Types of kidney stone surgery

There are several different procedures for removing kidney stones that are too large to pass naturally.

Shock wave lithotripsy

This is the least invasive procedure. Your surgeon uses high frequency sound (shock) waves to break up your kidney stones.

An ultrasound or X-ray will be used to locate your kidney stone, and a gel-filled cushion will be put on your abdomen or behind your kidney. The cushion allows sound waves to be transmitted to the stone, breaking it up into smaller pieces that you can pass in your urine.

Afterwards, imaging is used again to see how well it’s worked. You may need more than one session to successfully treat your kidney stone.

Shock wave lithotripsy is usually done under sedation or general anaesthetic.

It’s generally a day procedure. You can go home after the sedation or anaesthetic has worn off, as long as you can pass urine. Your doctor will ask you to drink lots of water to help with this.

Shock wave lithotripsy is relatively effective for stones up to 15 mm in diameter but less so for larger stones.

You can’t have this procedure if you:

• are pregnant, as the sound waves and X-rays could harm your baby
• have a bleeding disorder
• have an untreated kidney infection, urinary tract infection or kidney cancer
• have kidneys with abnormal structure or function.

Advantages

• no incisions
• can be done as day surgery
• quick recovery.

Ureteroscopy

Your surgeon inserts a tube, with a camera and light on the tip, through your urethra and up towards the stone. Then they use a laser to break the stone into fragments which they’ll either take out or allow to wash out in your urine.

This method is often used for stones that aren’t suitable for shock wave lithotripsy or are obstructing the ureter. It’s used for stones up to 20 mm in diameter.

Your surgeon may leave a temporary stent (a hollow tube) in to help keep your urinary tract open while the stone fragments pass. Ureteroscopy is usually done under general anaesthetic.

You’ll most likely be able to go home after you’ve recovered from the anaesthetic, as long as you can pass urine.

Advantages

• no incision
• highly successful technique (95%)
• can be done as day surgery.

Percutaneous nephrolithotripsy

Your surgeon makes a small incision in your back and, using ultrasound or X-ray imaging, guides a hollow tube into your kidney. This enables them to insert a tube, with a camera and light on the tip, and stone grasping instruments. They then fragment and remove the kidney stones. They’ll use imaging again to check the results.

A drainage tube exiting through your skin may be left in to drain urine from your kidney. It’s taken out before you go home or during your post-surgery follow-up.

This procedure is often used for larger stones inside your kidney and complicated stones. It’s done under general anaesthetic and involves a 2–4 day hospital stay.

Advantages

• large or complicated stones can be treated in a minimally invasive way
• effective for removing cystine and struvite stones
• significantly shorter recovery time than open surgery.

Laparoscopic or open surgery

Occasionally, your surgeon may recommend laparoscopic or open surgery to remove a kidney stone. With improvements in technology, it’s very rare to need open surgery. It’s usually only considered if you were born with an abnormality in your urinary system or if other treatments have failed.

For this surgery, your surgeon makes an incision (or small keyhole incisions) in your side. Your kidney or ureter is opened and the stone is removed. After the incision is closed, a drain is put in place to carry urine away. Your surgeon may also leave a temporary stent (a hollow tube) in to help keep your urinary tract open while the area heals.

You may spend 2–9 days in the hospital. The drain will be taken out before you leave hospital or during your first check-up.

Advantage

• The surgery usually completely removes the stone.

Which procedure is best for me?

The best choice of surgery depends on the type and severity of your condition, your general health and your surgeon’s skills.

Your surgeon will probably recommend a less invasive procedure if you have small, uncomplicated stones, while percutaneous nephrolithotripsy or occasionally, open or laparoscopic surgery may be preferred for larger, more complex stones.

Print this page and take it with you when you discuss your procedure with your surgeon.