Open removal of stone(s) from the kidney

What is this?

This involves the removal of stone(s) from the collecting system of the kidney with incision(s) into the kidney

What alternatives are there?

Telescopic removal, laparoscopic removal, external shock wave treatment, observation.

What to expect before procedure

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. 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. An X-ray to confirm the position of your stone(s) will normally be performed shortly before your operation. You will be given an injection under the skin of a drug (Clexane), that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the veins.

What happens during the procedure?

Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post-operatively. You will usually be given injectable antibiotics before the procedure, after checking for any allergies. The incision is usually made in your loin, just at the lower edge of your ribs. The kidney is identified and an incision made into the pelvis of the kidney through which some of the stones are removed. Stones within the kidney may need additional incisions into the kidney and this usually requires the artery to the kidney to be clamped for up to 30 minutes to prevent bleeding. Contact X-rays are often taken at the time of surgery to confirm complete removal of the stone. A wound drain is usually inserted at the end of the procedure, together with a bladder catheter to monitor urine output; it may also be necessary to insert a drainage tube into the kidney itself (a nephrostomy) at the time of surgery.

After the procedure

Absorbable stitches are usually used and do not require removal; If the stitches used are not absorbable, we will arrange for them to be removed either on the ward or by your District Nurse after 7-10 days. You may have a further X-ray after the procedure to confirm that the stones have been completely removed and to check the position of the nephrostomy tube If this has been inserted. If stones remain in the kidney, we may use an irrigating fluid through the nephrostomy tube in an attempt to dissolve them. If a nephrostomy tube has been inserted, this will normally be removed after 7-10 days. An X-ray using contrast medium is often performed through the nephrostomy tube before it is removed. The average hospital stay is 10 days.

Potential side effects