Types of Surgery for Kidney Stones
In the past, surgery was the only possible means for the removal of kidney stones. Luminaries like Benjamin Franklin chose instead to suffer through their bouts with this painful condition.Today, open surgery, in which the kidney is opened for removal, is used in less than 1 percent of stone cases.
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Identification
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Kidney stones come in four main varieties; calcium-oxalate, uric acid, cystine and struvite. Medication can dissolve some of these stones. Regrettably, pharmaceuticals normally do not work on the most common of the four, the calcium-oxalate kidney stone. These, for the most part, must be passed through the urine stream, an incredibly painful process for most patients.
Basics
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The National Kidney Foundation notes that 90 percent of stones are allowed to pass on their own. Physicians do prefer to let this natural process occur, but in extreme instances surgery or another type of medical procedure may be necessary. This usually is the case when an infection has developed, massive blockage is occurring or when the stone is simply too large to pass through a very tiny area. Many stones grow to the size of small pebbles and in a few shocking cases, golf ball-size kidney stones have developed.
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ESWL
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The formal name for this procedure is extracorporeal shock wave lithotripsy. Lithotripsy is a Greek word translating as "stone crushing." A machine focuses shock waves to the kidney stone, smashing it into gravel-sized bits that are more easily passed. Previously, patients sat in a tub of water during the process. Today, higher-tech machines allow a patient to lie on on a table. It should be restated that this surgery does not remove the stone but only smashes it to allow for easier passing.
Physicians at Cornell University's Department of Urology say ESWL works best when used on softer stones such as the uric acid variety. Stones of denser content like calcium oxalate or cystine are more problematic and may require several ESWL sessions. The procedure normally lasts less than two hours with general anesthesia or intravenous sedation.
PCNL
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Percutaneous Nephrostolithotomy is commonly referred to as PCNL and is the only procedure in common practice that requires any actual cutting. A doctor initiates a tiny incision in the patient's back and inserts a fiber optic telescope (called a nephroscope) which enables the urologist to view the stone inside the kidney.
"Smaller stones can be grasped and removed while larger stones may need to be broken up by an electrohydraulic or ultrasonic energy probe," say physicians at Georgetown University Hospital. "The patient will need to stay in the hospital for several days with the nephrostomy tube in the back during healing. Once the tube is removed, the incision and kidney will heal in several days, and the patient can return to normal work and exercise usually within one week"
Ureteroscope
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In this type of kidney stone surgery, known as ureteropyeloscopy or laser lithotripsy, a urologist inserts a long, wire-like object called an ureteroscope into the patient's urethra and moves it through the bladder to the stone inside the uretra where the doctor can view it through a small camera in the ureteroscope. She then chooses whether to remove it with an instrument called a stone basket or to smash it with an ultrasonic laser. This option is primarily applied to stones that are trapped in the uretra on their journey to the bladder.
Performed under general anesthesia, the method requires one to three hours of time with no hospital stay. Georgetown urologists also note that "this procedure allows for the option of pushing the stone back into a region where ESWL is better suited."
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