Kidney Stone Surgery Complications

The risk of kidney stone surgery complications has been reduced greatly over the past two decades. The phrase "cutting for the stone" is an ancient one, but today it need not have such a negative connotation.

Basics

• There are four primary means of removing kidney stones. The two most popular require no surgery. The third is minimally invasive, while the fourth is a complete surgical procedure. Clearly, a method that requires no cutting into the body minimizes the potential for complications, but all the treatments carry some risk.

Open Surgery

• Previously, open surgery was the only option for the removal of kidney stones. Today, it is rarely used. Open surgery is only utilized in extreme cases where the kidney stone is far too large to be removed by other means, when an abnormality exists in the shape of the patient's urinary tract, or if other treatment options have failed. Physicians prefer to avoid it due to the potential for infection, extreme bleeding, complications from anesthesia and extended recovery time.

ESWL

• Extracorporeal shock wave lithotripsy (ESWL) is the most common procedure for the removal of kidney stones. It uses shock waves to disintegrate the stones. After treatment, traces of blood are likely to remain in the urine. The back or abdomen may experience bruising or some ache as a result of the shock waves.

  Occasionally, the smashed stone pieces cause blockage as they move along the urinary tract and bring on minor pain. The urologist may insert a small tube called a stent into the ureter to help the pieces pass. Additional ESWL treatments are sometimes necessary, especially when stones of a harder variety are present. Bleeding can sometimes occur around the kidney with a blood transfusion necessary in less than one out of 100 patients.

Ureteroscopy

• Ureteroscopy does hold some chance of complication although it is quite minimal. "Up to 95 percent of patients who undergo ureteroscopy for stones are made stone free," according to physicians at Cornell University's Department of Urology. "Very few complications have been noted in this group of patients with the majority of patients returning home the day of or 24 hours after the procedure."

  Difficulties that may develop include scar tissue building inside the ureter and the chance of accidental ureter perforation. Stones that have been stuck in the wall of the ureter for more than two months increase the risk of these complications. Frequent urination, pain or blood in the urine are normal side effects in the first few days after this procedure.

PCNL

• Percutaneous nephrostolithotomy is commonly referred to as PCNL. A small incision is cut into the patient's back and tiny medical instruments then are moved into place in order to disintegrate the stones. This increases the risk of complication due to the possibility of infection from the incision.

  Of course, with an incision, comes the possibility of excessive bleeding. " Blood loss during this procedure is possible and a transfusion is necessary in approximately 20 percent of patients," say physicians at George Washington University's Urology Clinic. There also exists the possibility that this particular surgery could take on larger proportions. " This surgical procedure may require conversion to the standard open operation if difficulty is encountered during this procedure," according to the university's urologists.