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Nephrolithomy: Removal of Kidney Stones




What Is It?


Kidney stones, also known as pebbles, form in the kidneys and can be the cause of great pain and suffering. They consist of various salts and minerals in the urine that typically does not cause any pain at all when they stay in the kidneys. Unfortunately these stones or pebbles often break loose and then travel to the ureters, which are tubes that connect the kidneys to the bladder. When they do this, they cause extreme pain.


Kidney stones typically cause pain on one side of the back, most often below the rib cage or a section of the back known as the flank. This pain may also spread into the lower abdomen and groin. Some other symptoms commonly experienced from kidney stones include blood when urinating and the need to urinate frequently. Other patients experience nausea or vomiting.




The Operation


Most of the time open surgery or general surgery is not recommended for kidney stones because most people will pass stones when they urinate. However, if kidney stones are excessively large (some may grow as large as quarters) and the bleeding resulting from kidney stones starts causing trouble, a doctor may recommend a nephrolithotomy surgery.


This surgery involves the placement of a telescope into the kidney using small incisions in the back. Then the doctor removes the kidney stones or breaks them apart and then removes the stones. This surgery is used when other procedures are ineffective or when the kidney stone is too large to break up or pass using other non-invasive techniques. Sometimes patients develop kidney stones because certain glands in the body known as the parathyroid glands produce too much hormone which can cause a particular kind of calcium-rich kidney stone.


To prevent this hormone from creating new stones requiring additional surgery, a doctor may recommend additional surgery to remove these glands. This surgery is known as a parathyroidectomy.




Alternatives to Surgery


The most common way to treat kidney stones is by increasing one’s intake of clear fluids to help pass the stones more easily. Sometimes taking medication helps to relieve the pain of passing a kidney stone. Usually it takes a few days before the stone passes. There are also treatments that can help break up the stone, including shock wave treatment. This treatment, known as lithotripsy, and help break up larger stones so patients can release them faster and easier.


Sometimes a physician will pass a ureteroscope, which is a tiny microscope through the ureter and bladder to help remove a stone that is stuck. The doctor may also try to break up the stone so he or she can flush it out if the stone is particularly difficult to pass.




Before The Operation


Prior to surgery a surgeon will review radiograph images to study the stone. You will also receive a comprehensive medical exam. You will prepare for surgery by avoiding foods for 12 hours before surgery so you can undergo general anesthesia safely. Many patients will need to have the following reports completed before surgery: EKG, complete blood count (CBC), PT/PTT, a comprehensive metabolic panel (CMP), and urinalysis. These tests will provide your surgeon with important information before surgery.


Certain medications have to be avoided before surgery. Your doctor may recommend you discontinue the following medications. (Be sure you talk with your primary prescribing doctor before stopping any medications).


  • Aspirin
  • Ibuprofen and medications containing ibuprofen like Motrin and Advil
  • Alka seltzer
  • Vitamin E
  • Blood thinners including coumadin
  • Celebrex, Vioxx, Voltaren
  • Vioxx
  • Plavix


There are other medications that may not be safe for surgery. Generally you will need to discontinue these and other medications for approximately one week before surgery. Make sure you have your prescribing doctor talk with your surgeon before surgery so your surgeon is well-informed of all your medical conditions and so you know exactly what medications you need to stop and when. You should also know when to restart medications following surgery.




After The Operation


You will be taken to a recovery room where you will have time to rest and recover. You will then stay in the hospital and receive pain medication. You will also have a drainage tube inserted in your back that will remain there for a couple of days to allow fluid to drain from your incision. Some patients also have a urinary catheter left in place for one to two days following surgery. Most patients are fed by a catheter for up to two days following surgery to ensure they receive enough fluid following surgery.


Many patients will be encouraged to walk as soon as possible to reduce the risk of blood clots following surgery.




Possible Complications


All surgeries come with potential complications. This surgery while not common tends to be safe, but there are risks. These include a risk of blood loss or bleeding during or after surgery, which may require a transfusion; the risk of infection, which may require antibiotic treatment (many patients receive prophylactic or preventive antibiotics during surgery); the risk of organ or tissue injury during surgery, and the risk that the doctor will have to make a standard open incision during surgery which will require a longer than average recovery period.


There are also cases when the surgeon for one reason or another is not able to remove an entire kidney stone, sometimes because of the location of the stone or because of its size. If this happens you may require follow up treatment to reduce the stone further.




General Advice


There are four different types of kidney stones, some are small and some are larger, the size of about a quarter. These can be debilitating and may require intervention, in the form of laser treatment, shock wave treatment and occasionally surgery to break up.


Kidney stones most commonly occur in adults but can occasionally form in young children although this is very rare.




Estimated Costs for Kidney Stone Surgery


Most countries will offer many other remedies before recommending surgery; the same is true in the US.


Country Costs
USA $4,000-12,000
Malaysia $900-$3,000
Singapore $1,000-$3,000
India $900-$3,000
Thailand $2,000-$3,000

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