What are the available surgical treatment options for kidney stones?

There are many different ways to treat stones in the kidney and ureter. The choice of treatment will depend on factors such as size and location of the stone and the overall health of the patient.

In extracorporeal shock wave lithotripsy (ESWL), shock waves are directed through the skin and focused onto the stone, causing it to fragment into smaller pieces. These fragments then pass out of the body in the urine. ESWL is most suitable for softer stones, less than 2cm in size, in the upper part of the kidney. It is not safe in pregnant women, obese patients, patients with aortic aneurysms and those who take blood-thinning medication.

Ureteropyeloscopy involves passing a long, narrow telescope through the urethra and bladder and into the ureter, up to the stone. A laser fibre is then used to fragment the stone into smaller pieces. In most cases these fragments can then be extracted. It is particularly useful for smaller stones, in any part of the kidney, and allows treatment of stones in the ureter and kidney at the same time.

In percutaneous nephrolithotomy (PCNL), a channel is developed through the skin and muscle of the back, into the kidney. Instruments are then passed through this channel to break up and remove the stone. PCNL can be used for any stone in the kidney, regardless of size, location or composition. However, this is a more invasive operation.