Surgery for Kidney Stones

Washington University’s team of stone experts offers advanced treatment for kidney stones, with a focus on minimally invasive techniques, even for the largest stones. 

Most procedures for small stones can be performed as same-day surgery, allowing you greater flexibility and a rapid return to work and other daily activities.

There are three main techniques for kidney stone surgery, and the choice of technique depends upon multiple factors, including the size and type of stone, medications you may be taking, your other medical problems and patient preference. Read on for a description of each technique.

Shockwave lithotripsy (SWL)
Shockwave lithotripsy (SWL) is a popular choice for the management of small- to medium-sized kidney stones, and is generally performed as an outpatient procedure with the patient under general anesthesia.

SWL works by focusing intense sound waves on the stone, causing the stone to shatter while minimizing the effect on surrounding tissue. The small pieces of stone then wash out of the kidney with normal urine flow, usually with little or no discomfort. SWL is highly effective at treating most stones in the kidney and ureter.

Advantages of SWL include:

  • Excellent success rate for most small- to medium-sized stones
  • Outpatient procedure
  • Minimal post-operative discomfort
  • No incisions or invasive procedures
  • Easy and fast scheduling

Washington University urologists offer one of the most comprehensive SWL services in the region, with access to the most effective lithotripsy equipment, including the Dornier HM3 lithotripter at our Barnes-Jewish West County location.

Frequently asked questions about shockwave lithotripsy
Q.
Where are your SWL services available?

A. We offer SWL services at our Barnes-Jewish Hospital and Barnes-Jewish West County Hospital locations

Q. Why should I choose SWL?

A. SWL is an outpatient procedure, and one of the preferred treatments for small- to medium-sized stones. It is considered a safe and effective procedure with an excellent track record. As it is an outpatient procedure, you will be home just a few hours after the procedure. Recovery is generally very rapid.

Q. Does SWL have any limitations?

A. As with any technology, there are limitations. Certain types of stones are very hard and resistant to breakage with shockwaves. Other, less common stones are invisible on X-ray, which means that they cannot be targeted for treatment.  Therefore, if you have a history of cystine, monohydrate or uric acid stones, SWL may not be the best treatment for you.

Also, very large stones or stones that have traveled into the lower part of the urinary tract may be better treated by other methods. There are also some patient factors, including other medical conditions, which may affect your suitability for SWL.  For instance, patients who are on blood-thinning medications or who may be pregnant should not undergo SWL procedures.

Q. Is SWL associated with any side effects?

A. SWL is a safe and effective procedure for kidney stones and has an excellent track record. However, as with any surgical procedure, problems can occur. Major complications such as bleeding and severe pain are extremely rare. The most common problem after SWL is discomfort at the skin closest to where the stone was targeted.

Q. How can I make an appointment to discuss SWL with a Washington University urologist?

A. Please call (314) 362-8200 to schedule an appointment at any of our clinic locations.

Ureteroscopy and laser lithotripsy
Along with SWL, ureteroscopy is a preferred method for the treatment of small- to medium-sized kidney stones located in any part of the urinary tract. Washington University was one of the first centers in the world to offer ureteroscopic stone management, and our stable of highly-skilled endourologists continues to offer advanced ureteroscopic stone management.

Ureteroscopy and laser lithotripsy are typically performed as a same-day procedure with the patient under general anesthesia. During the procedure, the urologist passes a small scope through the urinary opening into the bladder, and from there up into the ureter, the small tube that drains urine from the kidney to the bladder. Once the stones are located, they are targeted with a laser that breaks the stone into smaller pieces, which are then extracted, or into tiny pieces of dust that wash out of the kidney with normal urine flow. 

Often, a small tube, called a stent, will be placed temporarily to help the kidney drain after the operation. The stent is completely internal, and is generally removed after 3-10 days. Removal is performed quickly and easily in the office without the need for anesthetic.

Although slightly more invasive than SWL, ureteroscopy may be the preferred option if you have certain types of hard stones that don’t respond to SWL, or a stone that is not visible on X-ray. In addition, ureteroscopy is often preferable to SWL for stones that are low in the urinary tract, in the region approaching the bladder.

Advantages of ureteroscopy include:

  • Excellent results for small- and medium-sized kidney stones
  • Versatility and capability of treating some stones that won’t break with SWL
  • Can be performed without stopping blood-thinning medication
  • Outpatient procedure
  • No incisions
  • Easy and fast scheduling

Frequently-asked questions about ureteroscopy
Q.
Where are your ureteroscopy services available?

A. We offer ureteroscopy at our Barnes-Jewish Hospital and  Barnes-Jewish West County Hospital locations.

Q. Why should I choose ureteroscopy?

A. Ureteroscopy is one of two preferred methods for the treatment of small- to medium-sized kidney stones. Ureteroscopy has a high success rate for stones throughout the urinary tract, including some stones that cannot be treated by SWL. If you have a history of cystine, monohydrate or uric acid stones, ureteroscopy may be the best option for you. In addition, ureteroscopy is preferred if you must remain on blood-thinning medication because of other medical problems. Recovery times are generally very short.

