How are large kidney stones removed?

If you have large kidney stones -- stones that are bigger than 2 cm, or about the size of a marble -- your doctor may remove them with either percutaneous nephrolithotomy and percutaneous nephrolithotripsy. Both of these treatments are used for people with large or irregularly shaped kidney stones, people with infections, stones that have not been broken up enough by ESWL (extracorporeal shock wave lithotripsy) or people who are not candidates for another common stone treatment called ureteroscopy.

Both procedures involve entering the kidney through a small incision in the back. Once the surgeon gets to the kidney, a nephroscope (a miniature fiber optic camera on a thin tube) and other small instruments are threaded in through the hole. lf the stone is removed through the tube, it is called nephrolithotomy. lf the stone is broken up and then removed, it is called nephrolithotripsy. The surgeon can see the stone, use high frequency sound waves to break up the stone, and "vacuum" up the dust using a suction machine.

This is what the words mean:
  • Percutaneous means through the skin.
  • Nephrolithotomy is a combination of the word roots nephro- (kidney), litho-(stone) and -tomy (removal).
  • Nephrolithotripsy is a combination of the word roots nephro- (kidney), litho (stone), and -tripsy (crushed).
Large kidney stones are treated surgically, says Jayram Krishnan, DO, a urologist at Sunrise Hospital. In this video, is he explains what that surgical procedure involves.

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