Shock Wave Lithotripsy
Shock wave lithotripsy is a device that uses either x-ray or ultrasound to help the urologist pinpoint a stone from outside the body. The shock waves are targeted on the stone and break the kidney or ureteral stone into smaller fragments to help in their passage. This is typically performed with intravenous sedation or general anesthesia. Shock wave lithotripsy is generally performed on smaller stones and can be done on an outpatient basis. If the stone is not completely fragmented or cannot be successfully passed following the procedure, stent placement or additional procedures may be needed. Recovery time is short, complication rates are low, and most people can resume normal activities in a few days.
Ureteroscopy is a minimally invasive, endoscopic approach to treat kidney and ureteral stones. It can also be used in the management of malignancies and obstruction of the upper urinary tract.
Endoscopic surgery allows the urologist to inspect all aspects of the internal urinary tract, “dust” and fragment stones with devices such as the Holmium laser, and remove stones with specialized baskets and graspers. This technology also allows minimally invasive treatment of cancers of the renal pelvis and ureter, ureteropelvic junction (UPJ) obstruction, and ureteral strictures. It greatly reduces the length of hospitalization since the majority of procedures are performed on an outpatient basis, and also reduces recuperation and the cost of treatment.
Percutaneous Nephrostolithotomy (PNL)
PNL is a procedure used to treat large renal or ureteral stones, occasionally in the setting of a concomitant UPJ obstruction, or in difficult to reach locations (complex anatomy). It can also be used for the treatment of cancers of the upper urinary tract.
In this procedure, a small incision is made in the back and a tunnel is created directly into the kidney. This allows fragmentation and removal of large or unusual stones using special lithotriptors and stone removal devices. A special tube, a nephrostomy tube, may be left in the kidney following the procedure during the healing process. Larger stones may require a staged procedure to treat the entire stone burden. Most patients are able to go home the day after the procedure and recovery is typically 2 to 4 weeks following completion of the surgery.
Robotics/laparoscopy is typically reserved for the removal of kidneys (tumors or poorly functioning kidneys) and for management of ureteral strictures, complex calyceal diverticulum stones, renal cysts, and UPJ obstruction with or without kidney stones. It is also used in special circumstances for large stones in abnormally positioned (ectopic) kidneys.
Open Stone Surgery
Open stone surgery is rarely required, and is reserved for the treatment of large stone burdens in kidneys with unusual anatomy preventing a more minimally invasive approach.