What is the Best Procedure for Kidney Stone Removal?

Urologists treat kidney stones based on their type, size and location. Smaller kidney stones can pass on their own without treatment. Your urologist may advise you to drink plenty of fluids to help the stone move along your urinary tract. You will be able to pass smaller stones naturally without any treatment other than pain-relieving medication.

For kidney stones that are larger and block your urinary tract or cause unbearable pain, you may need treatment to break down and remove the stones. If you are vomiting and dehydrated, urgent treatment is necessary.

So what is the best procedure for kidney stone removal?

For larger stones causing excruciating pain or that may not pass on their own, surgery is typically the best treatment. There are four surgical procedures your urologist may consider: shockwave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, and robot-assisted surgery. The best surgical procedure for your kidney stones will depend on their type and location.

You will need surgical kidney stone removal if:

  1. You have a lot of pain
  2. You have large stones that cannot pass on their own
  3. Your stones are blocking urine flow out of your kidneys
  4. You have recurrent urinary tract infections due to stones

At St Pete Urology, our urologists are highly trained and experienced in a full range of surgical procedures for removing kidney stones. We conduct minimally-invasive procedures which guarantee faster healing.

The procedure we perform on a patient will depend on the nature and location of the stone, the patient’s overall health, and other factors.

We ensure that you get the best possible care as quickly as possible, from surgery through recovery.

How are the surgical procedures performed?

1. Shock Wave Lithotripsy

Shock wave lithotripsy (SWL) is a procedure in which kidney stones are targeted using sound waves and X-rays. The stones are broken down before they are passed naturally in urine. This non-invasive procedure is used for small to medium-sized kidney stones, usually less than two centimeters in size, softer, and located in the ureter.

During the procedure, you lie on a table and receive medicine to limit pain and discomfort before high-energy shock waves are aimed at the stone from the outside. No cuts are made in your skin as the waves go through and break the stones into smaller pieces. Your urologist may insert a tube in your ureter, called a stent, which will aid in passing the stones. The procedure will take about an hour and you are free to go home the same day. Recovery time for shockwave lithotripsy is relatively short, so you will be able to return to normal activities within a few days.

2. Ureteroscopy

For bigger stones, your urologist may consider ureteroscopy. For this procedure, a small scope, called a ureteroscope, is inserted into the kidney via the bladder. When the stone is in the upper part of the ureter and kidney, your urologist will use a more flexible ureteroscope. If the stones are in the lower portion of the ureter near the bladder, a rigid scope may be used. Ureteroscopy is an outpatient procedure done without incision and under general or spinal anesthesia.

At St Pete Urology, one of the most common surgeries to treat kidney stones is ureteroscopy with Holmium laser lithotripsy. During this procedure, the urologist inserts a narrow, flexible ureteroscope through your urethral opening and passes it through the bladder to reach the stone. The stone is then collected from the location or broken up using a small laser fiber and removed.

3. Percutaneous nephrolithotomy

Percutaneous nephrolithotomy is a minimally-invasive procedure in which a surgeon makes a small incision, usually at the back or side to create a tunnel directly to the kidney to break and remove a large or irregularly shaped stone. Once an incision is made, an optical instrument, called a nephroscope, is inserted through the incision to reach the stone. The stone is broken down into small pieces and drawn out. This procedure is ideal for kidney stones that are big (larger than 2 centimeters), numerous, too dense, or located in a hard-to-reach area in the kidney or ureter. A stent is inserted to help with the excretion of urine as you heal from the surgery. You may need an overnight stay in the hospital after the procedure and can expect to recover in two to four weeks.

4. Robot-assisted stone removal

Kidney stones can also be removed using the da Vinci surgical system, particularly if you were born with a kidney drainage problem (ureteropelvic junction obstruction) or have complicated stones that cannot be removed successfully using other surgical methods.

This robotic surgical system gives urologists a high-resolution and three-dimensional view of small areas. It allows for an increased range of motion and the ability to make more precise incisions, which ensure less scarring. Patients who undergo this procedure recover more quickly and spend fewer days in the hospital, compared to those who have had traditional open surgery.

Why have your kidney stone removal at St Pete Urology?

At St Pete Urology, our urologists frequently treat patients with kidney stones of different types, locations and sizes. We perform hundreds of kidney stone surgeries every year, using mostly minimally invasive and robotic procedures.

Your condition will be managed by specialists who will recommend the best procedure, apply a personalized treatment plan, and deliver top-notch follow-up care. We will see you through your recovery period and monitor your progress to make sure you are in the best of health.

For more information on kidney stone prevention, diagnosis and treatment, visit the St Pete Urology website.

How long should it take to pass a kidney stone?

Most kidney stones will pass through the ureter to the bladder and out of the body when given time. In fact, with ample fluid intake, nearly all kidney stones will pass through the urinary tract on their own within 48 hours. Nevertheless, the time it takes for a stone to be passed depends on its size and location in the urinary tract. For instance, smaller stones and those located in the lower portion of the urinary tract (closer to the bladder than the kidneys), have a higher likelihood of passing on their own and tend to pass more rapidly. Larger stones and those located in the kidneys are less likely to pass on their own and tend to pass more slowly.

