Urinary Stone Treatments

Medical management and prevention for kidney stone disease

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Given the high rate of recurrence in patients with a kidney stones, comprehensive metabolic evaluation with specialized urine and blood testing is performed to identify potential risk factors for new stone formation. Risk factors can be addressed through dietary lifestyle changes or medications. Our multidisciplinary team of urologists, nephrologists, and dieticians work together to create and support a urinary stone prevention plan tailored to each individual patient. 

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Percutaneous nephrolithotomy (PCNL)

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PCNL is used to treat large stones of the ureter or kidney, or stones that are difficult reach by less invasive approaches due to complex anatomy. A small (1 cm) skin incision is made on the back and X-ray or ultrasound is used to insert a needle into the center of the affected kidney. Using the needle tract, a small tunnel can be made for the surgeon to insert a special camera ("nephroscope") into the kidney. Special devices (“lithotripters”) are inserted through this camera to break and suction out the stones. Patients typically spend one night in the hospital after surgery and go home the next day.

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Ureteroscopy with laser lithotripsy

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An endoscopic (no incision) procedure used to treat kidney and ureteral stones. Under general anesthesia, a very small camera is inserted into the ureter and kidney through natural orifices. Intraoperative endoscopic tools, such as medical lasers and stone baskets, are then used to break the stone into smaller fragments for extraction, or sometimes completely into dust. This is almost always performed as a same-day, outpatient procedure. Ureteroscopy can also be useful for biopsy and treatment of urothelial cancers of the kidney and ureter, as well as treatment of ureteral strictures.

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Shockwave lithotripsy (SWL)

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This is a same-day surgery performed under intravenous sedation or general anesthesia to treat kidney or ureteral stones. The SWL device focuses sound waves at a target stone to break it and treat it from completely outside the body. There are no incisions or insertion of any endoscopic equipment. Complete stone clearance relies on the normal flow of urine from the kidney to pass the small resultant fragments and dust. Of note, its use is limited to select stones based on stone composition, size, and location, as well as patient anatomy.

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Cystolitholapaxy

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This is a same-day procedure performed under anesthesia to break and remove stones in the bladder. The procedure can be performed completely endoscopically with a camera inserted through the urethra (“transurethral cystolitholapaxy”), or with a very small skin incision (1 cm) on the lower abdomen with insertion of a camera directly into the bladder (“percutaneous cystolitholapaxy”).

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- The transurethral approach is well suited when patients need simultaneous treatment of an enlarged prostate (BPH). 

- The percutaneous approach is generally reserved for patients with larger stone burdens and in those with complex urinary tract anatomy. Examples include: previous surgery or radiation for prostate cancer, reconstructed bladders, artificial urinary sphincters, and urinary conduits/pouches.

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