Kidney stones

Kidney stones in different parts of the urinary tract are treated today with advanced minimally invasive instruments. Laser or ultrasound is often used to break down the stones. The most common methods are:

• Shock wave treatment, also called ESWL
• Minimally invasive surgery, which can be done through the flank and is then called percutaneous stone extraction or through the abdomen with robot assistance
• Laser treatment, also called ureteroscopy

The procedures are usually performed as day surgery, but sometimes an overnight stay may be required. In the most common treatment with laser, called ureteroscopy, the doctor uses a ureter-endoscope. It is a thin tube inserted through the urethra, up into the bladder, and further up into the ureter. The endoscope is flexible and has fiber optic equipment, allowing the doctor to see through the scope as it also contains a light source. Instruments can be inserted through the scope to remove the kidney stone.

Shock wave treatment involves using a machine to send energy waves ("shock waves") through the body from the skin to break up the stone, allowing the patient to later pass the fragments through urine. The treatment is done while the patient is awake and may need to be repeated 1-4 times over a few weeks.

Ureteroscopy is an endoscopic procedure through the urethral opening. Using small instruments with a camera, one navigates into the ureter and kidney, applying laser energy to the stone and breaking it into dust, which is then flushed out. The patient is asleep throughout the entire procedure.

Percutaneous nephrolithotomy (PCNL) is used for larger stones (often over 1.5 cm). Through a small incision from the back into the kidney, the stones can be broken down with powerful ultrasonic waves and then removed. In this procedure as well, the patient is asleep throughout, and they stay overnight in the hospital for recovery.