Kidney stone treatments - Urethroscopy, PCNL, and ESWL treatments

Kidney stones, also known as renal calculi, are small, hard mineral deposits that form in the kidneys and can lead to considerable symptoms. Fortunately, several advanced treatments are available for their effective removal.

Among the various treatments, urethroscopy, percutaneous nephrolithotomy (PCNL), and extracorporeal shock wave lithotripsy (ESWL) are the most notable. This article provides a detailed explanation of these methods.

Urethroscopy

- When is urethroscopy recommended for kidney stones?

Urethroscopy is typically recommended for kidney stones that are lodged in the ureter or bladder, for stones that fail to pass naturally through the urinary tract, and for stones causing ongoing pain, infection, or obstruction. This procedure is particularly effective for smaller stones, generally measuring between 5mm and 2cm in diameter.

- How is urethroscopy performed?

Urethroscopy is a minimally invasive procedure that utilises a thin, flexible tube (called a ureteroscope) to locate and either remove or break down kidney stones.

During the procedure, your urological surgeon will insert the ureteroscope into the urethra, guiding it through the bladder and up into the ureter. The ureteroscope is equipped with a tiny camera, and this will allow your urological surgeon to visualise the stone directly.

Once located, the stone will either be removed intact or broken into smaller fragments using laser lithotripsy. These smaller pieces will then be passed naturally or manually extracted.

The urethroscopy procedure typically lasts between 30 minutes to an hour, depending on the size and location of the stone. You will receive general or spinal anaesthesia to ensure your comfort.

- What is the recovery time after urethroscopy?

Urethroscopy is typically done as an outpatient procedure, meaning most patients can return home the same day. You may experience cramping, pain, or mild discomfort (including burning sensations when urinating or a small amount of blood in the urine) during recovery as the ureter heals or as small stone fragments pass.

In some cases, your urological surgeon will insert a temporary stent in the ureter to promote healing and facilitate easier urine flow. The stent will typically be removed within one to two weeks after the procedure.

- How effective is urethroscopy in treating kidney stones?

Urethroscopy is highly effective, with success rates of over 90% for smaller stones. You will typically experience relief from symptoms almost immediately after the procedure.

PCNL (percutaneous nephrolithotomy)

- Is PCNL suitable for all types of kidney stones?

PCNL is usually reserved for large kidney stones (greater than 2cm in diameter) and for complex kidney stones, including those that are hard, irregularly shaped, or in difficult locations within the kidney.

- How is PCNL performed?

PCNL is a minimally invasive surgical procedure performed under general anaesthesia. During the procedure, your urological surgeon will create a small incision, approximately 1 cm long, in the back. Your urological surgeon will then insert a thin tube equipped with a camera (called a nephroscope) directly into the kidney.

Using the nephroscope, your urological surgeon will locate the kidney stone and either remove it intact or fragment it into smaller pieces using ultrasound or laser technology. The resulting fragments will then be removed through the same incision.

The duration of PCNL can vary, but it usually lasts between 1 to 3 hours, depending on the size and complexity of the kidney stones. You might feel some pain or discomfort at the incision site, and you will likely have a drainage tube for a short period to assist in draining urine and passing any remaining stone fragments.

- How effective is PCNL?

PCNL is considered the most effective treatment for removing large or complex kidney stones, with success rates ranging from 85% to 95%.

In some cases, not all stones will be removed during the initial PCNL procedure, especially if there are multiple stones or if some fragments are difficult to access. In such cases, a follow-up PCNL procedure will be necessary.

ESWL (extracorporeal shock wave lithotripsy)

- When is ESWL recommended?

ESWL is a non-invasive treatment recommended for kidney stones smaller than 2 cm in diameter that are causing pain, infection, or other complications. Commonly, it is used for stones located in the kidney or the upper section of the ureter.

- How is an ESWL procedure performed?

ESWL uses high-energy sound waves to break kidney stones into small pieces, making them easier to pass naturally out of the body through urine.

During the procedure, you will lie on a specialised table, and a shock wave generator will be placed against your body, targeting the stone with X-ray or ultrasound guidance. This machine will send multiple shock waves through the skin and body tissues to reach the stone, causing it to break into smaller pieces. These fragments will then pass naturally through the urinary system.

The ESWL procedure typically lasts between 30 minutes to an hour, depending on the size and location of the stone. Most patients can go home the same day and resume their normal activities within a day or two.

- What is the success rate of ESWL for kidney stones?

ESWL has a success rate of about 70% to 90%, depending on the stones’ size, location, and composition. Sometimes, larger or harder stones will need more than one session of ESWL to be completely broken down.

Each of these kidney stone treatments offers unique benefits and is chosen based on the size, location, and type of stone. If you are concerned about kidney stones, it’s important to consult a urological surgeon to determine the most suitable treatment for your specific needs.