Conditions & Treatments
Observation of kidney stones involves waiting for a kidney stone to pass on its own without intervention (spontaneous passage). The rate of spontaneous passage is determined by the stone size and location.
- High rate of passage: < 4 mm size and distal ureter (near bladder)
- Low rate of passage: > 6 mm size and proximal ureter (near kidney)
During observation, pain medications are prescribed and the patient is instructed to drink a lot of water (> 2 liters/day) and strain the urine to catch the stone if it passes.
Observation is not an option with a coexisting infection, severe pain not controlled with medications, intractable nausea and vomiting, and in patients with underlying kidney disease.
If observation is not indicated or the stone does not pass while on observation for 2-3 weeks, then intervention is necessary.
Extracorporeal Shock Wave Lithotripsy (SWL)
Shock waves from a machine (lithotriptor) are focused onto stones in the kidney or ureter. The shock waves pass through the body and hit the stone, causing it to fragment into small pieces.
Because of possible discomfort from the procedure, patients will receive anesthesia during lithotripsy. A stent may have to be placed in the ureter through the urethra prior to SWL to help stone fragments pass down the ureter after treatment.
- Success rates: 50-80% depending on stone size and location.
- Possible complications: Bleeding in kidney (renal hematoma), obstruction duringpassage of stone fragments (steinstrasse), hypertension, adjacent organ injury and bruising of skin.
- Hospital stay and recovery: This is the least invasive intervention and is performed asan outpatient procedure (no overnight hospital stay). Recovery time is short and most people are back to normal activity in a few days.
Ureteroscopy involves treating stones in the ureter and kidney with a small fiberoptic telescope (ureteroscope) inserted through the opening in the urethra (NO incision). Stones are either grasped and removed or broken into tiny pieces with a laser.
After the procedure a small tube (stent) may be placed in the ureter for a few days to allow the lining of the ureter to heal. The doctor will remove the stent at a follow up appointment.
- Success rates: 75-100% depending on stone size and location
- Possible complications: Damage to the ureter, infection, bleeding, ureteral stricture (narrowing).
- Hospital stay and recovery: Most cases performed as an outpatient procedure. Recovery time is short and most people are back to normal activity in 1-2 weeks.
Percutaneous Nephrostolithotomy (PCNL)
Percutaneous nephrostolithotomy involves treating kidney stones in the kidney by making a one-inch incision in the back and creating a tunnel through the kidney to the stone.
Through the tunnel the doctor uses a fiberoptic telescope (nephroscope) to either remove the stone or break it up into tiny pieces using a laser, ultrasound probe, or pneumatic device (jack-hammer).
After the procedure a tube is placed in the kidney (nephrostomy tube) and the ureter (stent) to drain the kidney and allow it to heal. The doctor will remove these after X-rays have shown that the kidney has healed and all the stones have been removed.
X-rays will be done on the day after surgery to confirm that all of the stones have been removed. If stones are still present then another procedure (2nd look) will be performed to remove any remaining fragments.
- Success rates: 70-99% depending on stone size and location
- Possible complications: Bleeding, infection, urinary injury, pneumothorax (air around the lung), adjacent organ injury
- Hospital stay and recovery: 1-2 day hospital stay with 2-4 weeks until back to full activity
Open Stone Surgery
Open stone surgery involves making an incision with a knife to remove stones. While this was the original form of treatment for all stones, today it comprises < 5% of all treatments for renal stones.
Because of the expertise of our faculty in removing stones in a minimally invasive fashion at Emory, we rarely if ever resort to this treatment option.
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