Reasons For The Procedure
The primary advantage of lithotripsy is that it is completely non-invasive.
Lithotripsy is well suited to patients with small kidney stones that can be easily seen by x-ray.
When kidney stones become too large to pass through the urinary tract, they may cause severe pain and may also block the flow of urine. An infection may develop. Lithotripsy may be performed to treat certain types of kidney stones in certain locations within the urinary tract.
There may be other reasons for your doctor to recommend lithotripsy.
What Is A Minor Surgery
Minor surgical procedures are those that are minimally invasive. In most cases, these are performed laparoscopically or arthroscopically. Small incisions are made that allow surgical tools and a small camera to be inserted into the body. This allows the doctor to perform the procedure without damaging extensive amounts of tissue. The risk of infection is greatly reduced and the patient’s recovery time is much shorter. There are also surgical procedures that are superficial, only affecting the outermost portions of the body.
Ureteroscopy And Laser Lithotripsy
Along with SWL, ureteroscopy is a preferred method for the treatment of small-to-medium sized kidney stones located in any part of the urinary tract. Washington University was one of the first centers in the world to offer ureteroscopic stone treatment. Our highly skilled endourologists are available to offer advanced ureteroscopic stone management.
Ureteroscopy and laser lithotripsy are typically performed as a same-day procedure with the patient under general anesthesia. During the procedure, the urologist passes a small scope through the urinary opening into the bladder and from there up into the ureter, the small tube that drains urine from the kidney to the bladder. Once the stones are located, they are targeted with a laser that breaks the stone into smaller pieces, which are then extracted, or into tiny pieces of dust that wash out of the kidney with normal urine flow.
Often, a small tube, called a stent, will be placed temporarily to help the kidney drain after the operation. The stent is completely internal, and is generally removed after 3-10 days. Removal is performed quickly and easily in the office without the need for anesthesia.
Although slightly more invasive than SWL, ureteroscopy may be the preferred option if you have certain types of hard stones that dont respond to SWL, or a stone that is not visible on X-ray. In addition, ureteroscopy is often preferable to SWL for stones that are low in the urinary tract, in the region approaching the bladder.
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If The Kidney Stone Is Not Causing Any Symptoms Should I Still Be Treated
There are some instances when it is OK to leave a kidney stone untreated. If the stone is small and not causing any pain, there is a good chance that it will pass on its own after it falls into the ureter. Such stones may be followed with “watchful waiting.” This means that the stone is not actively treated, but instead your doctor keeps a check on the stone to be sure that it is not growing or changing. This can be done with periodic X-rays.
Whats The Urinary Tract How Does It Work
Your urinary tract is vital to your body because it gets rid of waste and extra fluid. Its made up of both your kidneys, two ureters, your bladder and your urethra. Each organ has an important job :
- Kidneys: Your fist-sized, bean-shaped kidneys are located on either side of your spine, below your rib cage. Each day they filter 120 to 150 quarts of your blood to remove waste and balance fluids. Your kidneys make one to two quarts of urine every day.
- Ureters: After your kidney creates urine, the liquid travels through the tube-shaped ureter to the bladder. There is one ureter per kidney. Kidney stones can pass through the ureters or, if theyre too big, get stuck in them. You may require surgery if the stone is too large.
- Bladder: Between your hip bones is your bladder, an organ that stores urine. It stretches to hold about one and a half to two cups.
- Urethra: Like a ureter, your urethra is a tube through which urine passes. Its the final stop of the urinary tract where your urine leaves your body. This is called urination.
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Why You Get Stones
Part of preventing stones is finding out why you get them. Your health care provider will perform tests to find out what is causing this. After finding out why you get stones, your health care provider will give you tips to help stop them from coming back.
Some of the tests he or she may do are listed below.
Medical and Dietary History
Your health care provider will ask questions about your personal and family medical history. He or she may ask if:
- Have you had more than one stone before?
- Has anyone in your family had stones?
- Do you have a medical condition that may increase your chance of having stones, like frequent diarrhea, gout or diabetes?
Knowing your eating habits is also helpful. You may be eating foods that are known to raise the risk of stones. You may also be eating too few foods that protect against stones or not drinking enough fluids.
Understanding your medical, family and dietary history helps your health care provider find out how likely you are to form more stones.
Blood and Urine Tests
Imaging Tests
When a health care provider sees you for the first time and you have had stones before, he or she may want to see recent X-rays or order a new X-ray. They will do this to see if there are any stones in your urinary tract. Imaging tests may be repeated over time to check for stone growth. You may also need this test if you are having pain, hematuria or recurrent infections.
Stone Analysis
What Questions Should I Ask My Healthcare Provider
- Do I have a kidney stone or is there another reason for my symptoms?
- What type of kidney stone do I have?
