Open removal of stone from the pelvis of the kidney

What is this?

This involves the removal of a stone in the collecting system of the kidney with an incision in the side or abdomen & possible placement of a plastic tube in the ureter

What alternatives are there?

Telescopic removal, laparoscopic removal, shock wave treatment, observation to allow spontaneous passage

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 the stone is removed. 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 stent into the ureter at the time of surgery or to use a kidney drainage tube inserted into the back (a nephrostomy tube)..

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/stent 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 12 days.

Potential side effects