Other Surgical Treatments for Kidney / Urinary Tract Stones

Ureteric Stent (Decompression without stone removal)

• This is a temporary hollow tube that is placed between the bladder and kidney in an emergency or if the ureter is too tight to allow definitive treatment
• Also usually inserted after definitive stone surgery

PCNL (Percutaneous nephrolithotomy)

Percutaneous Nephrolithotomy (PCNL) is a technique for treating large stones within the kidney involving keyhole surgery through a 1cm incision in the skin overlying the kidney with a tube and telescope (nephroscope) placed directly into the kidney to fragment and remove stones.

Hospital stay is 3-4 days, and out of hospital recovery time is significantly shorter than traditional open surgery.

The specific risks are uncommon but include infection, excessive bleeding (necessitating blood transfusion, embolisation, and rarely a kidney open operation), & adjacent organ injury (spleen, liver, bowel, and lung).

ESWL (Extracorporeal Shock Wave Lithotripsy)

• Under an anaesthetic using a device called a lithotripter, high energy sound waves are passed over the stone localized with xrays from outside the body. The shock waves will vibrate and break the stones down which will need to be passed spontaneously
• This is an older and less successful technique overall when compared to the newer laser treatments

Laparoscopic kidney and ureter stone removal (pyelolithotomy / ureterolithotomy)

• Although most stones can be treated with endoscopic surgery such as laser lithotripsy, large stones will often require 2 or 3 attempts to completely clear the stones. Laparoscopic surgery for kidney stone removal is a minimally invasive option to remove a large stone without fragmentation by laser in a single operation.
• Dr Louie-Johnsun gained exposure to this uncommon procedure on several urological medical aid trips to Vietnam where there is no access to laser lithotripsy.

Open surgery for kidney and ureter stone removal

This is performed through a large incision usually just below the rib cage and fortunately with newer technological advances such as laser lithotripsy and laparoscopy is rarely necessary.