- What size is my kidney stone?
- Where is my kidney stone located?
- How many kidney stones do I have?
- Do I need treatment or will I be able to pass the kidney stone?
- Should I be tested for kidney disease?
- What changes should I make to my diet?
- What type of procedure should I have to get rid of the stones?
A note from Cleveland Clinic
Kidney stones can be frustrating at best and agonizingly painful at the worst. To stop your situation from getting worse, you should be evaluated by a healthcare provider as soon as possible. The pain can get severe, and surgery might be necessary. Remember: dont skip your prescriptions, drink lots of water and follow any dietary guidelines. Also, remember that kidney stones are a temporary condition. They wont bother you forever.
Last reviewed by a Cleveland Clinic medical professional on 05/03/2021.
References
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Treatment Of Adult Patients With Ureteral Stones
Guideline Statement 7
Patients with uncomplicated ureteral stones 10 mm should be offered observation, and those with distal stones of similar size should be offered MET with -blockers. Strong Recommendation Evidence Level Grade B
Discussion
Natural history studies have shown that the likelihood of spontaneous stone passage correlates with stone size and stone location.48 The smaller the stone and the more distally in the ureter the stone is located, the greater the likelihood of spontaneous passage. Furthermore, smaller stones are likely to pass more quickly than larger stones.49 The control arms of RCTs evaluating tamsulosin as MET show that about half of patients with distal ureteral calculi < 10 mm in size will spontaneously pass their stones . Consequently, there is ample evidence that a trial of spontaneous passage is reasonable in patients amenable to conservative therapy with < 10 mm distal ureteral stones in whom pain is well controlled and there are no signs of infection or high grade obstruction. While there is less evidence for those harboring middle and distal ureteral stones, the panel also feels that observation should be offered to those with uncomplicated stones of similar size in these ureteral areas.
Patients should be informed that medications for MET are prescribed for an off label indication.
Guideline Statement 8
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Guideline Statement 10
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Symptoms Of Kidney Stones
Many people with kidney stones have no symptoms. However, some people do get symptoms, which may include:
- a gripping pain in the back usually just below the ribs on one side, radiating around to the front and sometimes towards the groin. The pain may be severe enough to cause nausea and vomiting
- blood in the urine
- cloudy or bad smelling urine
- shivers, sweating and fever if the urine becomes infected
- small stones, like gravel, passing out in the urine, often caused by uric acid stones
- an urgent feeling of needing to urinate, due to a stone at the bladder outlet.
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Percutaneous Nephrolithotomy Or Percutaneous Nephrolithotripsy
If your stone is large or lithotripsy doesn’t break it up enough, this surgery is an option. PCNL uses a small tube to reach the stone and break it up with high-frequency sound waves.
You will be given something so that you wonât be awake during this surgery. Your surgeon will make a small cut in your back or side and place a thin scope into the hole.
The surgery can be done in one of two ways:
Nephrolithotomy: Your surgeon removes the stone through a tube
Nephrolithotripsy: Your surgeon uses sound waves or a laser to break up the stone and then vacuums up the pieces with a suction machine.
The surgery takes 20 to 45 minutes. You’ll typically have to stay in the hospital for a day or two afterward. Usually, a stent will have to stay in your kidney for a few days to help urine drain.
Your doctor might do an X-ray or ultrasound a few weeks later to see whether any parts of the stone are left. They might also send the stone fragments to a lab to find out what they’re made of.
Risks from this surgery include:
- Infection
- Damage to the bladder, bowel, ureter, kidney, or liver
What Are The Most Common Types Of Kidney Stones
The most common type of kidney stone is a calcium oxalate stone. This type happens when calcium and oxalate combine in your urine. It can happen when you have high quantities of oxalate, low amounts of calcium and arent drinking enough fluids.
Stones caused by uric acid are also fairly common. These come from a natural substance called purine, which is a byproduct of animal proteins .
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Choose Expert Urologic Care
Our urologists are committed to treating your medical condition, reducing your pain and discomfort and easing your mind as quickly as possible. With same-day and next-day appointments at our 8 locations throughout Central Florida, you can get in, get relief and get back to your life faster than ever!
Whats The Outlook For Kidney Stones
The outlook for kidney stones is very positive, although there is a risk of recurrence . Many kidney stones pass on their own over time without needing treatment. Medications and surgical treatments to remove larger kidney stones are generally very successful and involve little recovery time.
Its possible to get kidney stones multiple times throughout your life. If you keep developing kidney stones, your healthcare provider may work with you to discover why the stones happen. Once the cause is found, you may be able to make dietary changes to prevent future stones.
