Treating large kidney stones

Treating large kidney stones

If a kidney stone is too big to be passed naturally – 6-7mm (about 0.23 to 0.27in) in diameter or larger – you may need treatment to remove it another way.

This could include:

Extracorporeal shock wave lithotripsy (ESWL)

ESWL is the most common way of treating kidney stones that can’t be passed in the urine.

It involves using ultrasound (high-frequency sound waves) to pinpoint where a kidney stone is. Ultrasound shock waves are then sent to the stone from a machine to break it into smaller pieces, so it can be passed in your urine.

ESWL can be an uncomfortable form of treatment, so it’s usually carried out after giving painkilling medication.

You may need more than one session of ESWL to successfully treat your kidney stones. ESWL is up to 99% effective for stones up to 20mm (0.8in) in diameter.

Extracorporeal shock wave lithotripsy (ESWL)

Extracorporeal shock wave lithotripsy (ESWL)

Ureteroscopy

If a kidney stone is stuck in the ureter, you may need to have a ureteroscopy, which is also sometimes known as retrograde intrarenal surgery (RIRS).

It involves passing a long, thin telescope called a ureteroscope through your urethra (the tube urine passes through on its way out of the body) and into your bladder. It’s then passed up into your ureter to where the stone is stuck.

The surgeon may either try to gently remove the stone using another instrument, or they may use laser energy to break it up into small pieces so that it can be passed naturally in your urine.

Ureteroscopy is carried out under general anaesthetic (where you’re unconscious), so you shouldn’t drive or operate machinery for up to 48 hours after the procedure.

For stones up to 15mm (0.6in), a ureteroscopy is effective in 50-80% of cases.

A plastic tube called a stent may need to be temporarily inserted inside you to allow the stone fragments to drain into the bladder.

Percutaneous nephrolithotomy (PCNL)

PCNL is an alternative procedure that may be used for larger stones. It may also be used if ESWL isn’t suitable – for example, because the person being treated is obese.

PCNL involves using a thin telescopic instrument called a nephroscope. A small incision is made in your back and the nephroscope is passed through it and into your kidney. The stone is either pulled out or broken into smaller pieces using a laser or pneumatic energy.

PCNL is always carried out under general anaesthetic, so you shouldn’t drive or operate machinery for up to 48 hours after the procedure.

PCNL is 86% effective for stones that are 21-30mm (0.8-1.2in) in diameter.

Percutaneous nephrolithotomy (PCNL)

Percutaneous nephrolithotomy (PCNL)

Open surgery

Nowadays, open surgery for kidney stones is rare (less than 1% of cases require this type of surgery). It’s only usually used if there’s a very large stone or abnormal anatomy.

During open surgery, an incision will be made in your back so that your surgeon is able to access your ureter and kidney. The kidney stone can then be removed.

Open surgery

Open surgery

Treating uric acid stones

If you have a uric acid stone, you may be advised to drink around three liters (just over five pints) of water each day to try to dissolve it.

Uric acid stones are much softer than other types of kidney stone, and they can be made smaller if they’re exposed to alkaline fluids.

drink around three liters

Treating uric acid stones

You may need to take some medication to make your urine more alkaline before the uric acid stone starts to dissolve.

take some medication
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