Kidney Stones - Other Treatments

Success rates range from 50% to 90% depending on the location of the stone and the surgeon's technique and level of experience. Recovery time is short, and most people can resume normal activities in a few days.

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Complications. Complications may include the following:

The most common complication is blood in the urine, which lasts for a few days after treatment. To reduce the chances of bleeding, doctors usually tell patients to avoid taking aspirin and other NSAIDs, which can promote bleeding, for seven to 10 days before the treatment.
Bruising and minor discomfort due to the shock waves are common in the back or abdomen.
Sometimes the stone is not completely fragmented with one treatment, and additional treatments then may be required. Inability to pass stone fragments may also be a particular problem in patients who have cysts or other kidney abnormalities.
Its safety for small or abnormal kidneys is not fully known. For example, ESWL appears to be safe for children, although a 2001 study reported temporary damage in the kidney tubules after treatment. It is not known if this complication has any long-term consequences. Experts recommend minimizing as much as possible the impact and number of shocks in young people. If more than one treatment is needed, there should be a waiting period of at least 15 days.

Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy may be used when ESWL is not available or effective (e.g., if the stone is very large, in an inaccessible location, or is a cystine stone). It is also preferred over ESWL for stones that have remained in the ureter for more than four weeks.

It is more effective that ESWL for patients with severe obesity and appears to be safe for the very elderly and the very young. Success rates have been reported to be about 98% for kidney stones and 88% for ureteral stones. They may vary according to the technique and patient group. For example, success rates are slightly lower in children, although the procedure can be done safely in young patients. Long-term effects are unknown.

A typical procedure is as follows:

The surgeon makes a tiny incision in the back and creates a tunnel directly into the kidney.
The surgeon then inserts an instrument called a nephroscope through the tunnel.
The stone is located and removed. If it is large it is destroyed using ultrasound, lasers, or other devices and the fragments are then removed. (An advantage of percutaneous nephrolithotomy over ESWL is that the surgeon is able to remove the stone fragments directly instead of relying on their natural passage from the kidney.)
Generally, patients stay in the hospital for five or six days and may need a small device called a nephrostomy tube left in the kidney during the healing process.