s urinary system or the location of the stone will not allow a ureteroscopy to be successful.
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