Treatment Options

Procedures for treating larger kidney stones

Ureteroscopy

This procedure is used to treat small to medium-sized stones that are in the kidneys and the ureters.

A ureteroscopy doesn’t involve making any cuts in your skin as the surgical tools are passed through your urethra (the tube which urine passes through) and into your internal urinary system. The procedure is carried out either while you are asleep under a general anaesthetic or while you are awake under spinal anaesthesia which numbs you from the waist down so that you do not feel anything.

The doctor uses a thin, flexible tube (called a ‘scope’) that is inserted through your urethra, bladder, and then the ureter and into your kidney. The thin tube has a tiny camera on the end which the doctor uses to find the stones. Surgical tools are then passed down the tube so that the doctor can remove any small stones.

If there are any larger kidney stones, the doctor will pass a laser through the scope to break the stones up into smaller pieces which they can then remove, or leave in place, to be passed out when you urinate.

After the procedure there may be a need to place a stent (a small plastic or silicone tube to help keep the ureter open so that urine can flow out) in the urinary system. This would only be temporary and would be removed by your doctor a couple of weeks after the procedure.

This animation shows what happens when you undergo a ureteroscopy.

 
Figure 1. A flexible ureteroscope allows your doctor to reach all areas within the kidney.
A thin, flexible tube allows your doctor to reach all areas within the kidney
Fig. 2: A stone is pulled from the ureter using a basket.
A stone is pulled from the ureter using a basket.

Shock-wave lithotripsy (SWL)

This procedure involves using sound waves from outside the body to blast the kidney stone into tiny pieces which can then be passed yourself when you urinate.
The procedure takes about an hour to do and is moderately painful, so you will be given pain medication. You may have it done under sedation, where you would be given medication to relax you, so you have limited awareness and recollection of the procedure. If you have a large stone, you may need several sessions to completely break it up.

Shock-wave lithotripsy is not recommended if you:

  • Are pregnant
  • Have a high risk of severe bleeding
  • Have any uncontrolled infections
  • Have uncontrolled high blood pressure
  • Have a high body mass index which means that it would be difficult for the sound waves to reach the stone
  • Have an aneurysm
  • Have an anatomical obstruction in the urinary tract, below the stone, or in the bladder
  • Have a very hard kidney stone (for instance, cystine stones).

Your doctor will advise whether this type of procedure would be suitable for you and will discuss the risks and benefits of shock-wave lithotripsy in relation to your individual medical circumstances.

This animation shows what happens when you undergo shock-wave lithotripsy.

 
Fig. 1: focussed shock waves break the stones into fragments.
Focussed shock waves break the stones into fragments
Fig. 2: a common type of SWL machine.
A common type of SWL machine
 

 

Surgical procedures for treating more complex kidney stones

 

 

Percutaneous nephrolithotomy

This type of operation is carried out when there are several kidney stones that are difficult to reach, or if they are too large to be treated by shock wave procedures or ureteroscopy.

During percutaneous nephrolithotomy, the doctor makes a small incision (cut) in your back and through into your kidney to reach and then surgically remove the stone(s).

This type of surgery is carried out while you are asleep under a general anaesthetic. You will need to stay in the hospital until you can empty your bladder sufficiently and your pain is well-controlled.

After the procedure there may be a need to place a stent (a small plastic tube to help the flow of urine) in the urinary system and/or a thin tube from your kidney and out through the skin of your back, to collect urine into a drainage bag. These would only be temporary and would be removed by your doctor a few days after the procedure.

This animation shows what happens when you undergo percutaneous nephrolithotomy.

 
A nephroscope is used to remove stones directly from the kidney
Fig. 1b: Stone fragments are removed in a single procedure with a nephroscope.
Stone fragments are removed in a single procedure with a nephroscope.
 

 

Side effects kidney stones treatments

 

What are the most common side effects of kidney stones treatments?

The side effects of kidney stone treatments depend on the size, type, and location of your kidney stone, as well as the type of treatment you have.
Your doctor will discuss with you any side effects and the risks and complications of each treatment type available to treat your kidney stone(s) when you are considering your options. This information will be specific to your individual circumstances and the exact medicine, procedure, or surgery being offered to you.
The below sections are for information purposes and provide examples of side effects that may be caused by some medicines and procedures/operations for treating kidney stones.
Side-effects of medicines
Medical expulsive therapy and dissolving medicines can cause dizziness or feeling light-headed, sinus congestion, or a runny nose. Dissolving medicines can also cause temporary changes in male ejaculation.
If you have a high temperature or are experiencing chills, are in a great deal of pain, cannot tolerate food or liquids, and have a large quantity of blood in your urine (or blood clots), you will need to contact your doctor straight away. These symptoms can indicate that you have an infection or that your kidney stones are causing problems that need to be addressed quickly.
Surgical side-effects and complications
Temporary side-effects of medical or surgical procedures to treat kidney stones include:
  • A mild burning feeling when urinating for a few days after surgery
  • Mild discomfort in the bladder area or kidney area when urinating
  • Small amounts of blood in the urine for a few days
  • The need to urinate more frequently or urgently
  • Temporary discomfort or pain resulting from surgical tools being inserted into the urinary system
  • Pain, bleeding, and frequent urge to urinate if a stent has been placed.
Complications arising from medical procedures and surgery include:
  • A urinary infection
  • Sepsis – a severe infection that can be extremely serious
  • Damage to the kidney or ureter during the procedure or surgery
  • Scarring or tightening of the ureter
  • Bleeding during surgery
  • A blocked ureter
  • Failure of the procedure to remove all of the kidney stone(s)
  • The need for repeat surgery if there are multiple stones or a single kidney stone is too large to remove in a single surgery
In rare cases, some people develop symptoms that require them to return to hospital after they have had a procedure or operation. These symptoms include:
  • A fever above 38.5 degrees
  • Nausea or vomiting
  • Chest pain or difficulty breathing
  • A serious burning sensation when urinating
  • Inability to urinate
  • Large amounts of blood in your urine, which do not go away with rest or hydration
  • Prolonged blood in the urine, lasting more than 3 days
  • Continuing to have severe pain in your kidney, back, or side, despite taking painkillers