Alternative Treatment Options
Open surgical treatment – With the invention of ESWL, open surgical procedures on the kidney are rare. There are, however, specific indications, which make open surgery necessary.
• Failure of less invasive treatments due to size, composition and location of the stone
• Certain anatomic abnormalities of the urinary tract
Minimally Invasive Treatments – Ureteroscopy (URS) can be performed to remove stones located in the lower part of the ureter. During this procedure, an ureteroscope is inserted through the urethra to gain access to the stone. Once the stone is located, it is either removed by means of a specialized basket or by laser lithotripsy. The advantage of Holmium laser lithotripsy over other endoscopic treatments is decreased stone movement and decreased bleeding during treatment.
Percutaneous Nephrolithotomy (PCNL) – This method is often used for calculi larger than 2 centimeters in size or for hard stones. General anesthesia is required. A small incision is made in the back and a nephroscope is passed directly into the kidney. Direct fragmentation of the stone is performed using an ultrasonic, electrohydraulic, or laser device through the nephroscope under direct vision. This treatment can also be performed using the Dornier Medilas H20.
Conservative treatment – Diet, hydration, medications or a combination of these treatments may assist the natural passing of the calculi. The conservative treatment is only successful for stones smaller than 5 mm in diameter. The effectiveness of medications is dependent on the composition of the stone.