Kidney & Ureteral Stones

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Minimally Invasive Approaches

Extracorporeal Shock Wave Lithotripsy (ESWL or SWL)

Extracorporeal shock wave lithotripsy is a technique for treating stones in the kidney and ureter that does not require an incision. Using x-rays or ultrasound to pinpoint the location of the stones, a special device delivers high energy shock waves through the body. These shock waves break the stones into tiny pieces that are small enough to pass along with the urine. The complete treatment takes about 45 to 60 minutes.

Not all types of kidney stones can be treated this way. Occasionally, stone fragments are left in the body and additional treatments will be needed to remove them. Also, you may need to have a ureteral stent placed as part of the procedure. Usually, ESWL is done on an outpatient basis. The stent is removed at a later date.

Ureteroscopic Stone Removal

For stones that are too large for ESWL or those found in the lower part of the urinary tract (ureter), a ureteroscopy is performed by inserting a ureteroscope, a hollow telescopic device, up into the bladder and ureter. The stone can then be crushed into tiny fragments using a laser. The fragments are then removed with a special stone basket. If the fragments are too small to be extracted with the stone basket, your doctor may decide to place a ureteral stent and allow the fragments to pass from the body with urine. This procedure is usually performed on an outpatient basis.

Percutaneous Stone Removal (PCNL or PSE)

When stones are quite large, numerous or in a location that does not allow other techniques, percutaneous stone removal may be used. This procedure is also known as percutaneous stone extraction (PSE) or percutaneous nephrolithotomy (PCNL). In this method, the surgeon makes a small incision, about 1cm, in the back and creates a tunnel directly into the kidney. The surgeon then can inspect the kidney using Digital Nephroscopy and remove the stones. A tube is inserted and the stone is crushed and removed through this tube. A nephrostomy tube (tube to drain kidney) and/or a ureteral stent may be placed temporarily at the end of the procedure. A one to two day hospital admission is needed after this operation.

What to Expect Prior to Surgery

To assure your safety to undergo the procedure testing needs to be performed before surgery. These should include:

  • History and Physical exam
  • EKG (electrocardiogram)
  • Chest X-Ray
  • Blood tests
    • CBC
    • PT / PTT
    • Comprehensive Metabolic Panel
  • Urinalysis, Urine culture

If you have a history of heart problems, we may request additional clearance from your Cardiologist, which may involve additional testing such as an Echocardiogram or Nuclear Medicine stress test. These tests would be ordered by your Primary Care Physician or Cardiologist depending on your medical history.