Surgical Procedures

There are four potential treatments that can be used on your kidney stones: Shock wave lithotripsy (ESWL), ureteroscopy, Percutaneous nephrolithotomy (PCNL) and open surgery.

Electro Shock Wave Lithotripsy

ESWL is a common treatment for small or medium stones, in which you lie on a table and after the receipt of some medication to keep you comfortable, X-ray and ultrasounds are used to locate the stone, after which the high-energy shock waves are directed at your stone from the outside. It’s noninvasive, and the energy goes through the skin and fragments the stones into small pieces which are easier for your body to expel naturally. On occasion, you may have to have a stent placed in your ureter, which helps the pieces of stone pass. ESWL is usually a day procedure, and may involve having the procedure repeated if the stone doesn’t pass on the first try. Side effects may include kidney bleeding, pain, infection, and blockage of the kidney. There is one ESWL machine for the entire GTA, and Dr Feifer will assess your suitability for ESWL and make the appropriate referral.

Ureteroscopy

This procedure treats stones endoscopically at all levels of the urinary tract. A small fiber ogeneral optic flexible camera and laser fiber are inserted into the urinary tract and the stone is removed. No surgical incisions are needed and you will either go to sleep or have regional anesthesia in this procedure. Small instruments are used to remove small stones after a laser fragments them. This is often a day procedure, and may require a ureteral stent which will be removed very simply by Dr. Feifer usually within a short window after the surgery. Possible problems after a ureteroscopy include infection, scarring of the ureter, and bleeding.

Percutaneous Nephrolithotomy

If the stone is too large for ureteroscopy or ESWL, an option for stone removal is Percutaneous Nephrolithotomy [PCNL]. In this procedure, PCNL uses a tube to reach the stone in the kidney to break it up with high-frequency sound waves. Anesthesia will be administered prior to the procedure, and a small incision in the lower back underneath the rib cage is made to accommodate a thin scope. The length of time to remove the stone varies and depends on the size of the stone and the complexity of the kidney anatomy. The procedure will require an admission to the hospital for 1-2 days to monitor you after surgery. Usually, a stent or a nephrostomy tube will have to stay in your kidney for a few days to help urine drain as it heals. Stone fragments will be sent for stone analysis in order to prevent stones from recurring in the future. The risks from this surgery include infection, bleeding, damage to the bladder, bowel, ureter, kidney, or liver, and rarely there may be a secondary procedure needed to stop bleeding.