How long does it take to pass a kidney stone?

According to the American Urological Association, the length of time required to pass a kidney stone located in the ureters (tube that connects kidneys to the bladder), is an average of 8 days if the stone is less than 2mm, about 12 days for a stone between 2mm and 4mm, and 22 days if the stone is between 4mm and 6mm. Generally, however, most kidney stones will pass on their own in 40 days. But when a medical expulsive therapy is applied, a kidney stone (2mm to 6mm) will pass within a few days or weeks provided the patient is in good health. Medications called antispasmodics can be used to accelerate the process of passing a stone. The drugs relax the ureters and increase the speed of passing a stone by up to 5-7 days. A urologist may allow for up to 6 weeks for a kidney stone to pass on its own, but earlier intervention may be necessary if the stone is causing severe pain, gastric discomfort or urinary problems.

Factors affecting the ability to pass a kidney stone

There are several factors that affect the ability to pass a kidney stone. They include:

  1. Prostate enlargement.
  2. Size of the person.
  3. Prior stone passage.
  4. Pregnancy.
  5. Size of the stone.
  6. Location of the stone.

For instance, a kidney stone that is 4mm in size has an 80 percent chance of passing while a stone that is 5mm in size has only a 20 percent chance. Kidney stones that are larger than 9mm-10mm can hardly pass without a doctor’s intervention and require timely treatment to avoid complications. To increase the passage rate of kidney stones, a urologist may recommend certain medications. The medications include alpha blockers such as tamsulosin (Flomax) and calcium channel blockers such as nifedipine (Procardia, Nifediac, Adalat or Afeditab).

Dealing with the symptoms of a kidney stone

Since most kidney stones will eventually pass through the urinary tract and out of the body when given time, treatment is usually directed toward controlling the symptoms. When the stones are passed at home, appropriate interventions usually include increased fluid intake and taking anti-inflammatory drugs such as Ibuprofen. If over-the-counter pain medications are ineffective, stronger drugs such as Ketorolac (an injectable anti-inflammatory drug) and narcotic pain medications are used. In case of severe nausea and vomiting, the doctor may give intravenous medications.

When do kidney stones require removal?

Waiting for kidney stones to pass is not ideal for every case. According to the American Urological Association, kidney stone removal should be considered if a stone fails to pass on its own within 2 months. Likewise, stone removal is necessary if complications arise due to the stone. Complications that require stone removal include ureter blockage or irritation, urinary tract infection, decreased kidney function and uncontrolled pain, nausea or vomiting.

To remove kidney stones, a procedure called lithotripsy is often used. During the procedure, kidney stones are subjected to shock waves, resulting in the breakdown of larger stones into smaller pieces that can easily pass through the urinary tract. When lithotripsy is not effective, surgical techniques may be necessary to remove kidney stones. This may be done either by making a tiny incision in the skin (percutaneous nephrolithotomy) or via an instrument (called ureteroscope) passed through the urethra and bladder into the ureter.

Effective treatment at St Pete Urology

At St Pete Urology, we provide a multidisciplinary approach to treating and managing kidney stones of all sizes. We have assembled a highly integrated team of nephrologists, urologists, radiologists and dietary and metabolic specialists to ensure comprehensive diagnosis, treatment and proper assessment of the risks leading to the formation of kidney stones. By applying the latest technology in treating kidney stones (including state-of-the-art lasers) and a broad range of noninvasive and minimally-invasive procedures for removing small and large stones, we guarantee only the highest quality and successful treatment to all our patients. For more information, visit the St Pete Urology site.

How do you know if you have a kidney stone?

 

A kidney stone is a solid piece of mineral substance formed in the kidney or urinary tract when normal substances found in urine become too concentrated. Once formed, a stone may remain in the kidney or pass through the urinary tract and eventually move out of the body. Kidney stones are a very common urinary tract disorder that can affect almost anyone. In America, one in every ten people has a kidney stone.

How do you know if you have a kidney stone?

How do you know if you have a kidney stoneIt is almost impossible to know that you have kidney stones until symptoms appear. In fact, most kidney stones are difficult to detect until they begin to move from the kidney through the ureter (the tube that connects the kidney to the bladder) and down the urinary tract. It is this movement that tends to cause irritation and blockage in the urinary tract and result in the severe pain and discomfort that is associated with kidney stones. Nevertheless, some kidney stones may lodge in an area of the kidney or urinary tract and cause noticeable symptoms.

To know if you have a kidney stone, you should first acquaint yourself with the symptoms. Knowing the symptoms of kidney stones will then allow you to suspect the condition as soon as you experience any symptoms and to seek immediate medical attention. A prompt visit to a urologist will ensure that your condition is accurately diagnosed and treated effectively.

Here are various ways of knowing if you have a kidney stone.

