Procedure of Kidney Stone Removal

Kidney stone removal are hard deposits of minerals and salts that form inside the kidneys and can cause severe pain and urinary complications. While some small stones may pass naturally, larger or persistent stones often require medical intervention. Understanding the procedure of kidney stone removal can help patients prepare mentally and physically for a smooth and effective treatment journey.

Kidney stones, medically known as renal calculi, are one of the most common and painful urological conditions affecting millions of people globally each year. These hard, crystalline mineral deposits form inside the kidneys when urine becomes concentrated, allowing minerals to stick together and crystallize. While small kidney stones may pass through the urinary tract unnoticed, larger ones can cause excruciating pain, obstruction of urine flow, infections, and long term damage if left untreated.

Understanding Kidney Stones

Before diving into the removal procedures, it’s important to understand what kidney stones are. Kidney stones form when minerals like calcium, oxalate, and uric acid become concentrated in urine and crystallize. These stones can vary in size, from as small as a grain of sand to as large as a golf ball. When stones block the urinary tract, they can cause severe pain, nausea, and even infection.

Treatment for kidney stones depends on the size, type, location, and symptoms experienced by the patient. When lifestyle changes and medications aren’t enough, removal procedures are recommended.

When Is Kidney Stone Removal Necessary?

Not all kidney stones require surgical removal. Stones that are small (usually less than 5 mm) may pass on their own with increased fluid intake and pain management. However, removal becomes necessary in the following cases

1. The stone is too large to pass naturally.

2. It causes unbearable pain, blood in urine, or frequent infections.

3. It blocks the flow of urine.

4. It remains in the kidney or urinary tract for too long.

5. It is made of certain substances like cystine or uric acid that tend to recur.

If any of these conditions are met, a urologist will recommend the most appropriate kidney stone removal procedure.

Common Procedures of Kidney Stone Removal

There are several medical procedures available to remove kidney stones. The method chosen depends on the size, type, location of the stone, and the patient’s overall health condition. Here are the most commonly performed procedures

1. Extracorporeal Shock Wave Lithotripsy (ESWL) :- ESWL is a non-invasive procedure that uses shock waves to break kidney stones into smaller pieces. These smaller fragments can then pass naturally through the urinary tract.

   The patient lies on a specialized table, and a machine targets shock waves to the stone using imaging techniques like X-ray or ultrasound. This procedure usually takes 30–60 minutes and may require mild anesthesia or sedation.

   ESWL is generally recommended for stones less than 2 cm in size located in the kidney or upper ureter. Recovery is quick, and most patients return to normal activities within a few days.

2. Ureteroscopy (URS) :- Ureteroscopy involves inserting a thin, flexible scope called a ureteroscope through the urethra and bladder into the ureter to locate and remove or break the stone. For smaller stones, special tools can grasp and extract them. For larger stones, a laser is often used to break them into smaller pieces before removal.

   URS is especially useful for stones lodged in the lower urinary tract or those that cannot be targeted with ESWL. It is performed under general anesthesia and usually requires no incisions.

   After the procedure, a temporary stent may be placed in the ureter to ensure smooth urine flow while healing. Recovery time is typically short, with patients resuming normal activities within 2–3 days.

3. Percutaneous Nephrolithotomy (PCNL) :- PCNL is a minimally invasive surgical procedure used to remove large kidney stones (usually more than 2 cm) or those that cannot be removed using ESWL or URS. It involves making a small incision in the back to insert a nephroscope directly into the kidney.

   The surgeon may use ultrasonic or laser energy to break the stone and remove it through the small incision. This procedure is done under general anesthesia and typically requires a short hospital stay.

   PCNL has a high success rate for removing large or complex stones and is often the preferred method in such cases. Recovery may take about a week, and patients are advised to avoid strenuous activities for several weeks.

4. Open or Laparoscopic Surgery (Rare Cases) :- Although rarely performed today due to advanced minimally invasive techniques, open surgery may still be required in complex cases with very large stones, anatomical abnormalities, or recurrent infections.

   During the surgery, the surgeon makes an incision in the side or abdomen to access the kidney and remove the stone. Laparoscopic approaches use smaller incisions and a camera to guide the procedure.

   Recovery time for open surgery is longer and requires more postoperative care. It is reserved for special situations where other procedures are not suitable.

How Doctors Decide the Best Procedure?

The choice of kidney stone removal technique is based on several factors. These include

1. Size and type of the stone :- Larger stones or hard types like cystine may require PCNL or URS.

2. Stone location :- Stones in the kidney may be treated with ESWL or PCNL, while ureteral stones are often removed via URS.

3. Patient’s medical history :- Certain conditions like bleeding disorders or infections may affect the choice of procedure.

4. Previous treatments :- If a stone does not respond to one method, another approach may be tried.

The urologist will also consider the patient’s comfort, recovery time, and the likelihood of complications before recommending a procedure.

What to Expect Before the Procedure?

Before any kidney stone removal, patients will undergo diagnostic tests such as

1. Blood and urine analysis

2. Ultrasound or CT scan to locate the stone

3. Kidney function tests

The doctor will explain the procedure, anesthesia, risks, and recovery plan. Patients may need to stop certain medications, fast for several hours before the procedure, and arrange for transportation and rest post-surgery.

Recovery After Kidney Stone Removal

Recovery varies depending on the type of procedure performed. Most minimally invasive techniques like ESWL and URS allow patients to return home the same day or after a short observation period. PCNL may require a 1–2 day hospital stay.

Common post procedure symptoms include

1. Mild pain or discomfort

2. Blood in urine (usually temporary)

3. Frequent urge to urinate

4. Fatigue for a few days

Doctors often prescribe pain medications, antibiotics, and instructions to stay well-hydrated. Follow-up imaging may be scheduled to ensure that all stones have been cleared.

Patients should avoid heavy lifting or strenuous activity until cleared by the doctor and report any signs of fever, severe pain, or difficulty urinating immediately.

Preventing Future Kidney Stones

Preventing kidney stones involves a combination of lifestyle and dietary changes

1. Drink plenty of water throughout the day.

2. Reduce salt, oxalate-rich foods (like spinach and nuts), and animal protein.

3. Maintain a healthy weight and exercise regularly.

4. Follow your doctor’s advice on medications or supplements if you have a history of recurrent stones.

Conclusion

Kidney stone removal procedures have advanced significantly in recent years, offering patients safer and more effective treatment options. Whether it’s through non-invasive shock wave therapy, endoscopic laser fragmentation, or minimally invasive surgery, the right procedure depends on the individual’s condition and the stone’s characteristics.