Q. Does ureteroscopy have any limitations?

A. Despite its versatility, there are some limitations of ureteroscopy. Very large stones are better treated by other methods. Also, despite their small size and flexibility, there are rare instances when our scopes are not able to reach your stone. Finally, stents are often placed after ureteroscopy to help maintain drainage while swelling resolves; many patients find these stents to be a source of discomfort until they are removed.

Q. Does ureteroscopy have any side effects?

A. Although ureteroscopy is generally very effective and well-tolerated, as with any procedure, problems can occur. Major complications, including severe bleeding, are exceptionally rare. Most problems are associated with the presence of a stent, and can include mild back pain and bladder irritation with frequent urges to urinate. These symptoms are not life-threatening and can be managed with medications. Blood in the urine is also common while the stent is in place, but is generally very mild and does not cause problems.

Q. How can I make an appointment to discuss ureteroscopy with a Washington University urologist?

A. Call (314) 362-8200 to schedule an appointment at any of our clinic locations.

Percutaneous Nephrolithotomy (PCNL)
For exceptionally large or complex kidney stones, or for a large number of small stones in one kidney, the recommended method of treatment is percutaneous nephrolithotomy. PCNL is an inpatient procedure, which typically requires an overnight hospital stay.

PCNL is performed by a urologist, typically with the assistance of an interventional radiologist. The urologist and radiologist work together to create a channel directly into the drainage system of the kidney through a small incision in the back, typically no larger than a dime. 

The urologist is then able to use a set of specialized equipment to shatter the stones, which are then either vacuumed or plucked out of the kidney. A drainage tube or stent is then left in place temporarily to help the kidney to drain. For exceptionally large or complicated stones, a second “clean-up” procedure may be necessary. Most patients can be discharged within 24 hours of their procedure.

The Washington University Division of Urology is a major referral center for PCNL, with urologists performing hundreds of procedures per year. Our faculty include several surgeons with considerable training and experience with this complex procedure, offering excellent outcomes for even the most difficult stones.

Despite its more invasive nature, this procedure remains a safe and effective form of treatment, with studies finding a high level of patient satisfaction compared to other forms of stone treatment.

Advantages of PCNL include:

  • Gold-standard for treatment for very large or complex stones, and for patients with several smaller stones in one kidney.
  • Capable of clearing most stones completely with one procedure
  • Safe and effective
  • Highly trained Washington University surgeons who specialize in PCNL

Frequently asked questions about percutaneous nephrolithotomy
Q.
  Where are your PCNL services available?

A. We offer office consultation for PCNL at our Barnes-Jewish Hospital and Barnes-Jewish West County Hospital locations. However, all PCNL procedures are performed at our Barnes-Jewish Hospital campus near downtown St. Louis.

Q. Why is PCNL only performed at your Barnes-Jewish location? If I see a Washington University urologist at another location, will he or she still perform my procedure? Will I be able to follow-up at my original clinic location?

A. PCNL is a complex procedure that requires highly trained support personnel and specialized equipment to ensure excellent outcomes. Although we see patients at many clinic locations, our resources for PCNL are concentrated on the Barnes-Jewish Hospital campus. 

Continuity of care is important to us. Therefore, although you may be seen at one of our other clinic locations, be assured that the your urologist will personally perform the procedure at our Barnes-Jewish campus and will oversee your hospital stay. You may then follow-up at your original clinic location.

Q. Why should I choose PCNL?

A. The decision to perform PCNL is generally based upon stone size. For large, complex stones, PCNL is the standard of care.

Q. Why shouldn’t my large stone be treated with SWL or ureteroscopy?

A. For exceptionally large stones (greater than 2 cm in size), SWL and ureteroscopy are generally incapable of clearing the stone in a single procedure. In fact, over half a dozen or more of these less-invasive procedures would be required to clear a large stone, which would expose you to a lot of unnecessary risk for a questionable benefit. The American Urologic Association has clear guidelines governing the treatment of large stones, and has identified PCNL as the standard-of-care for large kidney stones.

Q. Are there any limitations to PCNL?

A. PCNL is capable of providing excellent clearance of almost any stone, though there are limitations. Although most stones can be cleared with a single procedure, the largest and most complex stones may require more than one procedure to completely clear the stone. PCNL often requires a tube or stent for temporary drainage after the procedure, which may be associated with some discomfort. PCNL should not be performed on people taking blood-thinning medication. Because it is more invasive than SWL or ureteroscopy, it requires an overnight stay in the hospital.

Q. Is PCNL associated with any side effects?

A. PCNL is safe and effective in the hands of an experienced stone surgeon and is a procedure associated with high patient satisfaction. However, as PCNL is a more invasive procedure than SWL or ureteroscopy, it has a comparatively higher rate of problems associated with the procedure. Major complications, such as severe bleeding or injury to the kidney and adjacent structures, are relatively uncommon. The most common problems are pain associated with the small incision site, the need for a stent or tube to temporarily provide drainage of the kidney, and blood in the urine.

Q. How can I make an appointment to discuss PCNL with a Washington University urologist?

A. Please call (314) 362-8200 to schedule an appointment at any of our clinic locations.