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Most kidney stones can pass through the urinary system with plenty of water (2 to 3 quarts a day) to help move the stone along. Often, you can stay home during this process, drinking fluids and taking pain medication as needed. The doctor usually asks you to save the passed stone(s) for testing. If the kidney stone
then you may need one of the following procedures. Extracorporeal Shockwave Lithotripsy Extracorporeal shockwave lithotripsy (ESWL) is the most frequently used procedure for the treatment of kidney stones. In ESWL, shock waves that are created outside the body travel through the skin and body tissues until they hit the denser stones. The stones break down into sand-like particles and are easily passed through the urinary tract in the urine.
In most cases, ESWL may be done on an outpatient basis. Recovery time is short, and most people can resume normal activities in a few days. Complications may occur with ESWL. Most patients have blood in their urine for a few days after treatment. Bruising and minor discomfort in the back or abdomen from the shock waves are also common. To reduce the risk of complications, doctors usually tell patients to avoid taking aspirin and other drugs that affect blood clotting for several weeks before treatment. Another complication may occur if the shattered stone particles cause discomfort as they pass through the urinary tract. In some cases, the doctor will insert a small tube called a stent through the bladder into the ureter to help the fragments pass. Sometimes the stone is not completely shattered with one treatment, and additional treatments may be needed. ESWL is not ideal for very large stones. Percutaneous Nephrolithotomy Sometimes a procedure called percutaneous nephrolithotomy is recommended to remove a stone. This treatment is often used when the stone is quite large or in a location that does not allow effective use of ESWL.
One advantage of percutaneous nephrolithotomy over ESWL is that the surgeon removes the stone fragments instead of relying on their natural passage from the kidney. Ureteroscopic Stone Removal
Reference: National Kidney and Urologic Diseases Information Clearinghouse, USA.
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There are several types of ESWL devices. In one device, the patient
reclines in a water bath while the shock waves are transmitted. Other devices
have a soft cushion on which the patient lies. Most devices use either x rays
or ultrasound to help the surgeon pinpoint the stone during treatment. For
most types of ESWL procedures, anesthesia is needed.
In this procedure, the surgeon makes a tiny incision in the back and
creates a tunnel directly into the kidney. Using an instrument called a
nephroscope, the surgeon locates and removes the stone. For large stones, some
type of energy probe (ultrasonic or electrohydraulic) may be needed to break
the stone into small pieces. Generally, patients stay in the hospital for
several days and may have a small tube called a nephrostomy tube left in the
kidney during the healing process.
Although some kidney stones in the ureters can be treated with ESWL,
ureteroscopy may be needed for mid- and lower-ureter stones. No incision is
made in this procedure. Instead, the surgeon passes a small fiberoptic
instrument called a ureteroscope through the urethra and bladder into the
ureter. The surgeon then locates the stone and either removes it with a
cage-like device or shatters it with a special instrument that produces a form
of shock wave. A small tube or stent may be left in the ureter for a few days
to help the lining of the ureter heal. Before fiber optics made ureteroscopy
possible, physicians used a similar "blind basket" extraction
method. But this outdated technique should not be used because it may damage
the ureters.