Stone procedures

What are kidney stones?

Kidney stones are very common. They are usually caused by a combination of not drinking enough fluids and how your kidney is shaped. Every kidney is different inside and sometimes there are little channels where the urine does not flow very well. 

The salts and crystals in the urine can collect over time to form stones which then get bigger with more urine passing over them – just like stones in rivers. Sometimes these stones fall down into the ureter, the narrow duct between your kidney and your bladder.

There are some diseases and inherited conditions that can make people more likely to develop stones and these sorts of problems will be looked into in our special stone clinic.

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Why do renal tract stones need treatment?

A ureteric stone can block the ureter causing swelling of the kidney which leads to severe pain or a serious urine infection and may eventually cause the kidney to fail.

Kidney stones may get bigger, cause recurrent urinary infections and eventually cause loss of kidney function.

What options are available?

The options available depend upon the size and position of the stone.  For large kidney stones (>2 cm across) a percutaneous nephrolithotomy (PCNL) is the preferred option, but for most other stones all options are possible, including no treatment.  There are advantages and disadvantages of each procedure.    There is a small (less than 10%) risk of infection (sepsis) with any stone operation.  A urine sample is routinely checked before treatment and antibiotics are given with every general anaesthetic procedure.

No treatment

As described above, it is your choice to have a procedure for your kidney stone but there are risks of kidney infection and even failure if certain stones are left untreated.  It is self evident that all big stones were at some point small.

Shock wave lithotripsy

The major advantage of the shock wave lithotripsy service Philip has developed at Casey Hospital in Berwick, Victoria is that a general anaesthetic, and the risks that that involves, is not required.  Lithotripsy technology was developed during the 1970s and 80s and was one of the great medical innovations of the 20th Century.  Shock waves are aimed at the stones which are fragmented into small pieces which pass out with the urine.  Not all stones can be broken up and bigger stones may need multiple treatments but the treatment can easily be repeated.  There can be a little bit of skin bruising following the treatment but major complications are very rare. 

Ureteroscopic stone removal

Shock wave lithotripsy and ureteroscopic stone removal are the only two treatment options for stones lodged in the ureter. Ureteroscopy requires a general anaesthetic.  A very small telescope (ureteroscope) is passed directly into the ureter through the bladder.  The stone is either pulled out with a small basket or broken up with a probe or a laser.  It is sometimes necessary to put a stent (a long plastic tube) into the ureter either before or after this procedure. This stent must be removed within a few weeks, which means you may have a further day case procedure.  While this treatment is generally very effective, complete stone clearance may require a number of procedures and there are rare risks that the ureter may be damaged (usually less than 1 in 100).  

Ureterorenoscopic stone removal Lithotripsy is usually reserved for kidney stones less than 1 cm in size, though in some cases can be used for stones up to 2 cm.  For small kidney stones the main treatment alternative is ureterorenoscopic stone removal.  This procedure involves a general anaesthetic.  A small flexible telescope is passed into the kidney through the bladder and ureter.  Any stones found can be fragmented with a laser and then either left to pass out with the urine or pulled out with a basket.  Stents are usually left behind to prevent pain, and these will need to be removed during a later day procedure.   Occasionally (about 1 in 4 cases) a stent needs to be left in place to stretch the ureter prior to getting the telescope into the kidney.  In these circumstances the main operation will be rebooked for 2-4 weeks later. Damage to the ureter and kidney are also rare complications (between 1 and 5 per 100 cases).

Percutaneous nephrolithotomy (PCNL)

This is the main option for removing larger kidney stones and Philip has developed particular expertise in a modified procedure which reduces operative time and hospital stay.  A very small hole is made in the skin and a needle passed through to the kidney.  This is then stretched to enable a tube to be placed in the kidney. A telescope is passed through the tube to allow direct vision of the stones.  The stones can be broken up with various technologies and the fragments removed through the tube.  This can be major surgery and will require a general anaesthetic and at least one night in hospital. There are risks of bleeding, rarely needing a transfusion (about 2 to 5 per 100 cases) or embolisation, where small metal coils are placed in the kidney blood vessels blocking off the bleeding via a puncture in the groin (about 1 in 500 cases).   Damage to the kidney or the organs surrounding the kidney can occur but is rare (about 1 in 400) and rarely requires additional treatment.