Kidney Stones Surgery – PreOp® Patient Education & Patient Engagement


The normal body has two kidneys, in the middle
of the back, under the lowest ribs. Kidneys filter and clean blood to make urine. Ureters drain urine from the kidneys to the
bladder. The bladder empties urine from the body through
another tube called the urethra. The urinary tract includes all of these structures
the kidneys, ureters, bladder and urethra. Kidney stones start as tiny crystals of minerals
that stick together when urine is concentrated. This happens with dehydration. Crystals build into stones as more minerals
deposit, similar to how a pearl builds in an oyster. Most small stones pass out of the body, carried
by urine. Larger stones tend to remain in the kidney,
or become stuck as they move down the ureter. About 1 in 10 people are affected by kidney
stones in their lifetime. Dehydration, family history, and some medical
conditions increase the risk of stone formation. Symptoms and problems often begin when urine
flow is blocked by a stone. This can lead to severe pain, complicated
infection, and blood in the urine. These problem stones are a risk for kidney
damage. Many of these stones eventually pass without
surgery. This is called expectant management. Medications may be prescribed for pain, infection,
and to help the stone pass. Rest, heat and ice may also be recommended. It can take days to weeks for some small stones
to pass on their own. Surgical treatment can be necessary,
when a small stone doesn’t pass with expectant management,…
for stones too large to pass on their own,… any stone causing infection with fever, and…
for uncontrolled pain, especially with nausea and vomiting. Stones larger than half a centimeter are more
likely to need intervention. Some stones need more than one surgery, especially
stones larger than 2 centimeters. Procedures for managing kidney stones that
may be considered, include: cystoscopy,
ureteroscopy, stent placement,
PCNL ESWL We will discuss each of these in more detail
to get a better understanding of how, when, and why they may be used. Most of these procedures are performed using
scopes, long instruments with a light and a camera. The surgeon uses different scopes for different
functions, to see and operate on places inside the urinary tract. Cystoscopy is the most basic procedure on
the list. The surgeon uses a scope to look inside the
urethra and bladder for stones and other problems. When needed, guidewires and dilators are passed
through the cystoscope into the ureter. During a ureteroscopy, a thinner scope is
used. This is guided further, through the bladder,
into the ureter, and sometimes up to the kidney. Once kidney stones are reached, other tools
are used to break the stones apart and pull the pieces out. Large stones in the kidney, and high in the
ureter can require a more invasive approach. A PCNL procedure is done using a scope, guided
through a tube in the back, directly into the kidney. A guidewire is inserted before surgery using
x ray guidance to map where the tube should be placed during surgery. This may be done in a separate radiology suite
or in the operating room just before surgery. In the operating room, dilators are placed
over the guidewire to create a passage to the kidney. A tube is placed to hold this open. The surgeon guides a scope through the tube
to see the stone. Other tools are used to break the stone apart
and remove the pieces. ESWL, is known as lithotripsy [say lith-oh-trip-sy]. This noninvasive procedure is often useful
for stones in the kidney. An x ray device is used to pinpoint the kidney
stone location and a water filled lithotripsy device, is positioned against the skin over
the kidney and aimed at the stone. Pulses of shock waves are directed at stones
to break them into tiny pieces so they can pass out of the body. These pulses create a tapping noise, and sensation
on your back, as hundreds of bursts are used at a time. Patients can have bruising and soreness in
their back from the shock waves. Placement of a temporary stent is often a
necessary step before, during or after the procedures we have discussed so far. This thin, straw like, tube is passed through
a cystoscope into the ureter then guided up to the kidney. The curl at each end holds the stent in place. Stents keep the kidney draining. They are temporary, but may be needed for
days or weeks. Stents can relieve stone pain, and dilate
the ureter to help a stone pass. Stents are placed while an infection is being
treated, before a stone can be removed. Stents are also needed while the ureter heals
after some procedures. The most appropriate procedures for you depend
on the size and location of the stone or stones, the severity of the blockage, and your other
medical conditions. Before your surgery, understand which procedures
are planned or may become necessary to treat your kidney stone.