Urologist Treatments for Kidney Stones

Most stones less than 10 mm in size have an excellent chance of passing spontaneously. Your urologist may prescribe medication to help you pass a stone, such as the alpha blocker drug tamsulosin (Flomax).

Larger stones are treated with a procedure called percutaneous nephrolithotomy (PCNL). Under general anesthesia a urologist makes an incision big enough to pass a telescope into your kidney and locate the stone. The urologist uses surgical instruments to break up the stone and suction it out of your kidney.

Ureteroscopy
Ureteroscopy is a minimally-invasive procedure that can remove most kidney stones. During ureteroscopy, a doctor inserts a telescope-like instrument called a ureteroscope through your urinary tract opening and up into your bladder and a tube that connects the kidney to the bladder (ureter). The urologist can then see the stone inside your bladder, locate it, and use the ureteroscope’s slender shaft to break it apart or remove it.

The urologist will give you a general anaesthetic before performing the surgery. You should not eat or drink anything for 4 to 6 hours before the operation to ensure that the anaesthetic is working properly.

During ureteroscopy, your urologist will often place a small plastic tube into the ureter at the end of the surgery to help control inflammation and keep the ureter open until the area heals. The stent is usually removed at a follow-up appointment in your urologist’s office.

When considering ureteroscopy, it’s crucial to consult with an experienced urologist like Dr Marlon Perera. Because ureteroscopy is minimally-invasive, it can be performed even when you are taking blood thinners such as warfarin or aspirin. However, it’s best to discontinue these medications for 10 days before the procedure, if possible. Be sure to our urologist about any medications you are taking that may affect your platelet function or ability to clot, and report any signs of pain, bleeding or infection immediately. Ureteroscopy is the only non-invasive stone removal surgery that can be done while you are on anticoagulants

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Shock Wave Lithotripsy (SWL)
Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive treatment that uses ultrasound and a series of high-energy shock waves to break up kidney stones. The goal is to pulverize your stone and make it small enough that it will pass through your urinary tract without causing an obstruction. The procedure typically takes about an hour and can be done on an outpatient basis. A urologist will use a special machine to send shock waves through your skin and into your kidney or ureter to target the stone. X-rays or ultrasound imaging will help your provider locate the stone and position you to aim the shock waves accurately. You may be under light sedation or local or regional anesthesia for comfort and safety.

You will be asked to drink a lot of water after the procedure. You may also be given a medication to take at home to relax your ureters and help your stone fragments pass with urine. You will be able to resume most activities after one to three days. Some patients experience blood in their urine or have minor discomfort after ESWL, but this usually does not last more than a few days.

Some stones, based on composition and size, do not break up sufficiently with ESWL, so your urologist might recommend another treatment such as ureteroscopy or a ureteral stent to assist in the passage of your stone fragments.

Percutaneous Nephrolithotomy (PNL)
If you have large kidney stones, a urologist will use kidney stone treatments Melbourne to remove them. This surgery uses a thin tube called a nephroscope, which is inserted through a small incision in your abdomen. This procedure is done under general anesthesia.

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After the nephroscope is inserted, your doctor will break up any large stone fragments with a laser or ultrasonic energy. Your urologist will also use the nephroscope to clean out any stone fragments left behind.

The urologist may then insert a JJ stent and/or nephrostomy tube to hold the kidney until the urine passes through the ureter. If your urologist suspects that you might form more kidney stones, he or she will do a metabolic evaluation, which is a series of blood and urine tests. This will help identify what causes you to form kidney stones, and your urologist will recommend preventive measures and medications to reduce your risk of developing more stones.

In some cases, your urologist might be able to perform PNL through a small incision in the back of your belly (supracostal approach). This method may be a safer option for older patients who might have a higher risk of complications with the prone surgery. This technique can also be used for lower pole stones and staghorn or partial staghorn calculi. In a recent study, patients treated with PNL had a better stone-free rate than those with ESWL or ureteroscopy.

Laser Lithotripsy
If a stone is lodged in the ureter (the tube that connects each kidney to the bladder), laser lithotripsy can be used to break up the large stone into small pieces that may then pass through the urinary tract. This procedure is done under general anesthesia, and a urologist will use a scope called a ureteroscope to locate the stone. A laser fiber is then passed through the ureteroscope, and the energy of the laser breaks up the larger stone into smaller pieces.

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During this treatment, you will have a feeling of burning when you urinate for several hours, but drinking plenty of water should help to minimize the discomfort. Your doctor may also place a stent in your ureter after this procedure, and the stent will remain in your body for a few weeks.

If the stent is not removed, it could block your urine flow and lead to pain or swelling in the affected area. To avoid this, your doctor will remove the stent after the broken kidney stone has been removed from the ureter. After the procedure, you will need to follow up with your urologist to make sure that there are no further issues. You will also need to continue to drink plenty of fluids, so the stones can pass easily through your ureter.