Urinary Tract Calculi VI: Surgical Management

Interventional procedures for urinary tract stones include the following techniques.

First, endourological procedures, such as cystoscopy, are used to remove small bladder stones.

Larger stones are treated with transurethral or percutaneous suprapubic cystolitholapaxy, in which ultrasonic, laser, or electrohydraulic energy breaks up the stones for removal, which are then flushed out.

Ureteral and renal pelvis stones are treated using a ureteroscope, and lithotripsy techniques fragment the stones for easier removal.

For larger renal pelvis stones, percutaneous nephrolithotomy is performed under fluoroscopic or ultrasound guidance to break up the stones before removing them.

Next, lithotripsy options include laser lithotripsy, which uses a holmium laser to fragment ureteral or bladder stones, and extracorporeal shock wave lithotripsy, which uses shock waves to break up kidney or upper ureter stones smaller than 2 cm, allowing them to pass naturally.

Lastly, in severe cases, open surgical procedures such as nephrolithotomy or ureterolithotomy may be necessary, depending on the stone’s size and location.