A large kidney stone cannot be passed through the urinary tract in the way that smaller ones usually can, and eliminating them usually requires invasive procedures like nephroscopic surgery. This may either be treated as an inpatient in the hospital or as an outpatient in a doctor's office. Other procedures to remove a large kidney stone include ureterscopic removal or extracorporeal shock wave lithotripsy.
While small kidney stones often produce no symptoms at all, a large kidney stone may cause severe discomfort. This happens when the stone moves and blocks urine flow. This causes a sharp pain or severe cramp in the back on the side where the stone is located. Blood may appear in the urine as a result of this blockage. If fever or chills occur, this may be a sign of a kidney stone infection, which can be treated with antibiotics.
Percutaneous nephrolithotomy is the kidney stone surgery that is often performed to remove a large kidney stone. Under general anesthesia, an incision is made into the kidney with a nephroscope, and the stone is removed. Patients will usually have to stay in the hospital for a day or two, and complete recovery from this surgery may take a few weeks.
Ureterscopic kidney stone removal involves inserting a small scope into the ureter to break up larger stones. A laser may be used to shatter the stones into small pieces, which makes removal easier. A tube called a stent may be temporarily inserted to help reduce swelling. This is done under both general and local anesthesia, depending on the individual circumstances.
In extracorporeal shock wave lithotripsy (SWL), shock waves are employed to shatter a large kidney stone into smaller pieces that are the size of a grain of sand. This unique procedure is done while the patient is underwater or lying down on a thick cushion and usually takes less than an hour. It is done under sedation or with local or general anesthesia. Shock waves pass through the entire body and break the kidney stones apart. The tiny pieces are easily passed in the urine.
Side effects to treating kidney stones with the SWL method include blood in the urine and bruising of the back and abdomen. In addition, very large stones may require more than one treatment to break them into small enough pieces. It may take several months for all of the pieces to pass through the urinary tract.