Kidney stones, or renal calculi, are hard mineral and salt deposits that form in the kidneys.

While many kidney stones pass naturally through the urinary tract, some require medical intervention, including surgery.

Knowing when surgery is necessary is crucial to prevent complications such as kidney damage, severe pain, or infections.

This blog by Mykare Health provides a detailed overview of when surgery is required for kidney stones, the types of surgical options available, and how to prepare for and recover from these procedures.

Understanding Kidney Stones

Kidney stones vary in size, shape, and composition. They are classified into types based on their mineral content, such as calcium oxalate, uric acid, struvite, and cystine stones.

Smaller stones often pass on their own with increased fluid intake and pain management, but larger stones or those causing complications might need surgical intervention.

When Does Surgery Become Necessary?

Not all kidney stones require surgery. However, the following conditions may necessitate surgical intervention

• Large Kidney Stones: Stones larger than 6 millimetres often struggle to pass through the urinary tract naturally. Surgery is usually recommended for stones that cause persistent pain or obstruct urine flow.

• Persistent Pain and Symptoms: Severe and unrelenting pain that does not improve with painkillers or home remedies may require surgical treatment to remove the stone. Other symptoms, such as blood in the urine or persistent nausea, can also indicate the need for intervention.

• Urinary Tract Obstruction: If a kidney stone blocks the urinary tract, it can lead to hydronephrosis, a condition where the kidney swells due to urine backup. Surgery is often required to remove the obstruction and restore normal urine flow.

• Infections and Complications: Kidney stones can lead to urinary tract infections (UTIs). If the infection becomes severe, surgery may be necessary to remove the stone and prevent further complications like sepsis or kidney damage.

• Failure of Non-Surgical Treatments: When medications, lifestyle changes, and other non-invasive treatments fail to dissolve or pass the stone, surgery may be the only option left.

• Recurrent Kidney Stones: If you have frequent kidney stone formation despite preventive measures, surgical removal of stones or addressing underlying conditions might be required.

• Location of the Stone: Stones located in certain areas, such as the ureter or near the bladder, can be challenging to pass and may require surgical intervention.

Types of Surgeries for Kidney Stones

There are several surgical procedures available to treat kidney stones. The choice of surgery depends on the size, type, location of the stone, and the patient’s overall health.

1. Shock Wave Lithotripsy (SWL)

• When It’s Used: For stones up to 2 centimetres located in the kidney or upper ureter.

• How It Works: High-energy shock waves break the stone into smaller fragments that can pass naturally through urine.

• Benefits: Non-invasive with minimal recovery time.

• Limitations: May require multiple sessions for larger or harder stones.

2. Ureteroscopy (URS)

• When It’s Used: For stones in the ureter or kidney that are too large to pass or cause blockage.

• How It Works: A thin, flexible scope is inserted through the urethra to access and remove the stone. A laser might be used to break it into smaller pieces.

• Benefits: Minimally invasive and effective for both small and medium-sized stones.

• Limitations: May cause temporary discomfort or urinary tract irritation.

3. Percutaneous Nephrolithotomy (PCNL)

• When It’s Used: For larger stones (over 2 centimetres) or complex cases.

• How It Works: A small incision is made in the back to access and remove the stone directly from the kidney.

• Benefits: Highly effective for large stones.

• Limitations: Requires hospitalisation and has a longer recovery period.

4. Open Surgery

• When It’s Used: Rarely performed, only for extremely large stones or in cases of severe anatomical abnormalities.

• How It Works: A surgical incision is made to access and remove the stone.

• Benefits: Effective for complicated cases.

• Limitations: Invasive, longer recovery, and higher risk of complications compared to other methods.

5. Laparoscopic Surgery

• When It’s Used: For stones that cannot be treated with less invasive procedures.

• How It Works: Small incisions are made to insert instruments for stone removal.

• Benefits: Minimally invasive with quicker recovery than open surgery.

• Limitations: Requires specialised surgical expertise.

Preparing for Kidney Stone Surgery

Preparation for kidney stone surgery depends on the type of procedure but generally involves the following steps

• Pre-Surgical Evaluation: Your doctor will assess your overall health, stone size, and location through imaging tests such as X-rays, CT scans, or ultrasounds.

• Medications: You may need to stop certain medications like blood thinners before the procedure.

• Fasting: Some procedures require fasting for a few hours beforehand.

• Hydration: While fasting, you’ll need to stay hydrated to support kidney function.

Post-Surgery Recovery and Care

Recovery from kidney stone surgery varies based on the procedure. Here’s what you can expect

• Pain Management: You might experience mild pain or discomfort, which can be managed with prescribed painkillers.

• Hydration: Drink plenty of water to flush out remaining stone fragments.

• Rest: Avoid strenuous activities for a few days to weeks, depending on the procedure.

• Follow-Up: Attend all follow-up appointments to monitor kidney health and ensure proper healing.

Preventing Future Kidney Stones

Surgery removes existing stones but doesn’t guarantee prevention of future ones. Adopting preventive measures is crucial to reduce recurrence.

Tips for Prevention

• Stay Hydrated: Drink at least 2-3 litres of water daily to dilute urine.

• Dietary Adjustments: Limit salt, sugar, and oxalate-rich foods like spinach and chocolate.

• Maintain a Healthy Weight: Obesity can increase the risk of stone formation.

• Medication: Your doctor may prescribe medications to reduce stone formation based on their composition.

When to Seek Medical Attention

If you experience any of the following symptoms, seek immediate medical attention

• Severe, unrelenting pain in the back or side.

• Blood in the urine.

• Signs of infection, such as fever, chills, or cloudy urine.

• Difficulty urinating or complete blockage.

Delaying treatment can lead to complications like kidney infection or permanent damage.