First, a quick refresher: What is a kidney stone? And why are they so problematic?
Do all stones cause pain? Must they be removed if they're not causing pain?
DR. SILVA: It is a common belief that the kidney stone is causing the pain when that is not exactly true. The pain of kidney stones is when the stone causes a blockage of the urine. When this happens, the kidney gets backed up and stretches, causing the famous kidney stone pain. If a stone is not causing pain and it is a size that is passable (smaller than 4-5mm), then yes—a stone can be observed, but this does require a discussion between patient and MD to review all the pros/cons.
At what point would a patient and their urologist consider surgical options for kidney stones?
What are the surgical options for kidney stones?
DR. SILVA: There are four surgical options for kidney stones, each with its advantages/disadvantages. The least invasive is shockwave lithotripsy, which uses targeted sound waves from the outside to break up the stone. The next more invasive is ureteroscopy with laser lithotripsy—here we use a small camera and a laser to break up and extract all the stone from the natural tubes. More invasive is called percutaneous nephrolithotomy (PCNL). With PCNL, we make a temporary tract from the back down to the kidney and use a telescope with larger tools to break up and extract the stone. The most invasive method is robotic/open surgery, which is only reserved in rare situations.
OK, let's discuss the various surgical options for kidney stones—how each procedure works and what patients can expect.
Shock wave lithotripsy (SWL)
- During this procedure, the patient undergoes general anesthesia, and a small incision is made into the back (from the size of a pea to maximum the size of a nickel). A temporary tube is put into the kidney, and a telescope with tools are used to break up and remove the stones. A ureteral stent is then usually placed at the end of the surgery. In my practice, I DO NOT leave tubes in the back unless there are extenuating circumstances.
- Pros: Highest success rate for clearing larger, harder, or more-difficult-to-get-to stones.
- Cons: Most invasive of the three commonly done stone surgeries. Low/moderate risk of injury to GU/adjacent organs. Sometimes requires an overnight stay at the hospital.
Open or robotic surgery
Are there any newer surgical options for kidney stones in the works that you're particularly excited about?
Any final thoughts that you want to convey about surgical options for kidney stones—or kidney stones in general?
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