Table of ContentsView AllTable of ContentsWhat Is Kidney Stone Surgery?PurposeHow to PrepareWhat to ExpectRecovery
Table of ContentsView All
View All
Table of Contents
What Is Kidney Stone Surgery?
Purpose
How to Prepare
What to Expect
Recovery
Kidney stone surgery involves the surgical removal of kidney stones that are too large to pass on their own, or are causing too much pain or an infection. Stones that are impairing kidney function may also require surgical removal.
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If a stone blocks the passage of urine from the kidney to thebladder, symptoms occur. These include severe pain in your lower abdomen or sides (between your ribs and hips).Blood in the urinemay also occur.
Surgical removal of the stone relieves symptoms and/or restores the normal flow of urine.
What Exactly Are Kidney Stones?Kidney stones are pebble-like masses that become stuck in thekidneyorureter. They develop when substances like calcium, oxalate, cystine, or uric acid accumulate or become concentrated in the urine. These substances form tiny crystals and, eventually, these solid stones.
What Exactly Are Kidney Stones?
Kidney stones are pebble-like masses that become stuck in thekidneyorureter. They develop when substances like calcium, oxalate, cystine, or uric acid accumulate or become concentrated in the urine. These substances form tiny crystals and, eventually, these solid stones.
There are different types of kidney stone surgeries. Depending on the one performed, you may go home the same day or stay in the hospital for one or more nights.
Surgery Types
The type of surgery performed depends on factors like the size and location of the stone and patient preference.
Depending on the surgery chosen, you may be discharged home on the same day or stay overnight in a hospital.
Shock Wave Lithotripsy
Shock wave lithotripsy (SWL) is the least invasive method for stone removal and is considered the first-line therapy for most kidney stones and many ureteral stones.
This surgery entails using high-energy shock waves to break apart a kidney stone into tiny, fine fragments. Doing so allows the pieces to easily travel through the urinary tract and out of the body.
Patients can often go home the same day as the procedure. They may stay one night in the hospital if the surgery was long or complicated.
Ureteroscopy
A ureteroscopy (URS) is used to treat stones in theureter, especially stones closest to the bladder.
A small, flexible tube called a ureteroscope is passed through the urethra and bladder and up the ureter to the location of the stone. The stone is removed whole or, if it’s too large, broken up with a laser first.
As with SWL, patients may go home the same day as their surgery or stay overnight in the hospital.
Percutaneous Nephrolithotomy
Percutaneous nephrolithotomy (PNL) is generally used for patients who have large stones (greater than 20 millimeters, mm) or staghorn stones (large, branching stones associated withurinary tract infections).
During this surgery, an endoscope is inserted through a small incision in the back to visualize and remove the kidney stone. A laser may be used to break the stone into pieces prior to removal.
In some cases, a nephrostomy tube may be temporarily inserted through the skin into your kidney to help drain urine.
Patients undergoing percutaneous nephrolithotomy stay in the hospital for one to two nights.
Laparoscopic and Robot-Assisted Surgery
Laparoscopicand robot-assisted surgery is more invasive than the surgeries described thus far. It is usually utilized when one of them fails.
The healthcare provider uses thin surgical instruments to remove the stone through small cuts made in the patient’s abdomen. If a robot is used, the practitioner controls robotic hands that have surgical instruments attached to them instead.
This surgery involves around a three-night stay in the hospital.
Open Surgery
Open surgery is rarely performed. It may be used in patients for whom minimally invasive approaches have failed and/or for those with staghorn stones, complex kidney or ureter anatomy, ormorbid obesity.
During open surgery, the stone is removed through a cut made in the patient’s abdomen or side. A nephrostomy tube is placed temporarily to drain urine.
Open surgery generally requires a six- to nine-night hospital stay.
Contraindications
Some people may be advised against having surgery in general—for example, if they have bad reactions to anesthesia.
Beyond that, though, there is almost nothing that would outright prevent you from having a kidney stone removal procedure.
The exceptions relate to shock wave lithotripsy.
If any of the following apply to you, you should not have SWL:
Your healthcare provider may cautiously consider SWL if you have:
Potential Risks
There are specific risks associated with each type of kidney stone surgery.
As an example, risks associated with shock wave lithotripsy include:
The most frequent risks associated with a ureteroscopy include:
The main risks associated with percutaneous nephrolithotomy include:
Purpose of Kidney Stone Surgery
The purpose of kidney stone surgery is to remove a stone in order to reduce symptoms and/or reverse a medical condition associated with the presence of the stone (e.g., urinary tract infection oracute kidney failure).
Specific indications for kidney stone surgery include:
Aside from the above indications, emergency surgery to remove a kidney stone may be warranted in the following cases:
Pre-Op Testing
When kidney stone surgery is scheduled, various tests will be performed.
