This involves following the patient at periodic intervals with a progress history, physical, urinalysis, and imaging study.
This involves the passage of a ureteroscope through the bladder into the ureter until the stone is in view. The stone can then be broken into small pieces or removed intact with special instruments. Energy sources used to break up the stone include laser, ultrasound, mechanical, and electrohydrolic energy. New energy sources are constantly being developed.
Extracoporeal Shock Wave Lithotripsy (ESWL)
This treatment involves the creation of a shock wave by a special machine called a lithotripter. The shock wave is focused on the stone, passing harmlessly through body tissue until it hits the stone, causing fragmentation. The goal is to create small enough fragments that can be passed spontaneously. How well the stone breaks up depends upon the location, size, and density (hardness) of the stone. With some stones, there is a higher ESWL success rate if it can be moved from one location to another. This procedure is called a stone dislodgement and is generally done under anesthesia just prior to lithotripsy. Lithotripsy is the only noninvasive method of treating kidney stones.
Other Surgical Options
For very large stones in the kidney, Percutaneous Nephrolithotomy (PCNL) may be necessary. This involves entering the kidney through a puncture wound in the flank, inserting instruments that can fragment and remove the stone from the entire kidney. This involves an anesthetic and short hospital stay but usually requires fewer treatments than shock wave lithotripsy or ureteroscopy. Open surgical removal involves making an incision into the body, opening the urinary tract, and removing the stone. This is very reliable method of stone treatment but is the most invasive and involves the longest recovery time. Several days of hospitalization is required and recovery is usually several weeks.
Some stones may require more than one type of treatment. Common combinations include percutaneous treatment followed by shock wave lithotripsy for any retained fragments. Shock wave lithotripsy or percutaneous nephrostolithotomy can be followed by ureteroscopic removal of a stone fragment that has moved from the upper urinary tract into the lower ureter where it can be reached by a ureterscope and further fragmented. Our goal is complete stone removal with the fewest surgical procedures taking into account the "best treatment" procedure and the patient's wishes.
A note on the use of stents prior to ESWL
There are times when it is necessary to insert a J-J stent into the urinary tract prior to lithotripsy. One end of the stent coils in the kidney, and the other coils in the urinary bladder. If the urologist at the Center inserts a J-J stent, the patient and the referring urologist will be informed of its placement. It is absolutely mandatory that this stent be removed by the referring urologist. Stents that are allowed to remain in place for an extended period can become covered with calcium and require other surgical procedures to remove them. Sometimes the urologist inserting the stent will choose to leave a string on the stent leading outside the body. This makes it easier to remove at a later time by the referring urologist.