Kidney Stones in Adults (cont.)
Surgical Treatment
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
Extracorporeal Shock Wave Lithotripsy
Extracorporeal shock wave lithotripsy (ESWL) is the most frequently used procedure for the treatment of kidney stones. 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.
Several types of ESWL devices exist. Most devices use either x-rays or
ultrasound to help the surgeon pinpoint the stone during treatment. For most
types of ESWL procedures, anesthesia is needed.
In many cases, ESWL may be done on an outpatient basis. Recovery time is
relatively short, and most people can resume normal activities in a few days.
Complications may occur with ESWL. Some patients have blood in their urine
for a few days after treatment. Bruising and minor discomfort in the back or
abdomen from the shock waves can occur. To reduce the risk of complications,
doctors usually tell patients to avoid taking aspirin and other medicines that
affect blood clotting for several weeks before treatment.
Sometimes, the shattered stone particles cause minor blockage as they pass
through the urinary tract and cause discomfort. In some cases, the doctor will
insert a small tube called a stent through the bladder into the ureter to help
the fragments pass. Sometimes the stone is not completely shattered with one
treatment, and additional treatments may be needed.
As with any interventional, surgical procedure, potential risks and
complications should be discussed with the doctor before making a treatment
decision.
Percutaneous Nephrolithotomy
Sometimes a procedure called percutaneous nephrolithotomy is recommended to remove a stone. This treatment is often used when the stone is quite large or in a location that does not allow effective use of ESWL.
In this procedure, 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.
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.
Ureteroscopic Stone Removal
Although some stones in the ureters can be treated with ESWL, ureteroscopy may be needed for mid- and lower-ureter stones. No incision is made in this procedure. Instead, the surgeon passes a small fiberoptic 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. Before fiber optics made ureteroscopy possible, physicians used a similar "blind basket" extraction method. But this technique is rarely used now because of the higher risks of damage to the ureters.
Next: What about research on kidney stones? »
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