Lab tests include:
If an infection is detected, it will be treated with antibiotics.
Acomputed tomography (CT)scan of the abdomen and pelvis will also be obtained, if not already done.
On the scan, if a patient has evidence of certain kidney concerns (e.g.,hydronephrosis), a blood test called abasic metabolic panel (BMP)will be done to assess kidney function.
Other imaging studies like a contrast-enhanced CT,intravenous pyelography (IVP), or magnetic resonance urography without contrast (for pregnant patients) may be required if a patient has a complex urinary tract anatomy or staghorn stones.
Finally, additional studies may be needed for anesthesia clearance, like anelectrocardiogram (ECG).
If your surgery is scheduled, your healthcare provider will give you information on how to prepare.
Location
What to Wear
You will change into a hospital gown upon arrival, so wear loose-fitting clothes that are easy to remove.
Leave all valuables, including jewelry, at home.
Food and Drink
Avoid eating or drinking after midnight on the eve of your surgery.
Medications
Stop taking certain medications that may cause bleeding; ask your healthcare provider for guidance on a timeframe for this.
Before surgery, tell your healthcare provider all of the drugs you are taking including prescription and over-the-counter medications, dietary supplements, herbal remedies, and recreational drugs.
What to Bring
On the day of your surgery, be sure to bring:
If you are staying overnight in the hospital, remember to pack a bag with:
Arrange for someone to drive you home once you are discharged.
Pre-Op Lifestyles Changes
Stop smoking prior to surgery to lower your risk for surgical complications. The longer you stop smoking, the greater the benefits.
What to Expect on the Day of Surgery
On the day of your surgery, you will arrive at the hospital or surgical center/office and check-in.
Before the Surgery
You will be taken to a pre-operative room where you will change out of your clothes into a hospital gown.
A nurse will then review your medication list, record yourvitals, and place an intravenous (IV) line into a vein in your arm or hand.
Your surgeon will come to greet you and briefly review the operation. From there, you will be wheeled into the operating room on a gurney where the anesthesia process and surgery will begin.
During the Surgery
Kidney surgery may be performed under general or regional anesthesia, depending on the specific surgical procedure being performed.
The steps of kidney stone surgery depend on the surgical technique/approach being used.
Since ureteroscopy is a common surgery used to remove kidney stones, especially those that have failed shock wave lithotripsy, let’s review the basics steps of that surgical procedure as an example:
After the Surgery
In the recovery room, a nurse will monitor yourvital signs. Once you are fully awake and alert, you will be discharged home.
If you are staying in the hospital, you will be wheeled to a hospital room.
If your stone was broken into fragments, you may be given a medication calledFlomax (tamsulosin). This helps facilitate thepassing of the stone fragmentsout of the body in your urine.
You will likely be asked to strain your urine through a filter to capture the stone fragments. Save any you find and bring them to your healthcare provider. The fragments will be sent off to a pathology lab for chemical analysis.
Symptoms You Might Experience
Some symptoms you may experience after kidney stone removal can seem alarming, but are usually normal. These include:
Of course, if you are ever concerned about any symptoms you are experiencing—especially if they persist for more than a few days—call your surgeon.
When to Seek Medical AttentionCall your surgeon right away or go to the emergency room if you experience any of the following symptoms:Fever or chillsSevere pain, which may be a sign of a blockage or other surgical complicationHeavy bleeding or blood clots in your urine, which may be a sign of bleeding around the kidneySigns of a urinary tract infection like burning when you urinate or foul-smelling urineSigns of a wound infection like increased warmth/redness/swelling/tenderness around your incision site(s)
When to Seek Medical Attention
Call your surgeon right away or go to the emergency room if you experience any of the following symptoms:Fever or chillsSevere pain, which may be a sign of a blockage or other surgical complicationHeavy bleeding or blood clots in your urine, which may be a sign of bleeding around the kidneySigns of a urinary tract infection like burning when you urinate or foul-smelling urineSigns of a wound infection like increased warmth/redness/swelling/tenderness around your incision site(s)
Call your surgeon right away or go to the emergency room if you experience any of the following symptoms:
Activity
The overall recovery timeline from kidney stone surgery depends on the type of surgery performed.
Generally speaking though, you can likely return to your normal activities after about two to three days if you underwent shock wave lithotripsy or a ureteroscopy.
Recovery from the other procedures takes longer. For example, expect around one to two weeks for percutaneous nephrolithotomy and four to six weeks for open surgery.
Long-Term Care
Around two to three months after your kidney stone surgery, your healthcare provider (usually a kidney specialist called anephrologist) will order an imaging test. This is done to ensure that you are completely stone-free and that all stone fragments have been removed.
In addition, based on the chemical analysis of your stone, your practitioner will devise a plan for you to help prevent future stones from forming.
