Nephrology

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Less-invasive ways to remove stones from the kidneys and ureters
Cleveland Clinic Journal of Medicine, 10/15/09

Samplaski M et al. – Less–invasive interventions for upper tract urolithiasis are extracorporeal shock–wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. Each has advantages and disadvantages, depending on the location, size, and composition of the stone and on the patient’s renal anatomy, body habitus, and comorbidities.

• Stones that obstruct the flow of urine or that are associated with infection (ie, struvite or “staghorn” stones) should be removed promptly.
• For small stones in the distal ureter, medical therapy is an option: pain control, hydration, and control of ureteral spasms with calcium channel blockers and alpha–blockers help the patient pass the stone spontaneously.
• Extracorporeal shock–wave lithotripsy is the mostly commonly used option, but it is less effective for large stones and in obese patients.
• The ureteroscope can now be used to extract stones as high up as the kidney. Catheters that contain lasers and lithotripsy devices can break up large stones in situ for removal.
• Percutaneous nephrolithotomy is very effective for large stones in the kidney and is especially indicated for struvite stones.

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