Kidney stone treatments

Not all kidney stones require surgical treatment. Many smaller stones can be allowed to pass naturally or with medication assistance, whilst others can be dissolved. If surgery is needed, the options are one of the following:

1. Extracorporeal Shock Wave Lithotripsy (ESWL): This non-invasive procedure uses shock waves to break up smaller stones, which can then be passed naturally through urine.
2. Ureteroscopy (URS): URS involves passing a thin, flexible scope through the urethra and bladder to reach and remove stones in the ureter or kidney.
3. Percutaneous Nephrolithotomy (PCNL): The most effective treatment option for large or complex kidney stones

Extracorporeal Shock Wave Lithotripsy (ESWL)

Extracorporeal Shock Wave Lithotripsy, or ESWL, is a non-invasive procedure for treating kidney stones and stones lodged in the ureter (water pipe between the kidney and the bladder), avoiding a more invasive approach. ESWL uses shock waves to fragment stones, allowing your body to pass them through urine naturally. Success rates of ESWL depend on stone composition, location and size. Stone-free rates are slightly lower than more invasive approaches of ureteroscopy or PCNL.

How is ESWL performed?

1. Preparation: You’ll be positioned on a cushioned table under general anaesthesia, and a water-filled cushion will be used to transmit shock waves to the stone.
2. Imaging: Operative X-ray or ultrasound locates the stone precisely.
3. Shock Waves: High-energy shock waves are generated outside your body and focused on the stone to break it into smaller fragments. The procedure takes 30 minutes.
4. Recovery: After the procedure, you’ll usually be able to go home the same day. You may experience blood in the urine and mild flank discomfort on the treated side, usually settling within 24 hours. Stay well-hydrated to help flush out stone fragments. A check scan is performed 4-6 weeks after the procedure to confirm clearance.

ESWL risks and complications

ESWL is generally considered safe, but there are some potential risks:

• Bruising: You may notice bruising or soreness on your back or abdomen where the shock waves were applied.
• Pain: Some patients may experience pain during and after the procedure, but it’s usually manageable.
• Incomplete fragmentation: In some cases, the stone may not completely break, requiring further treatment.
• Obstruction: Fragments may block the ureter temporarily, causing pain or requiring additional procedures.
• Kidney injury: Rarely, shock waves may cause damage to the kidney, requiring additional procedures

You may not be suitable for ESWL if you are pregnant, have a bleeding disorder, are on essential blood thinning medication, or have a urine infection. Dr Kapil Sethi will carefully weigh all considerations to advise the best treatment plan for your circumstances.

Ureteroscopy

Ureteroscopy is a common procedure that urologists use to diagnose and treat problems in your kidneys and ureter, the tubes that carry urine from your kidneys to your bladder. It is the most common way to reach small to medium sized kidney stones internally. Stone-free rates are slightly higher than the less invasive approach of ESWL and similar to PCNL.

How is a ureteroscopy performed?

Ureteroscopy is typically performed under general anaesthesia, and the procedure usually lasts from 15 to 90 minutes. A thin, flexible tube called a ureteroscope is gently inserted through your urethra and into the ureter till the stone is reached.

If the stone is small, it may be snared with a basket device and removed whole from the ureter. If the stone is large, or if the diameter of the ureter is narrow, the stone will need to be fragmented with a laser with all the tiny pieces removed.

The procedure is normally performed as a day case, but there may be a need to sometimes stay in hospital overnight for observation.

A ureteric stent is a small tube inserted into the ureter to help urine flow from the kidney to the bladder. A stent may be necessary after a ureteroscopy or PCNL procedure to help the ureter stay open and prevent blockages and pain. The stent is usually removed 1-2 weeks after the procedure.

Symptoms associated with a ureteric stent include discomfort or pain in the lower back or groin, urinary urgency or frequency, and blood in the urine. These symptoms are usually mild and resolve after the stent is removed, but in some cases, they can be severe and require early removal.

Ureteroscopy risks and complications

While ureteroscopy is generally safe, there are some potential risks, including:

• Infection: There’s a small risk of urinary tract infection.
• Bleeding: Minor bleeding may occur during or after the procedure.
• Stent Discomfort: If a ureteric stent is placed, you may experience blood in the urine, bladder spasms, increased urination urgency, or discomfort.
• Perforation: In very rare cases, there could be damage to the ureter or surrounding structures.

Percutaneous Nephrolithotomy (PCNL)

Percutaneous Nephrolithotomy, often called PCNL, is a minimally invasive (keyhole) surgical procedure used to treat kidney stones that are too large or complex to be effectively managed with other options.

What happens during a PCNL?

1. Anaesthesia: PCNL is performed under general anaesthesia. The procedure takes between 1-3 hours on average.
2. Positioning: You will be positioned on your back with legs in stirrups. Dr Sethi favours this (supine) approach and will help minimise any risks associated with being turned facing down (prone).
3. Small incision: A small incision, usually around a centimetre, is made on your skin near the kidney. Sometimes, if small instruments are enough, this may be even smaller (mini-PCNL).
4. Kidney access: A thin, flexible guidewire is inserted through the incision and passed into the kidney, guided by imaging, creating a path to the stone. Over the guidewire, a tract to the kidney is created as a tunnel-like passage.
5. Stone removal: A camera and small instruments are inserted into the kidney to locate and remove the kidney stone(s) using specialised tools and a laser.
6. Drainage and closure: After the stones are removed, a temporary tube (nephrostomy tube or internal ureteric stent) may be left in place to permit adequate kidney drainage.
7. Recovery: The procedure may cause some short-term discomfort, and most patients stay in the hospital for a day or two to ensure a smooth recovery and possibly any for any required further imaging. You can typically return to driving, work and most activities within 7-10 days, and exercise and heavy-duty work in 3-4 weeks.

PCNL risks and complications:

Like any surgical procedure, PCNL carries certain risks and potential complications, although relatively rare. Some of these include:

• Infection at the incision site or within the urinary tract.
• Bleeding, which may require blood transfusion or additional procedures to control.
• Injury to nearby structures, such as blood vessels, the bowel, or the lung.
• Respiratory problems or reactions to anaesthesia.
• Formation of scar tissue in the kidney.
• Failure to completely remove the stone(s), requiring additional procedures.

PCNL is generally considered safe and highly effective for treating large kidney stones that may otherwise be difficult to manage. Dr Kapil Sethi will work with you to determine the best approach for your case, ensuring the highest likelihood of a successful outcome and a smooth recovery.