When a patient cannot pass kidney stones on his or her own, it's time for kidney stone surgery. There are a number of surgical options to deal with kidney stones, and each works slightly differently. In all cases, the patient should expect to spend at least a few hours in the hospital and possibly a few days.
For any type of kidney stone surgery, the doctor will confirm the presence of kidney stones before operating. The patient's general health will also be assessed to confirm that he or she is a good candidate for surgery. Patients will be interviewed about any history of reactions to drugs or anesthetics, and the patient will usually meet with an anesthesiologist to talk about what to expect from the anesthetic used, which may range from a mild sedative to full anesthesia in which the patient is totally asleep.
Patients usually cannot eat or drink for several hours prior to their surgery, due to concerns about reactions to the anesthetic. During the surgery, a doctor will either break up the kidney stones, or take them out, depending on the procedure. Once the surgery is complete, the patient will be given drugs to offset the anesthesia or sedative used. After the surgery, the patient will be given prophylactic antibiotics to prevent infection, along with care instructions for the surgical site.
In the least invasive form of kidney stone surgery, extracorporeal shock wave lithotripsy (ESWL), the doctor will attempt the break the kidney stones up from outside the body with a sound wave or electrical impulse, so that the patient can pass the stones independently. This procedure includes the use of a tracer dye and medical imaging device so that the doctor can pinpoint the location of the stones.
Ureteroscopy is another surgical option, usually performed under general anesthesia. In this procedure, the doctor threads a device into the ureter and pulls the kidney stones out or attempts to break them up with a laser in laser lithotripsy, using the camera on the device to see what is going on inside the kidneys. This kidney stone surgery may include the temporary placement of a drainage tube in the kidneys to promote rapid drainage of fluids after the surgery.
Percutaneous nephrolithotomy is a more invasive option. In this procedure, the doctor makes a small incision in the back to access the kidney directly, inserting medical tools into a catheter placed in the incision for the purpose of viewing the kidney and pulling out the kidney stones. This procedure is also performed under general anesthesia, and it has a recovery time of a few days.
It is also possible for a surgeon to decide on open surgery to treat kidney stones. This is an extremely rare choice, as most other surgical techniques will accomplish the desired goal of removing kidney stones. Open surgery has a much longer recovery time, because it requires the creation of a long incision to access the kidney, and the patient will have to live with drainage tubes for a few days or weeks after the surgery.