Kidney Stones - Other Treatments

Highlights	Risk Factors	Other Treatments
Introduction	Diagnosis	Resources
Complications	Treatment	References
Causes	Prevention
Symptoms	Medications

Other Treatments

Surgery is usually needed if the stone is too large to pass on its own, if there are indications that it is growing, or if it is blocking the urine flow and causing urinary tract infection or damaging the kidney. Until recently, the procedure to remove a stone was a very painful, major surgery that required a 4- to 6-week recovery period. Today, treatments for stones are much less invasive and major surgery is performed in less than 2% of patients.

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The primary methods of stone removal are the following:

Extracorporeal shock wave lithotripsy (ESWL). In general, ESWL is the first choice for small stones (less than one centimeter) in the upper ureter. (One 2000 trial attempted to determine whether ESWL offered any advantage for treating very small stones that caused no symptoms; no benefit was detected.)
Percutaneous nephrolithotomy (PNL). PNL can be used for very large stones in the upper tract, when ESWL fails, for kidney transplant patients, or when there are structural abnormalities in the kidney or surrounding area. It is the preferred procedure for drug-resistant cystine stones, which are usually resistant to shock wave therapy. For small staghorn calculi in normal or near normal kidneys, either ESWL or PNL is usually effective. For complicated conditions involving staghorn calculi, however, experts usually recommend PNL followed by ESWL (called a sandwich procedure) or a repeat PNL procedure.
Ureteroscopy. For stones in the lower tract, ureteroscopy is generally the best procedure, although lithotripsy is also usually feasible and patients ordinarily prefer it.
Standard open surgery (nephrolithotomy) may be required if any of these procedures fail or are not appropriate, or in special cases, such as when the patient is very obese.

Most procedures are more effective for calcium and uric acid stones and less effective for struvite and cystine stones, although new techniques may be improving their effects on all stones.

Extracorporeal Shock Wave Lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) is the most frequently used procedure for destroying and removing simple stones located in the kidney or upper urinary tract, including struvite stones. ESWL is not used for cystine stones. It is generally not successful for stones larger than three centimeters in diameter (which is slightly over an inch).

All ESWL procedures deliver shock waves from outside the body to break the stones. ("Extracorporeal" means "outside the body" and "lithotripsy" means stone-breaking.) There are several variations. The following is a typical procedure:

Most ESWL procedures use some anesthesia, although they are often done on an outpatient basis.
The patient is positioned in a water bath. (In some procedures the patient lies on a soft cushion.)
The procedure uses ultrasound to generate shock waves that travel through the skin and body tissues until they hit the dense stones. (X-rays or ultrasound are used to help the surgeon pinpoint the stone during treatment.)
The stones are crushed into tiny sand-like pieces that usually pass easily through the urinary tract.
The shattered stone fragments may cause discomfort as they pass through the urinary tract. In such cases, the doctor may insert a small tube called a stent through the bladder into the ureter to help the fragments pass. This practice, however, has not proved to speed up passage of the stones in most cases and is not used routinely.

Extracorporeal shock wave lithotripsy (ESWL) is a procedure used to shatter simple stones in the kidney or upper urinary tract. Ultrasonic waves are passed through the body until they strike the dense stones. Pulses of sonic waves pulverize the stones, which are then more easily passed through the ureter and out of the body in the urine.