Surgery is done when the stone is too large to pass in the urine, blocks urine flow, or damages the urinary tract. It can also be done to prevent a kidney infection or kidney failure. Stones that are very large or in a spot that is hard to get to with extracorporeal shock wave lithotripsy (ESWL) can be removed. Options include:
Percutaneous Nephrolithotomy
A small cut is made in the back to get to the kidney. A nephroscope is a tube placed into the kidney. Lights, a camera, and tools are used through the tube. Once the stone is reached, it can be removed through the tube. Sometimes, the stone must be broken into smaller pieces with shock waves. A small tube may be placed into the kidney to drain urine while it heals.
Ureteroscopy
A tube is passed through the urethra and bladder, and into the ureter. Lights, camera, and tools can be used through the tube. Once the stone is reached, it can be removed through the tube. Sometimes, the stone must be broken into smaller pieces with a laser. A stent may be left in place to keep the ureter open as it heals. The stent will be removed after the ureter heals.
Open Surgery
Though rare, open surgery may be needed if the stone is very large or has an odd shape. This can keep urine from flowing out of the kidney. A long cut is made along the side to get to the kidney. Once the stone is found, it is taken out. Recovery time with open surgery is longer than with the other types.
References
Kidney stones. National Kidney Foundation website. Available at: https://www.kidney.org/atoz/content/kidneystones. Accessed April 2, 2019.
Kidney stones. Urology Care Foundation website. Available at: https://www.urologyhealth.org/urologic-conditions/kidney-stones. Accessed April 2, 2019.
Nephrolithiasis in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114904/Nephrolithiasis-in-adults . Updated March 22, 2019. Accessed April 2, 2019.
Treatment for kidney stones. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-stones/treatment. Updated May 2017. Accessed April 2, 2019.
Urinary calculi. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/genitourinary-disorders/urinary-calculi/urinary-calculi. Updated March 2018. Accessed April 2, 2019.
Revision Information
- Reviewer: EBSCO Medical Review Board Adrienne Carmack, MD
- Review Date: 03/2019
- Update Date: 04/02/2019