Kidney Stone Surgery: Everything You Need to Know

Kidney stone surgery involves the surgical removal of kidney stones that are too large to pass on their own, or are causing too much pain or an infection. Stones that are impairing kidney function may also require surgical removal.

If a stone blocks the passage of urine from the kidney to the bladder, symptoms occur. These include severe pain in your lower abdomen or sides (between your ribs and hips). Blood in the urine may also occur.

Surgical removal of the stone relieves symptoms and/or restores the normal flow of urine.

What Is Kidney Stone Surgery?

Kidney stone surgery involves a surgeon either physically removing a kidney stone whole or in pieces, or essentially blasting it apart so that it can be passed by the body.

This surgery may be scheduled or performed urgently by a urologist—a healthcare provider who deals with diseases of the urinary tract.

There are different types of kidney stone surgeries. Depending on the one performed, you may go home the same day or stay in the hospital for one or more nights.

Surgery Types

The type of surgery performed depends on factors like the size and location of the stone and patient preference.

Depending on the surgery chosen, you may be discharged home on the same day or stay overnight in a hospital.

Shock Wave Lithotripsy

Shock wave lithotripsy (SWL) is the least invasive method for stone removal and is considered the first-line therapy for most kidney stones and many ureteral stones.

This surgery entails using high-energy shock waves to break apart a kidney stone into tiny, fine fragments. Doing so allows the pieces to easily travel through the urinary tract and out of the body.

Patients can often go home the same day as the procedure. They may stay one night in the hospital if the surgery was long or complicated.

Ureteroscopy

A ureteroscopy (URS) is used to treat stones in the ureter, especially stones closest to the bladder.

A small, flexible tube called a ureteroscope is passed through the urethra and bladder and up the ureter to the location of the stone. The stone is removed whole or, if it's too large, broken up with a laser first.

As with SWL, patients may go home the same day as their surgery or stay overnight in the hospital.

Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy (PNL) is generally used for patients who have large stones (greater than 20 millimeters, mm) or staghorn stones (large, branching stones associated with urinary tract infections).

During this surgery, an endoscope is inserted through a small incision in the back to visualize and remove the kidney stone. A laser may be used to break the stone into pieces prior to removal.

In some cases, a nephrostomy tube may be temporarily inserted through the skin into your kidney to help drain urine.

Patients undergoing percutaneous nephrolithotomy stay in the hospital for one to two nights.

Laparoscopic and Robot-Assisted Surgery

Laparoscopic and robot-assisted surgery is more invasive than the surgeries described thus far. It is usually utilized when one of them fails.

The healthcare provider uses thin surgical instruments to remove the stone through small cuts made in the patient's abdomen. If a robot is used, the practitioner controls robotic hands that have surgical instruments attached to them instead.

This surgery involves around a three-night stay in the hospital.

Open Surgery

Open surgery is rarely performed. It may be used in patients for whom minimally invasive approaches have failed and/or for those with staghorn stones, complex kidney or ureter anatomy, or morbid obesity.

During open surgery, the stone is removed through a cut made in the patient's abdomen or side. A nephrostomy tube is placed temporarily to drain urine.

Open surgery generally requires a six- to nine-night hospital stay.

Contraindications

Some people may be advised against having surgery in general—for example, if they have bad reactions to anesthesia.

Beyond that, though, there is almost nothing that would outright prevent you from having a kidney stone removal procedure.

The exceptions relate to shock wave lithotripsy.

If any of the following apply to you, you should not have SWL:

• Obesity
• Pregnancy
• Bleeding disorder
• Severe skeletal abnormalities

Your healthcare provider may cautiously consider SWL if you have:

• Chronic kidney infection
• Scar tissue in the ureter
• Stones made up of cystine or certain types of calcium
• A stone that must be cleared immediately and/or completely
• A cardiac pacemakers

Potential Risks

There are specific risks associated with each type of kidney stone surgery.