Three keystone-prevention strategiesinclude:
Possible Future Surgeries
Office-based procedures are typically used to remove a ureteral stent or nephrostomy tube (under local anesthesia).
Future surgical procedures may be warranted if stone fragments are left behind or if a stone forms again.
A Word From Verywell
Kidney stones are common and may occur because of different factors including genetics, diet, fluid intake, and medications, to name a few.
If you or a loved one has a stone that needs to be surgically removed, be sure to carefully review your options with your urologist. Choose the surgery that is going to be the most effective and comfortable for you.
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18 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Preminger GM. Kidney stones in adults:Surgical management of kidney and ureteral stones. Goldfarb S, O’Leary MP eds. UpToDate. Waltham, MA: UpToDate.Neisus A, Lipkin ME, Rassweiler JJ, Preminger GM, Knoll T.Shock wave lithotripsy; the new phoenix?World J Urol.2015 Feb;33(2):213-21. doi:10.1007/s00345-014-1369-3Johns Hopkins Medicine.Ureteroscopy.National Kidney Foundation.Ureteroscopy.Assimos D, Krambeck A, Miller NL et al.Surgical Management of Stones: American Urological Association/Endourological Society Guideline, Part II.J Urol.2016 Oct;196(4):1161-9. doi: 10.1016/j.juro.2016.05.091Mayo Clinic.Percutaneous nephrolithotomyUniversity of Michigan Medicine.Open surgery for kidney stones.National Kidney Foundation.Kidney stone treatment: shock wave lithotripsy.Johns Hopkins Medicine.Lithotripsy.De Coninck V, Keller EX, Somani B et al.Complications of ureteroscopy: a complete overview.World J Urol.2020 Sep;38(9):2147-2166. doi:10.1007/s00345-019-03012-1de la Rosette J, Assimos D, Desai M et al.The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients.J Endourol. 2011 Jan;25(1):11-7. doi:10.1089/end.2010.0424Assimos D, Krambeck A, Miller NL.Surgical Management of Stones: American Uological Association/Endourological Society Guideline, Part II.J Urol.2016 Oct;196(4):1161-9. doi: 10.1016/j.juro.2016.05.091University of Utah.What to expect at your kidney stone surgery.Pierre S, Rivera C, Le Maître B et al.Guidelines on smoking management during the perioperative periods.Anaesth Crit Care Pain Med.2017 Jun;36(3):195-200. doi:10.1016/j.accpm.2017.02.002Wollin DA, Joyce AD, Gupta M et al.Antibiotic use and the prevention and management of infectious complications in stone disease.World J Urol.2017 Sep;35(9):1369-1379. doi: 10.1007/s00345-017-2005-9Pais VM, Smith RE, Stedina EA, Rissman CM.Does Omission of Ureteral Stents Increase Risk of Unplanned Return Visit? A Systematic Review and Meta-Analysis.J Urol.2016 Nov;196(5):1458-1466. doi:10.1016/j.juro.2016.05.109Fulgham PF, Assimos DG, Pearle MS, Preminger GM.Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA technology assessment.J Urol.2013 Apr;189(4):1203-13. doi:10.1016/j.juro.2012.10.031Harvard Health Publishing. Harvard Medical School.How to prevent kidney stones.Additional ReadingCakici OU, Ener K, Keske et al.Open stone surgery: a still-in-use approach for complex stone burden.Cent European J Urol.2017 Jun 30; 70(2): 179–184. doi:10.5173/ceju.2017.1205Johns Hopkins Medicine.Percutaneous nephrolithotomy (PCNL).Torricelli FCM, Monga M, Marchini GS, Srougi M, Nahas WC, Mazzucchi E.Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta-analysis of randomized controlled trials.Int Braz J Urol.2016 Jul-Aug; 42(4): 645–654. doi:10.1590/S1677-5538.IBJU.2015.0696
18 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Preminger GM. Kidney stones in adults:Surgical management of kidney and ureteral stones. Goldfarb S, O’Leary MP eds. UpToDate. Waltham, MA: UpToDate.Neisus A, Lipkin ME, Rassweiler JJ, Preminger GM, Knoll T.Shock wave lithotripsy; the new phoenix?World J Urol.2015 Feb;33(2):213-21. doi:10.1007/s00345-014-1369-3Johns Hopkins Medicine.Ureteroscopy.National Kidney Foundation.Ureteroscopy.Assimos D, Krambeck A, Miller NL et al.Surgical Management of Stones: American Urological Association/Endourological Society Guideline, Part II.J Urol.2016 Oct;196(4):1161-9. doi: 10.1016/j.juro.2016.05.091Mayo Clinic.Percutaneous nephrolithotomyUniversity of Michigan Medicine.Open surgery for kidney stones.National Kidney Foundation.Kidney stone treatment: shock wave lithotripsy.Johns Hopkins Medicine.Lithotripsy.De Coninck V, