Surgery for Kidney Stones
Although most kidney stones pass on their own, your doctor may decide that surgery is the best treatment if you have stones lodged in the ureters, the tubes that carry urine from the kidneys to the bladder; large or particularly painful kidney stones; stones causing an obstruction of urine flow; or stones resulting in bleeding or infection.
At NYU Langone, our doctors also frequently treat people with more advanced kidney stone conditions, such as staghorn stones, which are large and can be caused by infection, and bilateral stones, which develop simultaneously in both kidneys or in the ureters.
Our surgeons perform hundreds of kidney stone surgeries each year, many of which involve minimally invasive techniques that do not require a hospital stay. In fact, traditional or “open” surgery, as it is commonly known, is now rarely performed at NYU Langone for the treatment of kidney stones.
The goal in any kidney stone surgery is to treat all stones at once. However, some people with kidney stones require a staged treatment approach in which more than one surgery is needed to reduce or clear the stones.
At NYU Langone, the most common surgery to treat kidney stones is ureteroscopy with Holmium laser lithotripsy. This procedure is used to break up—and often remove—the stone fragments.
In this procedure, the surgeon inserts a narrow, flexible instrument called a ureteroscope through the urethral opening, passing it through the bladder to where the stone is located in the ureter or kidney. A small laser fiber is passed through the ureteroscope to break up and remove the stone.
This technique requires no incision. It’s typically an outpatient procedure in which you are given spinal or general anesthesia, allowing you to go home that same day.
In shockwave lithotripsy, a surgeon uses sound waves and X-rays to locate and break up stones, which can then be passed naturally through the urine. This type of procedure is most often used for kidney stones that are less than two centimeters in size, for softer stones, and, sometimes, for those located in the ureter.
Shockwave lithotripsy is typically performed as an outpatient procedure, allowing you to go home the same day. It is most often performed under general anesthesia or sedation. The recovery time for shockwave lithotripsy is relatively short, with most people returning to their normal activities within a few days.
If the kidney stones cannot be broken into small enough pieces to pass naturally through the urine, your surgeon may install a stent in the ureter to allow urine and stones to pass. Sometimes additional procedures, such as ureteroscopy or percutaneous nephrolithotomy, may be necessary after shockwave lithotripsy.
Percutaneous nephrolithotomy is a surgical procedure typically used to treat kidney stones that are larger than two centimeters, and may be in hard-to-reach locations in the kidney or ureters. In this procedure, a surgeon makes a small incision, most commonly in the back, creating a narrow tunnel directly to the kidney to break up and remove large or irregularly shaped stones. Larger stones may require additional surgeries in order to completely remove them.
A tube may be left in the kidney to allow the drainage of urine out of the body while you heal from surgery. Most people can go home the day after the procedure, and can expect to recuperate in two to four weeks.
Our doctors also perform the “mini-perc,” which is a less invasive version of percutaneous nephrolithotomy that results in a smaller incision and may reduce pain after surgery.
Robotic-Assisted Kidney Stone Removal
NYU Langone was the first medical center in the New York City area to perform kidney stone removal using the da Vinci Surgical System® robotic surgery device. Robotic-assisted, also called laparoscopic, surgery gives doctors a high-resolution, three-dimensional view of small areas, such as the ureters. It also provides surgeons with an increased range of motion and the ability to make more precise incisions, which can lead to less scarring. People who have this procedure may heal more quickly and spend fewer days in the hospital compared with those who have had traditional open surgery.
Robotic-assisted kidney stone surgery is most often used in people who were born with a kidney drainage problem, called a ureteropelvic junction obstruction, who also have kidney stones. The stones can be removed at the same time as the surgery to repair the ureteropelvic junction.
In rare situations, your doctor may recommend robotic-assisted surgery to remove complicated stones that cannot be successfully removed using other surgical methods.