Earlier, Large and problematic kidney stones required open surgery in which a large incision was made on the back to remove the kidney stone. Recuperation and hospital stay extended to several weeks and the entire process was painful and inconvenient. Today, percutaneous ultrasonic stone removal has made things much easier. This methodology requires a small incision through which instruments are inserted to first disintegrate the large stones and then remove its pieces. This procedure is much quicker, less convenient and hospital stay is reduced to a couple of days.

Percutaneous ultrasonic stone removal is now a well established procedure. This method is being used more and more widely for removal of large and complex renal or Ureteral calculi. The procedure requires an arrangement of ultrasonic lithotripsy to break down the kidney stones and extraction techniques to remove all the fragments. This combined radiologic and urologic approach is a safe and effective way of treating kidney stones.

The success of this procedure is dependant on several factors. One of them is the establishment of good access for lithotripsy and correct nephrostomy placement. Firstly, a nephrostomy track is created to allow for clear vision of the stone through the nephroscope. The track is then dilated using fascial angiographic-type dilators or high-pressure balloon dilation catheters. Through the dilated tract, effective stone removal is conducted immediately or a nephrostomy tube is inserted to tamponade the track until later stone removal.

A nephroscope is inserted through the track with the help of a guide wire. This device is equipped with optical viewing elements, irrigation and suction features and the ability to introduce required surgical tools. A lithotrite is used to disintegrate the kidney stone, already brought into focus using the nephroscope. Sound wave generation breaks the large stone into tiny pieces. These pieces are removed via irrigation and suction of fluid by the lithotrite. If the stone position is complicated, stone baskets, forceps or a variety of angiographic catheters may have to be used for retrieval. Once the stone is successfully removed, follow-up radiographs are obtained. Regular follow-ups are advised!

The complications related to this procedure are sepsis and bleeding. Expect bloody urine for 24-48 hours after the procedure. If the bleeding persists, you may consult your urologist for immediate action. Percutaneous ultrasonic stone removal is a great alternative to open surgery. It is least invasive, effective and lessens recuperation time. This is just the starting point of discovery and research that shall lead to non-invasive and permanent treatments of kidney stones. Till then, the best combination of all knowledge and procedures at hand must be used to best fulfill the individual needs of every patient.