Surgery

There are a number of options available to break up (and remove) kidney stones. There are advantages and disadvantages to these and the specifics of these will be discussed with you by your surgeon.

a) Lithotripsy (ESWL) - ESWL is short for 'extracorporeal shockwave lithotripsy'. Lithotripsy comes from the Greek words “Lithos” and “Tripsis” and literally means “stone breaking”. The procedure works like ultrasound and uses shock waves to break your kidney stones into small sand-like particles that can then pass out of your body through your urine. It is performed as a day case procedure and avoids the need for a general anaesthetic. During the procedure, you lie on the machine and x-rays are used to find and target your stone. Shocks are then delivered to the stone at the rate of approximately two per second. The treatment lasts about 40 minutes and delivers around 3,000 shock waves, which pass through your body to break the stone into fragments. A lithotripter is shown in the figure to the right.


b) Ureteroscopy - This is a procedure that involves a fine telescope being passed through the bladder (via your urethra (water passage)) and up the ureter to the kidney. It is performed under general anaesthetic. Once the stone is found a laser is used to fragment and vapourise the stone into tiny pieces and dust. Usually the holmium laser is used which is able to break all types of stone.This procedure is generally suitable for stones up to 1.5cm in size and usually takes 60 minutes to complete. Commonly a plastic tube (known as a JJ stent) is inserted afterwards - this runs from the kidney to the bladder and allows the urine to drain and protects the ureter.

A flexible ureteroscope is shown to the right with a laser fibre below.



Below is a short (99 seconds) clip of a cystine stone in the lower pole (bottom) of the kidney being broken using the holmium laser. (Broadband connection advised for viewing).



Laser fragmentation of cystine stone



c) Percutaneous nephrolithotomy (PCNL) - This procedure is performed under general anaesthetic and is generally used for stones that are too big for ESWL or ureteroscopy. A telescope is inserted through the back into the kidney allowing your stone to be broken up and removed. It generally takes 2 to 3 hours to do and requires a few days in hospital.

d) Open surgery - this is rarely required now but patients may have had open stone removal in the past especially the removal of a kidney prior to their diagnosis. It involves a much longer stay in hospital (5-7 days).

Disclaimer and Copyright
vBulletin stats