By: Dr. Gary Bellman on November 17, 2017
Here at Southern California Urology Institute, Dr. Gary C. Bellman selects surgeries for kidney stones that allow the vast majority of patients to go home the day of surgery or, in the case of the percutaneous procedure, following a short overnight hospital stay.
Shock-Wave Lithotripsy (SWL)
With shock wave lithotripsy (SWL), x-ray and/or ultrasound guidance is used to concentrate high-energy pressure waves upon kidney or ureteral stones, reducing them to sand-like particles. The fragments are then passed through the urinary tract.
The majority of patients undergo SWL with monitored sedation, which allows patients to regain almost full alertness within minutes of completing the procedure. Most patients go home within a couple of hours.
Ureteroscopy is an excellent option for treating either larger or multiple stones within the kidney, stones located within the kidney and ureter, or impacted ureteral stones. A thin, flexible instrument called a ureteroscope is inserted directly into the ureter through the bladder. No incisions are made. Fiberoptic technology allows the ureteroscope tip to bend in multiple angles, providing Dr. Bellman with the ability to reach stones anywhere within the ureter or kidney.
Some stones can be extracted whole with a device inserted through the ureteroscope. In other cases where the stone is too large for extraction, a laser is used to break the stone into small pieces, which can then be extracted or passed by the patient.
Tubeless Percutaneous Nephrolithotomy (PNL)
Percutaneous Nephrolithotomy (PNL) is a minimally invasive surgical procedure used to treat large kidney stone burdens by creating a small 'keyhole' passage directly into the kidney. Traditionally, at the end of a PNL procedure, an external tube is placed into the passage to ensure proper drainage of urine from the kidney. Patients typically stay overnight in the hospital, with removal of the tube the morning after surgery and discharge soon after.
Following complete stone clearance, the small "keyhole" incision can be closed and an internal stent used to facilitate urinary drainage. This eliminates the need for an external tube, thus minimizing a patient's discomfort and any need for post-operative wound care. In select cases, patients treated with the tubeless technique can also be discharged the day of surgery.
Medical Management of Kidney Stone Disease
Following any surgical stone procedure, a key element of a patient's care is the prevention of future stone formation. To achieve this goal, a comprehensive metabolic evaluation may be necessary to define one's stone risk factors. As a result, preventative regimens can be tailored for every individual. Tests which may be performed as part of a stone patient's medical evaluation include: stone composition analysis, serum stone risk-blood panels, and 24-hour urine evaluations.