Kidney Stones

Overview

Treatment for kidney stones depends on the site/size of the stone(s) and on how much trouble (usually pain, blockage, bleeding or infection) is caused by them. Our surgeons have a great deal of experience of all contemporary means of treating stones, and will be able to discuss the best treatment options. Some of the options follow:

Conservative management

Some small stones of the kidney, that cause no problems can be simply observed. People who have, or have had stones should consider modifying their lifestyle to reduce the risks of further stones forming. Such changes include dietary changes to consume a normal calcium, low-salt, low-protein diet, which can reduce the risk of further stone formation by a half. Drinking enough of fluids to keep the urine colourless may reduce the risk by a further one third. Common advice is to try to take in 2 litres of fluid per day. Taking exercise is also important.

If stones grow, move or start to cause problems during conservative management, active treatment may be more appropriate. If a small stone passes into the tube between the kidney and bladder (ureter) it could pass, depending on size. Therefore it might be appropriate to wait for a small amount of time to see if the stone will pass through on it’s own, before active treatment is planned. During this period of observation pain killers should be taken when required and other tablets may be prescribed to encourage the stone pass (medical expulsion therapy). If there is no movement of the stone, severe pain or features suggesting infection (sweats or high temperature) then observation alone is not appropriate.

Extracorporeal shock wave lithotripsy (ESWL)

This is a non-invasive type of stone treatment, in which the patient lies on a machine that fires shock waves into the body. The waves pass through the skin causing a slight discomfort and are focused on the stone, which is fragmented. The fragments are then passed in the urine. Not all patients are suitable for this treatment, and even those that are selected for this treatment may need more than 1 treatment or may not respond at all.

Rigid ureteroscopy and laser stone fragmentation

Stones that get stuck into the tube between the kidney and bladder (ureter) cause pain and blockage. If they do not pass on their own, they should usually be treated. The best option is likely to be an operation to insert a long, thin telescope (ureteroscope) through the bladder, into the ureter. When the stone is seen it is either pulled out, or if it is too large it is broken with a laser, and the fragments removed. It may be that a stent needs to put left in the ureter (narrow plastic tube that lies between the kidney and bladder that stops fragments of stone causing further blockage, and promotes healing of the ureter) after the surgery, which would need to be removed at a later date, usually under local anaesthetic. This type of surgery is usually performed as a daycase, or overnight stay, and patients are usually fit to return to work after days (although if a stent is left in the ureter it may give a feeling that the bladder needs to be emptied frequently, interfering with normal life). There are risks involved with all operations, such as heart, lung or thrombosis problems. This surgery can cause bleeding, infection or local damage to the urethra, bladder or ureter, and is not always totally successful at removing the stone. However, our surgeons perform this type of procedure most days of the week, and are therefore very experienced with high success rates.

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Flexible ureteroscopy and laser stone fragmentation

Some stones that are in the kidney can be removed by flexible uereteroscopy. Like rigid ureterosocpy, this involves passing a long thin telescope through the bladder, ureter and into the kidney. This type of telescope is very flexible so it can be manoeuvred around the kidney. When the stone is seen it is either pulled out, or if it is too large it is broken with a laser, and the fragments removed with a wire basket, as seen below.

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A stent is almost always left in the ureter, that needs to be removed at a later date, usually under local anaesthetic. This type of surgery is usually involves an overnight stay in hospital and a week of recovery. It has similar risks to rigid ureteroscopy.

Percutaneous Nephrolithotomy (PCNL)

Some larger stones that are in the kidney are best treated by puncturing the skin over the kidney and introducing a telescope through the skin directly into the kidney. This type of operation is performed under general anaesthetic and usually requires a cystoscopy before the kidney surgery. When the stone is seen it is either pulled out, or if it is too large it is broken and the fragments removed. A tube is almost always left in the kidney that comes out throughthe hole in the skin made for the telescope. This is usually removed a day or 2 after surgery, if all is well. This type of surgery is usually involves an several nights stay in hospital and several weeks of recovery. It rarely involves a stent in the ureter. It has similar risks as rigid ureteroscopy, although there can be much more bleeding from, or damage to the kidney. It is almost always successful at removing the stone.

Laparoscopic or open surgery

Our surgeons are experts at laparoscopy (keyhole surgery), and in the very unlikely event that the telescopic techniques detailed above are not thought suitable to treat a stone (usually because of its large size or difficult position), keyhole surgery would be offered. It is exceedingly likely that with our modern techniques and equipment that kidney stone surgery will need a traditional large cutting operation.

What next?

If you would like to discuss treatment of kidney stones then please contact us and book a consultation with Mr Christopher Luscombe, Mr Lyndon Gommersall, Mr Sam Liu or Mr Anurag Golash.