Removal of kidney stones
About 4 out of 5 kidney stones are excreted from the body without removal. Regular check-ups are sufficient in such cases. Even if pain has occurred in the form of a so-called renal colic, a spontaneous stone discharge with the urine can be achieved through conservative treatment in the form of pain relief, application of heat, physical exercise and sufficient fluid intake.
The urologist should check whether these measures are successful by means of regular ultrasound or X-ray checks. In the case of larger stones or if they do not spontaneously dislodge and cause pain, there are various options for removal. Urinary stones that are the cause of a urinary tract infection or a urinary flow disturbance should also be removed, regardless of their size.
Kidney stones and other urinary stones can be crushed specifically with a laser probe that is advanced into the body through an endoscope to the stone. The endoscope can be advanced through the natural orifices of the body, through the urethra and into the bladder. Another option is to access the endoscope through a small incision below the costal arch and a thin tube that is advanced into the renal pelvis.
The stone fragments resulting from the comminution with the laser are removed through the endoscope. Injuries caused by the laser are very rare in experienced surgeons. Kidney stones, from a size of about 1 cm, are usually removed by the urologist via endoscopic surgery under general anesthesia.
The procedure is known as minimally invasive percutaneous nephrolithoapaxy or mini-PNL for short. A thin tube is inserted into the renal pelvis through a small skin incision (about 1 cm) below the ribs under visual control using ultrasound. An endoscope is inserted through this so-called puncture channel.
This is equipped with a camera and a laser probe. This allows a targeted comminution of the kidney stone to be performed under visual control. The fragments are immediately flushed out through the endoscope.
The procedure usually requires an inpatient stay of three to five days. Complications are rare.In contrast to the minimally invasive surgery described above, open surgery for kidney stones is only performed in exceptional cases, for example when the entire renal cavity system is filled with a huge stone or other methods of stone removal are not successful. To remove kidney stones with a sling, an endoscope about 3 to 4mm wide is inserted through the urethra.
The endoscope has a camera and a working channel through which the sling is advanced into the bladder and then through the ureter to the site of the kidney stone. The urethra is enclosed by the sling and finally pulled out of the body. The procedure is performed under general anesthesia. An inpatient stay is necessary for this.
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