How Are Kidney Stones Removed?

Naturally

Approximately 85 percent of all kidney stones are passed naturally, without surgical or intervention within 72 hours of the first symptom. Doctors may prescribe pain killers, but often over the counter pain medications are recommended. Doctors advise to increase water intake and to strain the urine, so that the passed kidney stone may be examined for cause in order to help with prevention of additional stones. If the stone has not passed within a week, doctors will typically intervene.

Doctors use extracorporeal shock wave lithotripsy (ESWL) to break apart larger kidney stones so that they may pass easily out of the body. This method involves directing high-energy shock waves to crush the stone into smaller pieces. The patient is either placed with her lower body in a water tank, or a water-filled cushion is placed between the body and the shock waves, in order to assist with the transmission of the shock waves. Urologists recommend using this method for stones that are too large to pass, yet under 3 cm. As a result of ESWL, most stones are reduced to powder. After undergoing ESWL, 65 to 75 percent of patients no longer have kidney stones. Anesthesia is only used in this procedure for very young children who have difficulty sitting still for the procedure. A similar treatment to ESWL is Ultrasonic lithotripsy, which uses sound waves instead of high-energy shock waves to crush the kidney stone.

Patients undergoing percutaneous nephrolithotripsy (PCN) are given anesthesia to put them to sleep. Then the surgeon makes a small incision into the kidneys and uses an instrument called a nephroscope to break up the kidney stone into smaller pieces. The surgeon then removes each of the fragments through the small incision. This procedure is used on patients who have stones too large to perform ESWL and on staghorn stones. Unlike the ESWL, no stones are left in the urinary tract because the surgeon removes all the fragments during the procedure.

If a kidney stone becomes lodged in the ureter, surgeons will remove it through ureteroscopic means. Both laser and electrohydraulic lithotripsy are popular forms of this method. In laser lithotripsy, a small instrument called a ureteroscope is inserted through the urethra until it reaches the location of the stone, then focused laser energy is unleashed upon the stone. With electrohydraulic lithotripsy, electricity is used instead of a laser. In both cases, the patient is put under anesthesia and the stone is made small enough to be passed by the patient or extracted by the surgeon.

If the kidney stone is large enough, surgeons may decide to operate under general open surgery. A cut is made in the patient's back and internal organs using traditional surgery equipment and doctors remove the stone. This method is utilized as a very last resort, because it requires a lengthy stay in the hospital, prolonged recovery time and is the most invasive of all treatments. If the stone is very large and the other methods do not work, open surgery may be necessary.