Endoscopic kidney stone treatment at Cardiff and Vale Hospitals

What is endoscopic kidney stone treatment?

Endoscopic kidney stone treatment uses a thin telescope, called an endoscope, passed through your urinary tract or through a small cut in your back, to reach and treat kidney stones. Your surgeon can then remove the stone whole or break it into small pieces, often using a laser, so it can be removed or pass out naturally in your urine.

What conditions does it treat?

You may be offered this treatment if:

• you’ve been diagnosed with kidney stones that are too large to pass naturally, or that are causing severe pain, infection or a blockage
• you have a suspected narrowing or blockage in your urinary tract, or symptoms such as unexplained bleeding or repeated infections
• your stones aren’t suitable for shockwave therapy, a different, non-invasive way of treating kidney stones that uses sound waves instead of a scope
• you have multiple or particularly large stones

What are the benefits of endoscopic kidney stone treatment?

Endoscopic treatment can offer:

• a minimally invasive way to clear stones, often without any cuts to your skin
• a quicker recovery than traditional open surgery, with less pain
• high success rates, with your surgeon able to see and treat the stone directly
• many procedures are done as day cases, so you may not need to stay in hospital overnight.

Research also suggests that removing a stone from the ureter and relieving any blockage can help your kidney function improve over the following months, particularly in women.

Are there different types of endoscopic kidney stone treatment?

There are two main endoscopic techniques, chosen according to the size and location of your stone.

Ureteroscopy

A long, thin telescope called a ureteroscope is passed through your urethra and bladder, then up into your ureter, and sometimes into your kidney itself. Rigid scopes are generally used for stones lower down in the ureter, while flexible scopes can reach further into your kidney’s drainage system, treating stones up to about 2cm. Your surgeon can gently remove the stone, or use a laser to break it into smaller pieces first.

Percutaneous nephrolithotomy (PCNL)

This keyhole approach is generally used for larger kidney stones, over about 2cm. Your surgeon makes a small cut, around 1cm, in the skin over your kidney and passes a telescope called a nephroscope directly into the kidney. The stone is then pulled out whole or broken up using a laser or pneumatic (air-powered) energy.

Shockwave lithotripsy (SWL) is a different, non-endoscopic option that uses sound waves from outside your body to break up stones, so no scope is needed. Your surgeon will discuss which approach suits your stones best.

What happens before the procedure?

You’ll have a pre-assessment, either on the day you’re admitted or at an earlier appointment. Make sure your care team knows about any medications you take, including blood-thinning medicines such as warfarin, aspirin or clopidogrel, or anti-inflammatory painkillers, as you may need to stop these for 7–10 days beforehand.

You’ll also need a urine test to check for infection before treatment, and you may need an X-ray to check the stone hasn’t moved. If you’re on dialysis, your procedure will be scheduled around your dialysis appointments.

Because this procedure is usually done under general anaesthetic, you’ll need to stop eating and drinking for several hours beforehand, often around 6 hours, though sips of water with your regular medications are usually fine. Ahead of PCNL specifically, you may also need more detailed scans so your surgeon can plan the best way to reach your stone, along with blood tests and a urine culture.

Bring any relevant scans, such as X-rays, CT or ultrasound images, and your usual medications with you on the day.

What happens during the procedure?

Ureteroscopy

1. Before you go into theatre, you may be given antibiotics to help prevent infection, and medicine to help you feel relaxed and sleepy.
2. You’re taken to the operating theatre and given a general or spinal anaesthetic (where you’re awake but numb and sedated from the waist down).
3. Your surgeon passes a fine telescope through your urethra and bladder, then up into your ureter, and sometimes into your kidney, to find the stone.
4. The stone is either removed directly, or broken into small pieces using a laser or another instrument.
5. Your surgeon may leave a small tube called a stent between your kidney and bladder to help urine drain while your ureter settles, and you might also have a temporary catheter.

This procedure is usually straightforward and takes around 30–90 minutes, depending on your stone.

Percutaneous nephrolithotomy (PCNL)

PCNL is done differently. Under general anaesthetic, you’ll lie on your front while your surgeon uses X-ray images to guide a narrow tube through a small cut in your back and into your kidney. A telescope and instruments are passed through this tube to break up and remove the stone, and a drainage tube (a nephrostomy tube) is usually left in your kidney at the end of the procedure. PCNL takes longer than ureteroscopy, usually around 2–3 hours.

What does recovery look like?

In hospital

After your procedure, you’ll wake up in a recovery area before being taken back to the ward. You may have a drip in your arm, and if you have a catheter, this will usually be removed the day after your procedure.

Many people can go home the same day if they’re able to pass urine on their own, though some people need to stay overnight. You may have another X-ray or scan to check all the stone fragments have been cleared.

If you’ve had PCNL, you’ll usually have a drainage tube in your kidney as well as a urinary catheter, both removed before you go home. Your hospital stay is likely to be longer, around 3–4 days on average.

At home

For the first couple of days, it’s common to have mild burning when you pass urine, need to empty your bladder more often, and notice small amounts of blood in your urine. This should settle within a few days.

You’ll be given antibiotics at the time of your procedure, but there’s still a small risk of infection, so your care team will explain the signs to watch for, such as worsening pain, bleeding or a fever. Drinking plenty of fluids, aiming for around 8 glasses (2.5 litres) a day, can help flush through any remaining fragments.

Avoid driving for the first 24 hours after a general anaesthetic, and arrange for someone to be with you for the first night at home. Avoid heavy lifting for about a week, and attend any follow-up appointments so your team can check you’re healing well.

If a temporary stent was placed, this is usually removed within a few weeks under local anaesthetic. Some stents have a string attached, which allows removal at home after about a week, by you or a nurse, without a further procedure.

If you’ve had PCNL, your recovery is likely to take a little longer. It’s sensible to take things easy for several weeks, with a follow-up appointment around 6 weeks after your operation.

What are the risks and complications?

Endoscopic treatment for kidney stones is routine and generally safe, though as with any procedure, there are risks to consider.

Common and minor risks

• temporary stinging or burning when you pass urine, and minor bleeding, which usually settles within a few days
• a small risk of infection, which can usually be treated with antibiotics
• a blocked ureter caused by leftover stone fragments
• pain during or after surgery

Less common risks

• damage to the ureter, including perforation, in around 1 in 200 procedures
• sepsis, an infection that spreads through the blood and affects your whole body
• excessive bleeding, which occasionally needs treatment such as a blood transfusion

If you have PCNL for a larger stone, there’s also a small chance of bleeding serious enough to need a blood transfusion (around 2 in 100), a procedure to stop bleeding from inside a blood vessel (around 1 in 100) or, rarely, further surgery to control it (around 1 in 200), along with a small risk of injury to a nearby organ, such as the spleen, liver, bowel or lung.

Your surgeon will explain how these risks apply to you and your particular stones before you go ahead.