1.Sharp, excruciating pain

The presence of a kidney stone is often marked by a sharp, excruciating pain on one side of the lower abdomen or upper back. The pain typically starts suddenly and then lingers for a long period, becoming more intense with time. The pain also may spread and affect a larger area, including the groin area, area below the ribs and genitals. The pain can be constant or it can come and go in waves, lasting for a few minutes and then disappearing before starting again in about 10 minutes. The pain also may last for a longer period, but with fluctuating intensity as the stone moves and changes its position in the urinary tract. The nature and intensity of pain caused by kidney stones depends on the size of the stone, its location in the urinary tract and whether or not it has caused damage, blockage or irritation in the delicate structures of the urinary tract.

2. Urination problems

Apart from causing severe pain, kidney stones also result in a variety of urinary problems. The following urinary issues will help you to know that you have a kidney stone:

  • (a) Pain during urination.
  • (b) Red, brown or pink colored urine.
  • (c) Cloudy or foul-smelling urine.
  • (d) Urge to urinate, which is stronger and more frequent than usual.
  • (e) Dribbling urine in small quantities.

3. Gastric distress

You can know that you have a kidney stone if you have pain and any of the following symptoms:

  • (a) Nausea
  • (b) Vomiting
  • (c) Chills
  • (d) Fever

One or more of these symptoms may indicate that you have a urinary tract infection and therefore need antibiotics. Make sure to visit a doctor as soon as possible if you have these symptoms.

4. Clock clues

Linking your symptoms to the time of the day also may help you to know that you have a kidney stone. Typically, the pain caused by kidney stones usually begins either early in the morning or late at night. This is due to the fact that people urinate less frequently in the early morning or late at night and the ureter remains highly constricted, allowing the stones to irritate the delicate structures of the ureter and cause pain. Therefore, monitoring the time pain occurs will enable you to tell whether or not it is caused by kidney stones.

Diagnosis of kidney stones

While the clues you get from the symptoms may be sufficient to help you suspect that you have a kidney stone, the only definitive way of knowing you have a stone is to visit a doctor for diagnosis and treatment. Generally, it is recommended that you see a doctor if you:

  1. Experience pain so severe that you are unable to stand, sit or lie down comfortably.
  2. Have serious pain in your belly.
  3. Have nausea or vomiting.
  4. See blood in your urine.
  5. Find it difficult to urinate.

When you visit a urologist, be ready to describe your symptoms clearly, including when and how they started. If possible, write them down, together with a list of the medication, vitamins and supplements you are taking. For instance, some medications such as diuretics, calcium-based antacids, topiramate (Topamax) and Indinavir (Crixivan) may cause kidney stones. You also should keep track of the amount of fluid you drink and the quantity of urine you pass in a 24-hour period.

The doctor will confirm that you have kidney stones by requesting various tests. These may include blood tests for the presence of calcium or uric acid in blood, since a buildup of these minerals may precipitate kidney stones. The doctor also may request urine tests, often on a urine sample collected in a 24-48 hour period. Apart from lab tests, the doctor may request imaging studies. For example, X-rays may be used to accurately show that you have kidney stones, particularly larger stones; computed tomography (CT) scans can be used to take in-depth images of the urinary tract from several angles, helping to identify smaller stones that X-rays can’t recognize; while ultrasound can be used to create clear images of the urinary tract in order to spot various sizes of kidney stones.

Treating kidney stones

Once the doctor confirms that you have kidney stones, you may be given a special strainer which you use every time you pass urine. The strainer will help you to collect any stones or pieces of stones you may pass. If you succeed in collecting a kidney stone, the doctor will send it to the laboratory for analysis. Knowing the type of kidney stone you have will help your doctor to recommend effective ways of minimizing the risk of such a stone in the future.

Most stones, though quite uncomfortable, will not cause serious damage to your body. So your doctor most likely will recommend that you wait for the stones to pass on their own. It may take a few days to several weeks for a stone to move from the kidney to the ureter and through the bladder to the outside of the body. Your doctor will prescribe pain medications and anti-nausea drugs and then recommend that you go home and wait for the stones to pass. Drinking 2-3 quarts of water every day also is recommended as a way of flushing out your urinary system.
But if through imaging studies the doctor finds that your kidneys stones are too big to be passed at home or notices that you have serious signs of infection, the doctor will use a medical procedure to remove the stones while you are at the clinic or hospital. For instance, lithotripsy is an effective procedure that relies on shock waves to break down larger stones into smaller pieces for easy removal. In cases where lithotripsy is either ineffective or inappropriate, the urologist will use a more invasive method such as inserting a ureteroscope (a special scope) into your urethra or reaching the stone via an incision, a technique called percutaneous nephrolithotomy.

Make sure to seek emergency treatment of kidney stones if you:

  1. Have fever and chills, which are indicators of an infection.
  2. Experience a total failure to pass urine.
  3. Have a history of kidney removal and only have one kidney.
  4. Develop severe fatigue or confusion.
  5. Have severe nausea or vomiting.

Emergency treatment should be sought even if the symptoms are mild. For more information and help with kidney stones, visit the “St Pete Urology” site.