Kidney Stone Surgery Procedures

Down through the ages there existed only two options for removal of kidney stones: natural passage through the urine stream or dangerous, invasive surgery. While surgery is still an option today, other techniques offer help and little or no time under the knife or in the hospital.

History

• "Cutting for the stone" is a phrase dating to early times as the medical procedure for the removal of kidney stones. It may be a testament to the pain of passing a stone that the specialty of urology is the only one noted in the Hippocratic oath.
  According to the book, "No More Kidney Stones: The Experts Tell You All You Need to Know About Prevention and Treatment," even X-rays of mummies from ancient Egypt clearly display kidney stones still in place. Benjamin Franklin, Peter the Great and Sir Isaac Newton are among some of the historical figures known to have suffered from the affliction of stones.

Passing

• According to the National Kidney Foundation, 90 percent of kidney stones pass by themselves within three to six weeks. Medication can usually dissolve some types of stones. Unfortunately, the most common type, calcium, is normally resistant to pharmaceuticals. Physicians prefer to wait for these to naturally pass, and normally resort to surgery only in very stubborn or extreme cases.

ESWL

• Commonly referred to as ESWL, the full name for this procedure is "extracorporeal shock wave lithotripsy." Lithotripsy is a Greek word that means "stone crushing." And that's what this procedure literally aims to do. A machine directs shock waves to the kidney stone with the intention of smashing it apart into smaller bits that will be easier to pass through the urine stream. Older varieties of this machine have patients sitting in a tub of water, while newer machines enable the patient to simply lie on a table.
  According to physicians at Cornell University's Department of Urology, ESWL shows most reliability when directed on softer stones like those of uric acid. Success is less likely when used on harder varieties such as calcium oxalate or cystine. Large or multiple stones may require additional ESWL treatments. Patients may receive either intravenous sedation or general anesthesia for a procedure that lasts between one to two hours.

PCNL

• Percutaneous Nephrostolithotomy is commonly referred to as PCNL, and is the most invasive of the three primary surgical procedures. It's the only technique in common practice that requires any actual cutting. A physician applies a small incision to the patient's back and tunnels through the skin with a minute telescope (called a nephroscope) to the stone lurking in the kidney. The stone is then broken apart with a tiny laser beam. This procedure is primarily reserved for large or hard stones. Patients receive general anesthesia and require a one- or two-day hospital stay.

Ureteroscope

• Formally known as ureteropyeloscopy or laser lithotripsy, doctors insert an object that looks like a long wire, called an ureteroscope, into the patient's urethra. Moving through the bladder to the uretra where the stone is waiting, the physician is able to view the irritant through a tiny camera inside the ureteroscope. The stone is then destroyed by a laser fiber inside the ureteroscope. This technique is primarily applied to stones that are trapped in the uretra on their journey to the bladder. Performed under general anesthesia, this method requires one to three hours of procedure time with no hospital stay.