What is the surgical management for a renal stone?

Surgery is not usually necessary. Most kidney stones can pass through the urinary system with plenty of water—2 to 3 quarts a day.

Surgery may be needed to remove a kidney stone if it

• does not pass after a reasonable period of time and causes constant pain
• is too large to pass on its own or is caught in a difficult place
• blocks the flow of urine
• causes an ongoing urinary tract infection
• damages kidney tissue or causes constant bleeding
• has grown larger, as seen on follow-up x rays

Until 20 years ago, open surgery was necessary to remove a stone. Today, treatment for these stones is greatly improved, and many options do not require major open surgery and can be performed in an outpatient setting.

Extracorporeal Shock Wave Lithotripsy
The stones break down into small particles and are easily passed through the urinary tract in the urine.

Recovery time is relatively short, and most people can resume normal activities in a few days.

Percutaneous Nephrolithotomy
This treatment is often used when the stone is quite large or in a location that does not allow effective use of ESWL.

Ureteroscopic Stone Removal
No incision is made in this procedure. Instead, the surgeon passes a small fiberoptic instrument called a ureteroscope through the urethra and bladder into the ureter. The surgeon then locates the stone and either removes it with a cage-like device or shatters it with a special instrument that produces a form of shock wave.