Tuesday, February, 14, 2012

Kidney Stones - Prevention

Table of Contents

SWL appears to be safe for children. Experts recommend using the least amount of shocks and impact possible in young people. If more than one treatment is needed, the patient should wait at least 15 days before the next treatment.

Ureteroscopy

Ureteroscopy may be used for stones in the middle and lower ureter. Because it uses smaller instruments, this procedure can be done successfully in children. During ureteroscopic stone removal:

  • The patient receives a general anesthetic, though no incision is required for the procedure.
  • The surgeon passes a small fiberoptic instrument called a ureteroscope through the urethra and bladder into the ureter.
  • The surgeon locates the stone or stones.
  • The urologist can use a laser to break up the stones, or remove them with a basket, grabber, or suction tool.
  • The surgeon may decide to leave a small tube, or stent, in the ureter for a few days after treatment, to help the lining of the ureter heal.

Ureteroscopy achieves a higher stone removal rate than SWL, but it also has a higher risk of complications. In some cases, large stones are not broken up into small enough pieces. This can result in a blockage of the urinary tract and possible kidney damage.

Imaging tests, such as ultrasound or spiral CT, are useful within 3 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, or if stones are found in the kidney. The risk for perforation of the ureter increases the longer the procedure takes.

Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy (PCNL) may also be used to treat kidney stones when SWL is not available or the patient is not a candidate for it (such as if the stone is very large, in an inaccessible location, or is a cystine stone). PCNL is also preferred over SWL for stones that have remained in the ureter for more than 4 weeks.

Review Date: 06/08/2010
Reviewed By: Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)