Stones: Kidney and Ureteral Stone Procedures

Many kidney stones pass on their own, and the procedures in this drawer come into the picture when a stone is large, causes pain, or blocks the flow of urine. The five cards here are meant as a first map for patients, families and students. Individual plans differ, and the treating urologist (a doctor who specializes in the urinary tract) makes the final call.

How the procedures differ in route

Shock wave lithotripsy (SWL) works from outside the body. Shock waves, guided by x-ray or ultrasound, pass through the skin and break the stone into small pieces, which are then passed in the urine. Ureteroscopy takes the opposite direction. A thin scope travels up the urethra, through the bladder and into the ureter, so the urologist can reach stones in the ureter or the kidney without a cut in the skin.

Laser lithotripsy describes the tool rather than the route. A laser fiber is usually passed through a ureteroscope, and sometimes through the nephroscope used in percutaneous nephrolithotomy (PCNL). PCNL itself goes through a small cut in the back, directly into the kidney. Afterward, a temporary tube called a ureteral stent may be left in place to help urine drain.

When each is typically considered

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says stones are usually treated according to their size, location and type. Cleveland Clinic describes SWL as an option for stones larger than about 5 millimeters that block urine flow or cause pain, and notes that it tends to work best on smaller stones. Stone position and body type can also affect how well it works.

Cleveland Clinic lists ureteroscopy for stones between 5 and 20 millimeters, and for people who are pregnant or take blood thinners, and says it can treat stones that SWL cannot. For PCNL, the same source names stones of 2 centimeters or larger, stones with an irregular shape, and people who cannot have the other treatments. The NHS adds that most kidney stones are managed at home with fluids and medicine, and that only larger stones need a hospital procedure.

Recovery compared

SWL and ureteroscopy are generally day procedures. After SWL, Cleveland Clinic says most people return to usual routines within a few days, although stone fragments can keep passing for several days to weeks. After ureteroscopy, the same source describes returning to normal activities a few days after any stent is removed.

PCNL is the larger operation. Cleveland Clinic says most people stay in the hospital one night and recover over two to four weeks, while NIDDK says a stay of several days is possible, so centers differ. Stent symptoms are a common part of recovery after ureteroscopy and PCNL, and the glossary explains the terms used across these cards.