Kidney stones are an extremely painful urologic disorder. Kidney stones are also very common, resulting in approximately 3 millions doctor visits each year, according to the National Institute of Diabetes and Digestive and Kidney Disease. Kidney stones often pass out out of the urinary tract naturally, without medical intervention. Sometimes, however, kidney stones can remain in the body for a long time and cause lasting complications. In these cases, medical intervention to remove the stones may be necessary. Although generally safe, each procedure to remove the stones can cause various types of complications.
Extracorporeal Shock Wave Lithotripsy
Extracorporeal shock wave lithotripsy (ESWL) is a common treatment for kidney stones that uses sound waves to break up the stones into smaller pieces, which are then passed naturally out of the body. The tiny pieces of stone often cause minor lacerations of the urinary tract, leading to blood in the urine lasting for a few days following the procedure. In rare cases, severe pain may result as the fragments rub against the inner membranes of the urinary tract. Signs of bruising may occur and pain may be felt in the area of the abdomen or back through which the sound waves passed.
Percutaneous Nephrolithotomy
Percutaneous nephrolithotomy is often used when ESWL is not possible. In this procedure, doctors make an actual incision in the back to reach the kidney, and remove the stones through a device called a nephroscope. Immediately after the procedure patients may experience pain around the incision and a mild fever, both of which usually disappear within a few days. Complications are generally rare but may include scarring of the tissue surrounding the incision site. Studies have shown, however, that this scarring reduces kidney function minimally. Additionally, the incision into the kidneys may lead to significant blood loss during the surgery. Complications of fluid overload may also result from the large volumes of fluids used. Infection and damage to other areas in the abdomen can occasionally occur.
Ureteroscopic Stone Removal
Often kidney stones in the ureter, the tube connecting the kidneys to bladder, cannot be reached by percutaneous nephrolithotomy. In this case, doctors may use a small instrument known as a ureteroscope to remove the stones through the urethra and the bladder. There is a slight risk of perforation of the ureter from this procedure, and the risk increases with the length of the procedure. If the kidney stone is too large and is not broken up into smaller pieces, it may cause a blockage in the urinary tract during removal.
Open Surgery
Open surgery, also called nephrolithotomy, is usually the treatment option of last resort for very large or complex stones. In this invasive procedure, surgeons cut through the side of a patient into the kidneys to remove the stone. Recovery may take four to six weeks after this surgery, which may cause infection and severe scarring. Because a large incision is made in the kidney, this procedure carries significant risk of permanent reductions in kidney function.
