Overview 

Kidney stones are hard clumps of minerals and other substances that can form in the urinary tract. Kidney stones can form in one or both kidneys, and typically affect people between the age of 30 and 60. They typically form in the kidneys or in the ureter (the tube linking the kidneys to the bladder), and are fairly common, impacting over 1 in 10 people. Most stones pass naturally through your urine, which can be a painful experience. If a stone is too large to pass on its own or is blocking the urinary tract, a procedure may be needed to break it up or remove it. The type of surgery you’ll need depends on the size and location of the stones. Let's look into the article how surgical treatment is used to treat kidney stones and how to improve health outcomes. If not treated, kidney stones can cause severe pain, kidney infections, or problems with kidney function...

What are the symptoms of kidney stones?

The primary symptom of kidney stones is pain in the lower back, abdomen, or side, which may radiate from the groin. This pain can vary in intensity, ranging from dull to sharp and severe, and is often described as colicky because it can come in waves.

Other symptoms of kidney stones include:

• Nausea and vomiting
• Blood in urine
• Pain during urination
• Inability to urinate
• Frequent urge to urinate
• Fever or chills
• Cloudy or foul-smelling urine

What is the cause of kidney stones?

Kidney stones do not typically have a single, clear cause, but various factors can heighten the risk of developing them. They develop when your urine contains higher levels of crystal-forming substances like calcium, oxalate, and uric acid; the high concentration of these substances form stones as the fluid in your urine cannot dilute them. Similarly, if urine lacks substances that help prevent crystals formation, it creates a favourable environment for kidney stone formation.

Indication for surgery

If you have a small stone that is expected to pass naturally, your healthcare provider will ask you to monitor your symptoms until it passes in your urine. They may also prescribe medications to help ease discomfort and assist the stone to pass on its own. For larger stones, treatment will depend on factors like their size, location, whether they’re causing symptoms or infections, and other considerations. If a stone is too large and causes a blockage that doesn’t pass within a few weeks, and you are experience symptoms, such as pain in your side or abdomen, intense pain that comes and goes, and feelings of nausea or vomiting, your healthcare provider will suggest procedures to break it up or remove it through surgery.

Types of surgical options for kidney stones

Extracorporeal shock wave lithotripsy (ESWL)

Extracorporeal Shock wave lithotripsy (ESWL) is the primary treatment option for kidney stones. It works by breaking up kidney stones using high-intensity, low-frequency sound waves directed at the stone from an external machine called a lithotriptor. To get the best results, several factors need to be considered, including:¹ 

• the type of machine
• the energy used
• the pulse frequency
• how well the patient is positioned with the machine
• the location of the stone
• and the anaesthesia method used¹ 

This type of intervention is contraindicated in pregnancy, untreated urinary tract infections, uncontrolled bleeding disorders, heart rhythm issues, and large abdominal aortic aneurysms.    

Common side effects include pain, urinary obstruction, and perirenal hematoma. Some research suggests ESWL might be linked to increased risks of hypertension and diabetes. The success of ESWL is influenced by stone size, location, and composition, as well as patient factors like obesity, kidney anatomy, and congenital kidney issues. Smaller stones (less than 1.0 cm) are more likely to be treated successfully, while stones in the lower kidney areas are usually less responsive to the procedure.¹ 

Ureteroscopy (URS)

A ureteroscopy is a procedure where a long, thin instrument called a ureteroscope is inserted through the urethra (the tube that carries urine out of the body) and into the bladder. The scope is then guided up into the ureter. The surgeon can either carefully extract the stone using a tool or use laser energy to break it into smaller pieces that can naturally pass through the urine. The procedure is performed under general anaesthesia, meaning you'll be asleep during the process.

Ureteroscopy (URS) achieves a higher stone-free rate (SFR), indicating it is more successful in fully removing stones. It also involves fewer repeat treatments and is notably more affordable, making it a more cost-effective solution for kidney stones of any size.²    

Percutaneous nephrolithotomy (PCNL)

Percutaneous nephrolithotomy (PCNL) is a surgical procedure used to remove kidney stones by inserting a thin tube through the skin into the kidney, and breaking the stones with tools like lasers or ultrasound; the fragments of kidney stone are then extracted through the tube. PCNL tends to have a higher success rate after three months, requires fewer repeat treatments, and generally involves longer hospital stays.³

Open or laparoscopic surgery

During laparoscopic surgery, the surgeon makes a small cut to remove the stone. In rare cases, open surgery with a larger incision may be required instead of laparoscopy.

Complications after surgery

Complications may arise following the treatment of large kidney stones. A medical professional should discuss these potential issues with you prior to the procedure. The likelihood of complications will vary based on the treatment type, as well as the size and location of the stones.

Possible complications include:

• Sepsis, an infection in the bloodstream.
• A blocked ureter due to stone fragments (the ureter connects the kidney to the bladder)
• Injury to the ureter
• Urinary tract infection (UTI)
• Bleeding during surgery
• Pain

Alternatives to surgery

The primary goal in the acute management of kidney stones is to provide pain relief. Such alternatives to surgery include:

• Nonsteroidal anti-inflammatory drugs, which are more effective and have fewer side effects compared to opioids
• If opioids are used, meperidine (Demerol) should be avoided due to the high risk of nausea and vomiting⁴
• Drink plenty of water
• Limit animal proteins
• Reduce intake of foods high in sugar and sodium
• Cut back on foods rich in oxalates, especially if you have calcium oxalate stones; avoid foods like spinach, rhubarb, wheat bran, tree nuts, and peanuts
• Maintain a healthy weight
• Eat foods that are good sources of calcium, as they can help prevent kidney stones. Calcium supplements or antacids that contain calcium can potentially raise your risk of developing stones

How to prevent kidney stones?

To prevent kidney stone recurrence, strategies include lifestyle changes, citrate supplementation, and medications. Lifestyle modifications are essential for low-risk patients after their first kidney stone, while citrate and medications are intended for those with recurrent stones.

Lifestyle modification

Increase fluid intake

• Strive for a daily intake of 2.5 to 3 litres
• Ensure a urine output of 2 to 2.5 litres
• Maintain urine specific gravity below 1.010

Fluid choices 

• Drink throughout the day
• Prefer beverages with a neutral pH
• Consider 24-hour urine collection to monitor diuresis

Limit carbonated drinks

• Reduce intake, especially those acidified with phosphoric acid (e.g fizzy drinks)

Balanced diet 

• High in fibre and vegetables
• Normal calcium intake (1.0 to 1.2 g per day)
• Limit salt intake and animal protein

Healthy weight management

• For overweight or obese individuals, pursue normal body weight through dietary changes and increased physical activity

General health benefits  

While evidence for preventing kidney stones is limited, these lifestyle changes help reduce the risk of other health issues⁴

Summary

Kidney stones can form in one or both kidneys and primarily affect individuals aged 30 to 60. They are quite common, impacting over 10% of the population. Most kidney stones are small enough to be passed in urine, and symptoms can often be managed at home with medication. However, larger stones may require surgical intervention to be broken up or removed. Various surgical methods are employed to treat kidney stones and achieve a successful recovery post-surgery. Approximately 50% of individuals who have had kidney stones will experience them again. To reduce the risk of recurrence, it's essential to stay well-hydrated, ensuring your urine remains pale in colour to help prevent the formation of stones.