As an example, risks associated with shock wave lithotripsy include:

• Bleeding around the kidney
• Urinary tract infection
• Blockage of the urinary tract by stone fragments

The most frequent risks associated with a ureteroscopy include:

• Ureteral stent discomfort
• Ureteral wall injury
• Stone migration

The main risks associated with percutaneous nephrolithotomy include:

• Bleeding
• Renal pelvis perforation (when a hole forms inside the kidney)
• Hydrothorax (when fluid accumulates in the space surrounding the lung)

Purpose of Kidney Stone Surgery

The purpose of kidney stone surgery is to remove a stone in order to reduce symptoms and/or reverse a medical condition associated with the presence of the stone (e.g., urinary tract infection or acute kidney failure).

Specific indications for kidney stone surgery include:

• Ureteral stones greater than 10 mm
• Uncomplicated distal ureteral stones less than 10 mm that have not passed after four to six weeks of observation
• Symptomatic kidney stones without any other explanation for the patient's pain
• Ureteral or kidney stones in pregnant women that have not passed after an observation period
• Persistent kidney obstruction related to stones
• Recurrent urinary tract infections linked to stones

Aside from the above indications, emergency surgery to remove a kidney stone may be warranted in the following cases:

• If the flow of urine from both kidneys is blocked and there is acute kidney injury
• If a patient has acute kidney injury from an obstructing stone and only one functioning kidney
• If a patient has an obstructing stone and a urinary tract infection

Pre-Op Testing

When kidney stone surgery is scheduled, various tests will be performed.

Lab tests include:

• Complete blood count (CBC)
• Urinalysis
• Urine culture (to check for infection)

If an infection is detected, it will be treated with antibiotics.

A computed tomography (CT) scan of the abdomen and pelvis will also be obtained, if not already done.

On the scan, if a patient has evidence of certain kidney concerns (e.g., hydronephrosis), a blood test called a basic metabolic panel (BMP) will be done to assess kidney function.

Other imaging studies like a contrast-enhanced CT, intravenous pyelography (IVP), or magnetic resonance urography without contrast (for pregnant patients) may be required if a patient has a complex urinary tract anatomy or staghorn stones.

Finally, additional studies may be needed for anesthesia clearance, like an electrocardiogram (ECG).

How to Prepare

If your surgery is scheduled, your healthcare provider will give you information on how to prepare.

Following these instructions is important. Note, however, that urgently needed surgeries will not be postponed due to a lack of preparation.

Location

Kidney stone surgery is performed in a hospital, surgical center, surgeon's office, or emergency room by a urologist.

What to Wear

You will change into a hospital gown upon arrival, so wear loose-fitting clothes that are easy to remove.

Leave all valuables, including jewelry, at home. 

Food and Drink

Avoid eating or drinking after midnight on the eve of your surgery.

Medications

Stop taking certain medications that may cause bleeding; ask your healthcare provider for guidance on a timeframe for this.

What to Bring

On the day of your surgery, be sure to bring:

• Your driver's license and insurance card
• List of your medications

If you are staying overnight in the hospital, remember to pack a bag with:

• Personal items (e.g., toothbrush, hairbrush)
• Comfort items (e.g., hand cream, earplugs, a tablet)
• Medical items (e.g., inhaler or eyeglasses)

Arrange for someone to drive you home once you are discharged.

Pre-Op Lifestyles Changes

Stop smoking prior to surgery to lower your risk for surgical complications. The longer you stop smoking, the greater the benefits.

What to Expect on the Day of Surgery

On the day of your surgery, you will arrive at the hospital or surgical center/office and check-in.

Before the Surgery

You will be taken to a pre-operative room where you will change out of your clothes into a hospital gown.

A nurse will then review your medication list, record your vitals, and place an intravenous (IV) line into a vein in your arm or hand.

Depending on the surgery you are undergoing, your healthcare provider may give you an antibiotic through your IV (or to be taken by mouth) at this time.

Your surgeon will come to greet you and briefly review the operation. From there, you will be wheeled into the operating room on a gurney where the anesthesia process and surgery will begin.

During the Surgery

Kidney surgery may be performed under general or regional anesthesia, depending on the specific surgical procedure being performed.

• Regional anesthesia: The surgeon will inject a numbing medication into your spine. You may feel a stinging sensation as the medication is being injected. You will also probably be given a sedative to help you fall asleep during the surgery.
• General anesthesia: The anesthesiologist will administer inhaled or intravenous medication to put you to sleep. Once asleep, a breathing tube called an endotracheal tube will be inserted. This tube is connected to a ventilator which will help you breathe during the surgery.

