Percutaneous removal of kidney stone(s)

What is this?

Disintegration & extraction of kidney stones with a telescope placed into the kidney through a small puncture in the back. This usually includes cystoscopy and x-ray screening

What alternatives are there?

External shock wave treatment, open surgical removal of stones, observation

What to expect before procedure

If you are taking Aspirin or Clopidogrel on a regular basis, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. There may be a balance of risk where stopping them will reduce the chances of bleeding but this can result in increased clotting, which may also carry a risk to your health. This will, therefore, need careful discussion with regard to risks and benefits. You will usually be admitted on the same day as your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. An X-ray may be taken in advance of surgery to confirm the position of your stone(s). You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy. If you are admitted on the day before surgery, you will normally be given antibiotics into a vein to prevent any infection at the time surgery.

What happens during the procedure?

Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. You will usually be given injectable antibiotics before the procedure, after checking for any allergies. The operation is usually carried out in a single stage. First, a small tube is inserted up the ureter into the kidney by means of a telescope passed into the bladder. You are then turned on to your face and a puncture track into the kidney is established, using X-ray guidance. Finally, a telescope is passed into the kidney and the stone(s) extracted or disintegrated. A catheter is usually left in the bladder at the end of the procedure together with a drainage tube in the kidney. It may be necessary to puncture the kidney at more than one site if you have many stones scattered throughout the kidney.

After the procedure

On the day after surgery, a further X-ray is normally performed to assess stone clearance. Occasionally, it may be necessary to perform an X-ray down the kidney drainage tube using contrast medium. If the X-ray is satisfactory, the tube in your kidney and the bladder catheter will be removed. There is often some leakage from the kidney tube site for 24-48 hours and you will be only discharged once this leakage has resolved. The average hospital stay is 4-5 days.

Potential side effects