Stone Surgery
What is Stone Surgery?
Stone surgery refers to a range of procedures used to remove kidney, ureteric, or bladder stones that are too large to pass naturally, are causing severe symptoms, or have not responded to less invasive treatments such as medication or lithotripsy. Modern stone surgery is typically performed using minimally invasive techniques that allow stones to be removed with little disruption to surrounding tissues.
The most appropriate procedure depends on several factors, including the size, location, number, and composition of the stones, as well as your overall health. Common surgical options include ureteroscopy with laser stone treatment, percutaneous nephrolithotomy (PCNL), and, less commonly, laparoscopic or open surgery for particularly complex cases.
What are the Benefits of Stone Surgery?
Stone surgery can provide effective relief from symptoms while preventing long-term complications associated with untreated urinary stones.
Benefits include:
- Complete or near-complete removal of urinary stones
- Relief from pain caused by stone obstruction
- Restoration of normal urine flow
- Reduced risk of recurrent urinary tract infections
- Protection of kidney function
- Minimally invasive techniques with smaller incisions or no external incisions
- Shorter hospital stays and faster recovery for most patients
- Lower likelihood of repeat procedures for larger stones
When is Stone Surgery Recommended?
Your urologist may recommend stone surgery when conservative treatments are unlikely to be successful or when complications develop.
Stone surgery may be recommended for:
- Large kidney stones that cannot pass naturally
- Stones causing severe or persistent pain
- Stones blocking the flow of urine
- Recurrent urinary tract infections caused by stones
- Stones associated with declining kidney function
- Failure of lithotripsy or medical management
- Multiple stones within the kidney or urinary tract
- Certain bladder stones causing urinary symptoms
Prompt treatment may also be necessary if stones are causing infection together with urinary obstruction, as this can become a medical emergency.
What does Preparation for Stone Surgery Involve?
Before surgery, your urologist will carry out a thorough assessment to plan the safest and most effective procedure.
Preparation may include:
- CT scan, ultrasound, or X-rays to identify the size and location of the stones
- Blood tests and urine tests
- Treatment of any urinary infection before surgery
- Review of current medications, particularly blood-thinning medicines
- Instructions about fasting before general anaesthesia
- Discussion of the planned procedure and expected recovery
Your surgeon will explain the benefits, risks, and alternatives before obtaining your consent.
How is Stone Surgery Performed?
The exact procedure depends on the type of stone surgery being performed.
Ureteroscopy involves passing a thin telescope through the urethra, bladder, and into the ureter or kidney. A laser is used to break the stone into small fragments, which are either removed with tiny baskets or left to pass naturally. A temporary ureteric stent may be placed to allow the kidney to drain while healing occurs.
Percutaneous nephrolithotomy (PCNL) is typically recommended for larger kidney stones. Under general anaesthetic, the surgeon makes a small incision in the back to create a direct pathway into the kidney. Special instruments are used to break up and remove the stone fragments.
In rare cases involving unusually large or anatomically complex stones, laparoscopic or open surgery may be required.
What to Expect during Recovery after Stone Surgery?
Recovery depends on the type of procedure performed.
Most patients undergoing ureteroscopy return home the same day or after one night in hospital. Recovery after PCNL usually involves a slightly longer hospital stay of one to three days.
During recovery, you may experience:
- Mild discomfort or soreness
- Blood in the urine for several days
- Temporary burning when passing urine
- Urinary frequency if a stent has been inserted
- Gradual return to normal activities over one to two weeks, depending on the procedure
Your urologist will arrange follow-up imaging to confirm that all stone fragments have been cleared and discuss strategies to reduce the risk of future stone formation.
What are the Risks and Complications of Stone Surgery?
Stone surgery is generally safe, but every procedure carries potential risks.
Possible complications include:
- Bleeding
- Urinary tract infection
- Injury to the ureter, kidney, or bladder
- Temporary blood in the urine
- Pain related to a ureteric stent
- Incomplete stone removal requiring further treatment
- Recurrence of urinary stones over time
- Rare need for additional surgery if complications occur
Your urologist will discuss the potential risks and benefits of stone surgery and recommend the treatment option best suited to your individual condition.