The steps of kidney stone surgery depend on the surgical technique/approach being used.

Since ureteroscopy is a common surgery used to remove kidney stones, especially those that have failed shock wave lithotripsy, let's review the basics steps of that surgical procedure as an example:

• Visualization: The surgeon will pass a ureteroscope through the urethra and bladder and up toward the ureter and kidney. Balloon dilators may be used to widen the ureter, depending on the precise location of the stone.
• Extraction: If the stone is small enough, forceps or a wire basket device will be used to remove it in one piece. If the stone is too large, it will be broken into pieces with a laser and allowed to pass naturally through the urine.
• Stone analysis: Any stone material is sent to a laboratory for examination of its chemical composition.
• Stent placement: Sometimes, a stent will be placed in the ureter, especially if it is swollen from the procedure. By keeping the ureter open with this small tube, the surgeon can make sure that urine drains well and that stone fragments pass easily if needed.

After the Surgery

In the recovery room, a nurse will monitor your vital signs. Once you are fully awake and alert, you will be discharged home.

If you are staying in the hospital, you will be wheeled to a hospital room.

Recovery

If your stone was broken into fragments, you may be given a medication called Flomax (tamsulosin). This helps facilitate the passing of the stone fragments out of the body in your urine.

You will likely be asked to strain your urine through a filter to capture the stone fragments. Save any you find and bring them to your healthcare provider. The fragments will be sent off to a pathology lab for chemical analysis.

Symptoms You Might Experience

Some symptoms you may experience after kidney stone removal can seem alarming, but are usually normal. These include:

• Pain and nausea: These are common and occur as kidney stone fragments pass through your urinary tract and out of your body. Your healthcare provider may prescribe you pain and anti-nausea medications to ease these symptoms.
• Mild discomfort at incision sites, if any: Ask your practitioner about how to best care for these sites, including when you can safely shower.
• Blood in urine; painful urination (dysuria): This may occur after ureteroscopy with ureteral stent placement. Most stents are removed around one to two weeks after surgery, but be sure to confirm the timing of this with your healthcare provider.
• Soreness at tube insertion site: If you have a nephrostomy tube placed, be sure to follow your practitioner's instructions for keeping the skin around the tube dry and clean.

Of course, if you are ever concerned about any symptoms you are experiencing—especially if they persist for more than a few days—call your surgeon.

Activity

The overall recovery timeline from kidney stone surgery depends on the type of surgery performed.

Generally speaking though, you can likely return to your normal activities after about two to three days if you underwent shock wave lithotripsy or a ureteroscopy.

Recovery from the other procedures takes longer. For example, expect around one to two weeks for percutaneous nephrolithotomy and four to six weeks for open surgery.

Long-Term Care

Around two to three months after your kidney stone surgery, your healthcare provider (usually a kidney specialist called a nephrologist) will order an imaging test. This is done to ensure that you are completely stone-free and that all stone fragments have been removed.

In addition, based on the chemical analysis of your stone, your practitioner will devise a plan for you to help prevent future stones from forming.

Three key stone-prevention strategies include:

• Drink around eight 8-ounce cups of water a day to continually flush out your urinary tract. If you are not used to drinking that much water, start slow and gradually increase your consumption every day.
• Taking certain medications, as recommended by your healthcare provider, depending on the type of stone you had (e.g. a thiazide diuretic or potassium citrate)
• Changing your diet, again depending on the type of stone you had: For instance, you may be asked to reduce your intake of animal protein and sugar-sweetened foods and drinks. You may also be asked to up your fruit and vegetable intake.

Possible Future Surgeries

Office-based procedures are typically used to remove a ureteral stent or nephrostomy tube (under local anesthesia).

Future surgical procedures may be warranted if stone fragments are left behind or if a stone forms again.

A Word From Verywell

Kidney stones are common and may occur because of different factors including genetics, diet, fluid intake, and medications, to name a few.

If you or a loved one has a stone that needs to be surgically removed, be sure to carefully review your options with your urologist. Choose the surgery that is going to be the most effective and comfortable for you.