Kidney Stones - Other Treatments

Devices Used to Destroy Stones. For large stones, some type of energy device may be needed to break the stone into small pieces. They are referred to as intracorporeal lithotripsy devices (meaning stone breakers within the body). The energy source may be one of the following:

Ultrasound is employed through a rigid nephroscope and results in a stone-free rate of 94%. It is currently the preferred method.
A more recent device uses a combination pneumatic drill and ultrasound with stone-free rates of 80% to 89%. It may be prove to be superior to ultrasound alone and to be effective against stones of all types.
The holmium laser literally melts the stones and destroys up 100% of stones of any composition. It uses a flexible nephroscopy and has an excellent safety record. It should be used sparingly, however, and particularly cautiously with large uric acid stones until more is understood about this effect. Another device, the erbium:YAG laser, is showing promise in lithotripsy but is not currently practical.

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Complications. Complication rates are about 3%, with major complications occurring in about 1% of cases. Some scarring occurs, but studies indicate that it does not impair kidney function, even if the patient requires repeat surgery. The procedure also poses a risk for blood loss during and after the procedure, which, in some cases, can be significant. Because large volumes of fluid are used during the procedure, fluid overload is a potential problem, particularly in children or patients with heart disease. In some cases infection may result. Other complications encountered are collapsed lung and injuries to areas outside the kidney but within the operative area, such as the abdomen or chest.

Ureteroscopic Stone Removal

Ureteroscopy may be used for mid- and lower ureter stones. With the advent of smaller instruments, it is also now being done successfully in children as well. The procedure involves the following:

No incision is made in this procedure, but a general anesthetic is still required.
The surgeon passes a small fiberoptic instrument called a ureteroscope through the urethra and bladder into the ureter.
The surgeon then locates the stone or stones.
Smaller ones are grasped and removed with tiny forceps. Large ones are shattered with lasers or pneumatic drill-like devices.
A small tube, or stent, may be left in the ureter for a few days after treatment to help the lining of the ureter heal.

Complication rates range from 10% to 20%, with major problems occurring in between 0% and 6% of patients. In some cases, large stones are not broken up into small enough pieces that can be passed, resulting in obstruction of the urinary tract and possible kidney damage. Imaging tests such as ultrasound or spiral CT are useful within three months to check for residual stones, and a second procedure may be required. The risk of complications is highest when the procedure is performed by less experienced surgeons and if stones are found in the kidney. The risk for perforation of the ureter is higher the longer the operative time.