Kidney stone treatments

The majority of urinary stones are small (less than 4 mm) and will pass spontaneously. They can safely be managed with conservative measures including increasing fluids (to prevent further kidney stone formation) and appropriate pain medication.

If you have severe pain caused by kidney stones in the kidney or ureter, you should go to your Accident and Emergency Department. Birmingham patients should go to Heartlands Hospital, Queen Elizabeth Hospital or City Hospital) for an urgent assessment and further investigations.

After a clinical review of your history, examination findings, and investigations we suggest management plans which are individually tailored to patients. Management decisions are typically based on stone factors (type, size and location), kidney factors (number, function, previous surgery) and patient factors (other illnesses or factors that may make surgical intervention higher risk).

We offer the following treatments for kidney or ureteric stones:

Extra-corporeal shockwave lithotripsy (ESWL)

Shockwave lithotripsy uses machine-generated shock waves to break up urinary stones. Patients are seen, and reviewed to ensure that the stone is visible with X-rays or ultrasound and given analgesia (usually a diclofenac suppository). Treatment sessions are carried out lying down (with patients awake), as day case procedures, last for approximately 45 - 60 minutes, and you should be sent home within 2-4 hours of arrival. An animated video from the European Association of Urology explains the procedure further.

Ureterorenoscopy and LASER lithotripsy

Whilst under a general anaesthetic (asleep), a thin camera is passed through the urethra, bladder and into the ureter and/or kidney (flexible ureterorenoscopy). A tiny LASER is then passed through the camera and used to break up stones into smaller pieces. These procedures are typically carried out as day case procedures. Patients typically have a plastic tube (stent) left inside to help protect the drainage of the kidney after this procedure. Typically stents are left in with strings on the end and are either removed by patients at home or in a a further clinic appointment in 3-5 days post ureteroscopy. Below is an animated video from the European Association of Urology explains the procedure further.

Percutaneous nephrolithotomy (PCNL)

PCNL is carried out under a general anaesthetic and involves a small incision in the skin near the kidney affected by kidney stones. Initially, a small tube (ureteric catheter) is inserted under vision (cystoscopy) through the bladder into the ureter, and an X-ray dye (contrast) is used to stretch the kidney. A needle is inserted into the kidney by a surgeon using ultrasound and X-ray guidance. The needle entry is then stretched enough to allow a special camera instrument to pass into the kidney and retrieve the stone fragments. This type of treatment is typically reserved for larger kidney stones (greater than 1.5-2 cm) or stones which are difficult to access with a flexible uretero-renoscope. There are various types of PCNL procedures including standard, mini PCNL and super mini PCNL, which refer to the size of the puncture into the kidney. Typically, the stone-free rates for equivalent-size stones are better for PCNL procedures than for flexible ureterorenoscopy.

Following this procedure, patients typically stay in the hospital for 1 to 2 days, though they can be done as a day-case procedure for a small number of patients. Below is an animated video from the European Association of Urology explains the procedure further. Or you can read more about the procedure in detail on the percutaneous nephrolithotomy page.

Laparoscopic, robotic or open surgery for kidney stones - Laparoscopic surgery or robotic surgery involves multiple keyhole incisions in the abdomen. This is rarely offered as almost all kidney stones can be treated with either shockwaves, ureteroscopy and LASER lithotripsy or percutaneous nephrolithotomy (PCNL) procedures. An open operation involves a large incision (10-15 cm) over the flank, to expose over the site of the kidney or ureter. Examples of where this treatment may be offered, include if other stone treatment methods have not been successful or if there is little or no remaining kidney function in a kidney with stone disease and the kidney should be removed.

Metabolic stone service – we work alongside our colleagues in the renal (kidney), biochemistry and microbiology departments to identify reasons why patients form recurrent kidney stones. Metabolic tests aim to prevent stone recurrence by identifying the underlying cause of kidney stone disease. Not all patients will require this service and the aim is to identify high-risk stone formers who would most benefit from further tests.

Additional services:

Investigation and treatment of upper tract transitional cell carcinoma – we investigate patients suspected of cancers in the ureter and renal pelvis with ureterorenoscopy and take biopsies where appropriate. Where clinically appropriate, we offer minimally invasive management of transitional cell carcinoma through ureterorenoscopy and LASER ablation.

Insertion of stents to unblock kidneys obstructed by pelvic and abdominal malignancies, kidney stones or ureteric strictures - we offer stenting procedures for patients with blocked kidneys. Where kidneys are blocked and cannot be stented, or where stenting is not appropriate, our interventional radiology colleagues will attempt nephrostomy tube insertion to relieve kidney obstruction.

Rendezvous procedures – alongside our interventional radiology colleagues we offer rendezvous procedures for the management of complex ureteric strictures. This is a minimally invasive management option, which is suitable for the treatment of some complex ureteric strictures.

Ureteroscopy and laser widening of pelvic-ureteric junction (PUJ) obstruction – we offer minimally invasive management of PUJ obstruction who are clinically suitable using ureteroscopy and laser widening of PUJ obstruction. Typically this is not a first-line therapy as reconstructive surgery of the narrowed area (pyeloplasty) has better long-term outcomes.

Mr Ivo Dukic is a consultant urological surgeon who offers personalised consultations. You can schedule an appointment with him for expert, bespoke advice through his Top Doctors profile or make an appointment through the Priory Hospital, Edgbaston, Circle Health Group or at Stourside Hospital, Stourbridge, Ramsay Healthcare.

Have any questions?

If you have any questions or wish to make an appointment please get in contact.