Kidney stones can cause severe pain and affect urine flow. Small stones may pass naturally. However, larger stones sometimes require medical treatment or kidney stone surgery.
Urology focuses on the urinary system, including the kidneys, ureters, bladder and urethra. A urologist diagnoses and treats kidney stones and other urinary conditions.
This guide explains why patients may need treatment. It also describes what happens before, during and after common kidney stone procedures.
What Are Kidney Stones?
Kidney stones are hard deposits that form from substances in urine. They can develop in one or both kidneys.
Stone size can range from a tiny grain to a much larger mass. In addition, stones can have different shapes and chemical compositions.
Small stones may leave the body through urine. In contrast, larger stones can become trapped in the kidney or ureter.
Why Do Kidney Stones Require Surgery?
Not every kidney stone requires surgery. The urologist considers the stone’s size, location and effect on the urinary system.
A doctor may recommend a procedure when:
- The stone causes severe or ongoing pain
- The stone blocks the flow of urine
- The patient develops a urinary infection
- The stone affects kidney function
- The stone is unlikely to pass naturally
- Other treatments do not work
- Stones continue to return
- The patient experiences persistent bleeding
Therefore, the best treatment differs from one patient to another. A urologist will review the available options before making a recommendation.
Tests Before Kidney Stone Surgery
Before treatment, the doctor needs to identify the stone’s size and location. The doctor may also investigate its possible cause.
Imaging Tests
A CT scan, ultrasound or X-ray can show the urinary tract. These tests help the doctor locate the stone and plan treatment.
Blood Tests
Blood tests can check kidney function and look for other health concerns. In addition, they may measure substances linked with stone formation.
Urine Tests
A urine test can identify blood, crystals or signs of infection. If the patient has an infection, the doctor may treat it before surgery.
Medical Evaluation
The medical team reviews the patient’s health, medicines and allergies. Patients should mention blood-thinning medicines and any previous reaction to anaesthesia.
Common Types of Kidney Stone Surgery
Urologists use several methods to treat kidney stones. The doctor chooses a procedure based on the stone and the patient’s health.
1. Shock Wave Lithotripsy
Shock wave lithotripsy uses focused shock waves to break a stone into smaller pieces. Patients can then pass these pieces through urine.
This treatment does not require an incision. However, it may not suit every stone size, location or type.
What Happens During Shock Wave Lithotripsy?
First, the medical team positions the patient on a treatment table. The doctor then uses imaging to locate the stone.
Next, the machine sends shock waves towards the stone. These waves break the stone into smaller fragments.
Afterwards, the patient may pass fragments for several days or weeks. The doctor may also recommend follow-up imaging.
2. Ureteroscopy
Ureteroscopy allows the doctor to reach a stone through the natural urinary passage. Therefore, the procedure does not require an external incision.
The surgeon passes a thin ureteroscope through the urethra and bladder. The instrument then enters the ureter or kidney.
What Happens During Ureteroscopy?
First, the anaesthesia team helps keep the patient comfortable. Next, the surgeon guides the ureteroscope towards the stone.
The surgeon may remove a small stone with a basket. Alternatively, laser energy can break a larger stone into smaller pieces.
Sometimes, the surgeon places a temporary ureteral stent. The stent supports urine flow while the ureter heals.
3. Percutaneous Nephrolithotomy
Percutaneous nephrolithotomy, or PCNL, treats large or complex kidney stones. It can also treat branching stones called staghorn stones.
During PCNL, the surgeon reaches the kidney through a small opening in the back or side. General anaesthesia keeps the patient asleep during the procedure.
What Happens During PCNL?
First, the surgeon uses imaging to select an access route. The surgeon then passes a needle and guidewire into the kidney.
Next, the surgeon widens the track and inserts a working sheath. A nephroscope passes through this sheath and displays the kidney’s interior.
The surgeon breaks the stone with specialised energy and removes the fragments. Finally, the surgeon may place a drainage tube or ureteral stent.
4. Open or Laparoscopic Stone Surgery
Doctors rarely use open surgery for kidney stones today. Modern endoscopic methods can treat most stones with smaller incisions.
However, open, laparoscopic or robotic surgery may help in unusual or highly complex cases. The surgeon may also consider these options when other treatments cannot solve the problem.
What Happens During Open Surgery?
The surgeon makes an incision to reach the kidney or ureter. The surgeon then removes the stone and closes the incision.
This approach usually requires a longer hospital stay and recovery. Therefore, doctors reserve it for selected patients.
What Happens on the Day of Surgery?
The hospital will provide instructions about eating, drinking and medicines. Patients should follow these instructions carefully.
Before the procedure, the medical team checks the patient’s identity and treatment plan. The anaesthesia team also explains the planned anaesthesia.
During treatment, the team monitors breathing, heart rate and blood pressure. After the procedure, staff move the patient to a recovery area.
Recovery After Kidney Stone Surgery
Recovery depends on the type of procedure. Shock wave treatment and ureteroscopy often allow faster recovery than PCNL or open surgery.
After treatment, patients may experience mild pain, frequent urination or temporary blood in the urine. A ureteral stent can also cause discomfort.
The doctor may prescribe pain medicine or antibiotics. In addition, the doctor may recommend drinking enough water when medically suitable.
Patients should avoid heavy lifting until the doctor approves it. They should also attend all follow-up appointments.
Possible Risks of Stone Surgery
Kidney stone procedures are common, but they still carry possible risks. These risks depend on the selected treatment.
Possible complications include:
- Bleeding
- Urinary infection
- Pain or swelling
- Injury to the urinary tract
- Remaining stone fragments
- Urinary blockage
- Need for another procedure
- Reaction to anaesthesia
The urologist should explain the expected benefits and personal risks before treatment.
When Should You Contact the Doctor?
Patients should seek medical advice if they develop severe or unusual symptoms. Warning signs may include:
- Fever or chills
- Severe or increasing pain
- Heavy bleeding or large blood clots
- Difficulty passing urine
- Persistent vomiting
- Signs of infection
How Can You Reduce the Risk of New Stones?
Kidney stones can return after treatment. Therefore, prevention forms an important part of follow-up care.
The doctor may analyse the removed stone. The doctor may also request blood tests or a 24-hour urine test.
Based on the results, the doctor may recommend more fluids, dietary changes or medicine. However, patients should follow personalised advice because stone types differ.
Conclusion
Kidney stone surgery can remove or break stones that cannot pass naturally. Urologists may use shock wave treatment, ureteroscopy, PCNL or another method.
Each procedure has different benefits, risks and recovery times. Therefore, patients should discuss their treatment options with a qualified urologist.
Understanding the process can help patients prepare for treatment. It can also help them follow recovery and prevention advice.
This article provides general educational information. It does not replace professional medical advice, diagnosis or treatment.
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