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Urinary System Parts And Their Functions:
- Two kidneys. A pair of purplish-brown organs located below the ribs toward the middle of the back. Their function is to:
- Remove liquid waste from the blood in the form of urine
- Keep a stable balance of salts and other substances in the blood
- Produce erythropoietin, a hormone that aids the formation of red blood cells
- Regulate blood pressure
The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule. Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney.
How Are Children Treated For Kidney Stones
Most childrens kidney stones can be treated with the shock wave lithotripsy , a completely non-invasive procedure. Your child is placed under anesthesia and sound waves of specific frequencies are focused on the stones to shatter them into fragments small enough to be easily passed during urination.
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Surgical Management Of Stones: Aua/endourology Society Guideline
To cite this guideline:Assimos D, Krambeck A, Miller NL et al: Surgical management of stones: American Urological Association/Endourological Society Guideline, part II. J Urol 2016 196: 1161.
AUA/Endourological Society Guideline: Published 2016
The purpose of this clinical guideline is to provide a clinical framework for the surgical management of patients with kidney and/or ureteral stones. Index patients discussed include adult, pediatric, and pregnant patients with ureteral or renal stones.
Español translated guideline courtesy of Confederacion Americana de Urologia
Quality Of Individual Studies And Determination Of Evidence Strength
The quality of individual studies that were either RCTs or CCTs was assessed using the Cochrane Risk of Bias tool.9 The quality of CCTs and comparative observational studies was rated using the Newcastle-Ottawa Quality Assessment Scale.10 Because there is no widely-agreed upon quality assessment tool for single cohort observational studies, the quality of these studies was not assessed.
The categorization of evidence strength is conceptually distinct from the quality of individual studies . Evidence strength refers to the body of evidence available for a particular question and includes not only individual study quality but consideration of study design consistency of findings across studies adequacy of sample sizes and generalizability of samples, settings, and treatments for the purposes of the Guideline. The AUA categorizes body of evidence strength as Grade A , Grade B , or Grade C . By definition, Grade A evidence is evidence about which the Panel has a high level of certainty, Grade B evidence is evidence about which the Panel has a moderate level of certainty, and Grade C evidence is evidence about which the Panel has a low level of certainty.7
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What Does Surgery For Kidney Stones Entail
Most kidney stone surgeries do not require an actual incision. Rather, urologists are able to perform procedures through a patient’s natural orifices, meaning the urethra and ureter. During the procedure, referred to as ureteroscopy, a urologist uses a small flexible camera to locate the stone. From there, they will often use a tiny wire basket or laser fiber to capture the stone and pull it out, or break it up into tiny fragments that are removed.
In other cases, urologists may not need to enter the body at all to treat the stone. Shockwave lithotripsy is used to break the stone apart into tiny fragments by transmitting ultrasound waves through the patients back while they are under anesthesia.
A more invasive surgery called percutaneous nephrolithotomy may be needed for larger stones. During PCNL, the scope is inserted through a small incision in a patients back.
What Are Some Minor Surgeries
Minor surgeries include:
| Cause damage to the tissues | No extensive damage to the tissues |
| A high risk of infection | The risk of infection is low |
| Extended recovery period | Recovery time is shorter |
Surgical procedures in both categories should be carefully considered. The risk involved is often outweighed by the benefits the procedure offers. Improving the quality of life and restoring health are the two main priorities when making the decision to go ahead with the procedure.
Far North Surgery is one of the trusted surgery centers in Alaska that provides safe and successful surgical procedures. We are committed to providing the best patient care and state-of-the-art technology. Contact us at to schedule an appointment.
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Treatment For Pediatric Patients With Ureteral Or Renal Stones
Guideline Statement 46
In pediatric patients with uncomplicated ureteral stones 10 mm, clinicians should offer observation with or without MET using -blockers. Moderate Recommendation Evidence Level Grade B
Discussion
An initial trial of observation with or without MET is appropriate in children with ureteral stones because a significant proportion of children will pass their stones spontaneously, thus avoiding the need for surgical intervention. In trials of MET in children, stone-free rates in the observation arm averaged 62% for stones under 5 mm diameter in the distal ureter, and 35% for stones > 5 mm201-203 Two of these trials demonstrated that -blockers facilitated stone passage. Observation can be carried out under carefully controlled conditions, assuming no evidence of infection, the patient is able to hydrate orally, and pain can be adequately controlled. Families should be aware that the probability of spontaneous passage is lower for children with stone approaching 1 cm in size.
Limited evidence does suggest that MET is effective in increasing passage of distal ureteral stones in children, and MET appears to be safe in this population. Three modest randomized trials of -blocker therapy in children with distal ureteral stones201-203 showed significant benefit, with an overall odds ratio of being stone free of 4.0 (95% CI
1.1-14.8). However, bias is a concern as these trials were not blinded.
Guideline Statement 47
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Guideline Statement 48
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