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Kidney Stones

Urinary stones are typically solid pieces of material that form in the kidney from excreted substances in your urine. These “stones” may stay in the kidney or travel down the ureter and into the bladder. The stone is named by where is it located upon discovery. Some remain in the kidney, others in the ureter, and some in the bladder. The size of these stones can vary; they can be as small as grains of sand or as large as oversized golf balls.

Some patients with stones may not even know that they have them. Typically, these stones are found if the patient has an X-ray or CAT scan. At times, patients may have urinary tract infections, blood in the urine, back or flank pain; further work-up of these symptoms reveals the stones.

Many times, patients become aware that they have a stone after an acute event. These patients present with severe back, flank, groin or testicle pain. Often there will be blood in the urine as well as symptoms of nausea and vomiting. Occasionally, the patient may have a fever or chills.

Depending on the size and location of the stone, some patients may pass the stone without any intervention. Occasionally, a stone that passes down the ureter may be too large and will become stuck. This is called an obstructing stone. These stones typically need surgical intervention. Other stones may be too large to pass at all and stay in the kidney or bladder. These stones may also need surgical intervention at some point. Your provider will help lead you to the right treatment for your stones.

Treatment Options

Extracorporeal Shock Wave Lithotripsy

Extracorporeal Shock Wave Lithotripsy (ESWL) is a noninvasive, outpatient treatment offered for kidney stones. You are taken to an operating room, placed on the specialized surgical table and given an anesthetic to go to sleep.

The stone location is identified and the externally applied lithotripter attempts to break up the stones using a high-frequency acoustic pulse. You then pass the fragments through the ureters into the bladder and eventually out of the body though the urine.

Typically you will follow up in the office a few weeks after the procedure with an imaging study to evaluate the status of the stone.

At times, you may have a ureteral stent placed after this procedure to help drain your kidney of urine. Depending on the size and location of the stone or stones, the stent may or may not have strings left on it. If there are strings, they will be secured with tape to the penis or tucked into the vagina. This stent will be removed in the office a few days after your procedure. It is extremely important to not pull on the strings; this will likely dislodge the stent, possibly leading to severe pain and uncontrolled leakage of urine.

Ureteroscopy With Holmium/EHL Laser

Ureteroscopy With Holmium/EHL Laser is a treatment for kidney and bladder stones. The patient is taken to the operating room, placed on the specialized surgical table and given an anesthetic to go to sleep. This treatment is done through a small hollow tube with a camera lens (cystoscope/ureteroscope) that is advanced through the urethra and up to the stones in the bladder, ureters or kidneys.

The laser fiber is placed near the stone, and the treatment pulverizes the hard stone material and allows the physician to remove them safely in a minimally invasive procedure. Some small stones can be removed in their entirety by a very small basket placed through the cystoscope. This procedure is typically done as an outpatient.

At times, you may have a ureteral stent placed after this procedure to help drain your kidney of urine. Depending on the size and location of the stone or stones, the stent may or may not have strings left on it. If there are strings, they will be secured with tape to the penis or tucked into the vagina. This stent will be removed in the office a few days after your procedure. It is extremely important to not pull on the strings; this will likely dislodge the stent, possibly leading to severe pain and uncontrolled leakage of urine.

Ureteral Stent

Ureteral stent is a flexible, thin hollow tube that is placed in the ureter to allow urine to drain from the kidney to the bladder. It is usually 5 to 12 inches long. Stents are placed when there is a blockage in the ureter and the flow of urine is obstructed. Learn more about Ureteral Stents.

Percutaneous Nephrolithotomy

Percutaneous Nephrolithotomy is a procedure offered for the removal of larger kidney stones. You are given general anesthesia and positioned on the surgical table.

A small incision is made on your back over the kidney with the stones. A small percutaneous needle is placed through the skin and into the kidney. An X-ray machine called a c-arm takes live pictures (fluoroscopy) to visualize where the needle is located in the kidney.

A guide wire is then passed through the needle and secured in the kidney. The needle is removed, the guide wire is left in place, and then a larger tube is passed over the wire.

This tube is a little larger than a pencil’s diameter. This larger diameter tube allows small stones to be removed. Larger stones can be broken up by small ultrasonic probes and then removed through the tube.

Typically this tube is left in, and a gravity bag is secured to it to collect any drainage. You will be transferred to a hospital room and recover overnight before being discharged to home.

How to care for a percutaneous tube:

  1. Empty the collection system daily and record the amount of output.
  2. Keep your catheter site and dressing clean and dry at all times.
  3. You may shower, but make sure to cover the site with plastic wrap and tape the edges securely against the skin to keep it dry. If it gets wet, remove the dressing and dry the area thoroughly before placing a new dry dressing.
  4. Change the dressing daily and as needed to keep the site dry.
  5. Make sure to place a rolled 4x4 between the catheter and the body to prevent kinking of the tube. Cover the catheter and 4x4 with tape. Make sure to tape the catheter to the skin to prevent pulling at the insertion site.
  6. No heavy lifting or straining while the catheter is in place.

Problems to call the office about:

  1. Redness or yellow or green drainage around the catheter
  2. Change in the color, consistency, or odor of drainage
  3. New onset of fever, shakes or chills
  4. Stitch around the catheter becomes loose or the catheter becomes dislodged or broken