Surgery
If a kidney stone does not move through the ureter within 30
days, surgery is considered. Urologists use several procedures
to break up, remove, or bypass kidney stones.
Ureteroscopy
This procedure can be used to remove or break up (fragment)
stones located in the lower third of the ureter. A fiberoptic
instrument resembling a long, thin telescope (ureteroscope) is
inserted through the urethra and passed through the bladder to
the stone. Once the stone is located, the urologist either
removes it with a small basket inserted through the
ureteroscope (called basket extraction) or breaks the stone
with a laser or similar device. The fragments are then passed
by the patient. Ureteroscopy is performed under general or
local anesthesia on an outpatient basis.
Lithotripsy
This procedure is effective for stones in the kidney or upper
ureter. It uses an instrument, machine, or probe to break the
stone into tiny particles that can pass naturally. Lithotripsy
is not appropriate for patients with very large stones or
other medical conditions.
Ultrasonic lithotripsy uses high frequency sound waves
delivered through an electronic probe inserted into the ureter
to break up the kidney stone. The fragments are passed by the
patient or removed surgically.
Electrohydraulic lithotripsy (EHL)
Uses a flexible probe to break up small kidney stones with shock
waves generated by electricity. The probe is positioned close
to the stone through a flexible ureteroscope. Fragments can be
passed by the patient or extracted. EHL requires general
anesthesia and can be used to break stones anywhere in the
urinary system.
Extracorporeal shock wave lithotripsy (ESWL)
Uses highly focused impulses projected from outside the body
to pulverize kidney stones anywhere in the urinary system. The
stone usually is reduced to sand-like granules that can be
passed in the patient's urine. Large stones may require
several ESWL treatments. The procedure should not be used for
struvite stones, stones over 1 inch in diameter, or in
pregnant women.
Patients undergoing lithotripsy are given a sedative and
general or local anesthesia, and the procedure takes over an
hour. More than one treatment may be required.
Percutaneous Nephrostolithotomy (PCN)
This surgical procedure is performed under local anesthesia
and intravenous sedation. Percutaneous (i.e., through the
skin) removal of kidney stones (lithotomy) is accomplished
through the most direct route to stones through the kidney. A
needle and guidewire are used to access the stones. The
surgeon then threads various catheters over the guidewire and
into the kidney and manipulates surgical instruments through
the catheters to fragment and remove kidney stones. This
procedure achieves a better stone-free outcome in the
treatment of medium and large stones than shock wave
lithrotripsy. This procedure usually requires hospitalization,
and most patients resume normal activity within 2 weeks.
Ureteroscopic Stone Removal
This procedure is performed under general anesthesia to treat
stones located in the middle and lower ureter. A small,
fiberoptic instrument (ureteroscope) is passed through the
urethra and bladder and into the ureter. Small stones are
removed and large stones are fragmented using a laser or
similar device. A small tube (or stent) may be left in the
ureter for a few days after treatment to promote healing and
prevent blockage from swelling or spasm.
Open Surgery
This procedure requires general anesthesia. An incision is
made in the patient's back and the stone is extracted through
an incision in the ureter or kidney. Most patients require
prolonged hospitalization and recovery takes several weeks.
This procedure is now rarely used for kidney stones.
Prevention
Prevention of kidney stone disease depends on the type of
kidney stone
produced, underlying urinary chemical risk factors, and the
patient’s willingness to undergo a long-term prevention plan.
The patient may be asked to make lifestyle modifications such
as increased fluid intake and changes in diet.
Lemonade with real lemon juice is a good source of citrate and
may be recommended as an alternative to water. Limiting meat,
salt, and foods high in oxalate (e.g., green leafy vegetables,
chocolate, nuts) in the diet may also be recommended.
Medication may be prescribed and treatment for an underlying
condition that causes kidney stone disease may be necessary.
The Austin Diagnostic Clinic, A
Multi-Specialty Medical Clinic
12221 MoPac Expressway North |
Austin, TX 78758 | 512.901.1111
Serving the communities of Austin, Round Rock, Pflugerville, San
Marcos and
Central Texas since 1952
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