What is Involved in Kidney Stone Removal?

Kidney stones, hard buildups of calcium and other minerals in the kidneys and urinary tract, can be very painful. Large stones not only make it difficult to urinate, but they can also damage tissue and lead to serious infections. There are many different surgical and non-surgical methods for kidney stone removal, and a specialist can determine the most appropriate treatment option based on the size and location of a stone. Common options for kidney stone removal include increasing fluid intake, breaking up stones with sonic waves and electricity, endoscopic excision, and classic open surgery.

Small kidney stones that do not cause excruciating pain can usually be passed in the urine without invasive surgery. Patients are instructed to drink a lot of water, as much as three quarts (about 2.8 liters) a day, to help flush the kidneys and pass the stones. Over-the-counter or prescription pain medication can help relieve symptoms until stones pass, which may take anywhere from a couple of days to a month or longer.

When stones are too large to pass naturally or threaten to cause infection, doctors must consider more invasive kidney stone removal techniques. A common procedure known as lithotripsy relies on intense sound waves or electrical activity to break up stones into smaller pieces that can be excreted in urine. With a patient under localized anesthetic, a thin probe is inserted through the ureter and directed to a stone. High frequency sound waves or electric pulses are then shot through the probe to break up the stone.

A procedure called extracorporeal shock wave lithotripsy relies on the same principles of ultrasonic and electric lithotripsy, but does not require a probe. It is usually reserved for stones that are smaller than about 0.5 inches (about 1.25 cm) in diameter. During the procedure, a patient's lower body is submerged in water and intense shock waves are released. When waves reach kidney stones, the impact pulverizes them.

Surgical kidney stone removal may be needed for large stones that do not respond to lithotripsy. A surgeon may choose to remove a stone by inserting instruments through the ureter or through a small incision in the abdomen near the site of the stone. Both techniques can be performed in an outpatient surgical center in about one hour with localized anesthesia. Open surgery is rarely needed for kidney stone removal, but it may be the only viable option if a stone severely damages the ureter and causes infection. The surgeon manually excises the stone, repairs surrounding tissue, and inserts a stent into the ureter to prevent further damage.