Kidney Stone Treatment
St. Peter's Hospital offers a full array of minimally invasive treatment options for kidney and ureteral stones. These options include:
These techniques allow the vast majority of patients to go home the day of surgery or, in the case of the percutaneous procedure, following a short 23-hour overnight stay.
Shock-wave Lithotripsy (SWL)
With shock wave lithotripsy (SWL), x-ray and/or ultrasound guidance is used to concentrate high-energy pressure waves upon kidney or ureteral stones, reducing them to sand-like particles. The fragments can then pass from the urinary tract.
The majority of patients undergo SWL with monitored sedation, which allows patients to regain almost full alertness within minutes of completing the procedure. Most patients go home within a couple of hours.
Ureteroscopy is an excellent option for treating either larger or multiple stones within the kidney, stones located concurrently within the kidney and ureter, or impacted ureteral stones. A thin, flexible instrument called a ureteroscope is inserted directly into the ureter through the bladder. No incisions are made. Fiberoptic technology allows the ureteroscope tip to bend in multiple angles, providing your urologist with the ability to reach stones anywhere within the ureter or kidney.
Some stones can be extracted whole with a basket device inserted through the ureteroscope. In other cases where the stone is too large for extraction, a laser is used to break the stone into small pieces, which can then be extracted or passed by the patient.
Percutaneous Stone Treatment
The percutaneous approach is typically used for the largest of kidney stones that would have been treated through a large incision in the past. With percutaneous stone surgery, a small passage just over a centimeter wide is made through the patient's back into the kidney. An endoscope (nephroscope) is then inserted and stones are either extracted with grasping instruments or broken up with an ultrasonic probe, which fragments stones and concurrently suctions fragments out of the kidney. The percutaneous approach provides the highest chance to completely clear the kidney of all stones in a single setting, thus minimizing the need for additional surgical procedures.
Tubeless Percutaneous Nephrolithotomy (PNL)
Percutaneous Nephrolithotomy (PNL) is a minimally invasive surgical procedure used to treat large kidney stone burdens by creating a small "keyhole" passage directly into the kidney. Traditionally, at the end of a PNL procedure, an external tube is placed into the passage to ensure proper drainage of urine from the kidney. Patients typically stay overnight in the hospital, with removal of the tube the morning after surgery and discharge soon after.
Urologic surgeons at St. Peter's were among the first in the Capital Region to perform the tubeless PNL technique. Following complete stone clearance, the small "keyhole" incision can be closed and an internal stent used to facilitate urinary drainage. This eliminates the need for an external tube, thus minimizing a patient's discomfort and any need for post-operative wound care. In select cases, patients treated with the tubeless technique can also be discharged the day of surgery.
Medical Management of Kidney Stone Disease
Following any surgical stone procedure, a crucial element of a patient's care is the prevention of future stone formation. To achieve this goal, a comprehensive metabolic evaluation may be necessary to define one's stone risk factors. As a result, preventative regimens can be tailored for every individual. Tests which may be performed as part of a stone patient's medical evaluation include: stone composition analysis, serum stone risk blood panels, and 24-hour urine evaluations.