Question 1

Ureteroscopy (URS)

Accepted Answer

Treats kidney and ureteral stones.
General anesthesia is used.
Involves using a long telescope called a ureteroscope that is placed into your bladder (through your urethra where you urinate from) and up to your ureter and kidney.
Typically, a laser is used to break up the stone into dust like fragments that will pass. Sometimes, larger fragments are removed with a small basket that fits through the ureteroscope.
Usually, a temporary stent is left in the ureter. The stent is used to hold the ureter open so that urine can drain from your kidney to your bladder. Sometimes these are left on a string that comes out your urethra (where you urinate from) for easy removal at home in 4 –10 days. Other times, no string is left on and your provider will remove it with a quick procedure in clinic. It is important to remember that these are temporary. Leaving a stent in for long periods can lead to further stones, infections and loss of kidney function.
- Ureteral stents can be discomforting to some. Common symptoms are frequency and urgency of urination, mild flank pain, painful urination or blood in your urine. Other patients won’t notice the stent at all. These symptoms are usually tolerable and can be diminished by medications prescribed by your provider.
No incisions are needed.
Typically, this is an outpatient procedure, and you can go home the same day.

Question 2

Shock wave lithotripsy (SWL)

Accepted Answer

Used to treat kidney and ureteral stones.
SWL does not work well on hard stones, such as cystine, some types of calcium oxalate and calcium phosphate stones, or very large stones.
Lower pole kidney stones or distal ureteral stones (close to the bladder) often are not treated well with SWL.
General anesthesia is used.
Your provider will use a machine that produces shock waves that are focused directly on the stone using X-rays to locate the stone. Repeated firing of shock waves on the stone usually causes the stone to break into small pieces. These smaller pieces of stones pass out in the urine over a few weeks. Most stone pieces pass painlessly. However, larger pieces may get stuck in the ureter, causing pain and needing other removal procedures.
No incisions are needed.
Typically, this is an outpatient procedure, and you can go home the same day.

Question 3

Percutaneous nephrolithotomy (PCNL)

Accepted Answer

PCNL is the best treatment for large kidney stones (>2cm in size).
General anesthesia is used.
A small 1 cm incision is made in the back. A rigid telescope, called a nephroscope, is passed into the kidney. An instrument that breaks up the stone and suctions out the pieces is passed through the nephroscope.
After the stone is removed, often a ureteral stent is left in the ureter to allow the kidney to drain. Sometimes a nephrostomy tube is also placed. This is a tube that drains your kidney into an external bag outside your body. This can usually be removed in 1–2 days.
- A stent is a small plastic tube used to hold the ureter open so that urine can drain from your kidney to your bladder. After a PCNL, no string is left on your stent and your provider will remove it with a quick procedure in clinic in a couple weeks. It is important to remember that these are temporary and must be removed when your provider tells you to. Leaving a stent in for long periods can lead to further stones, infections and loss of kidney function.
- Ureteral stents can be discomforting to some. Common symptoms are frequency and urgency of urination, mild flank pain, painful urination or blood in your urine. Other patients won’t notice the stent at all. These symptoms are usually tolerable and can be diminished by medications prescribed by your provider.
Typically requires an overnight stay in the hospital

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Kidney Stone Surgery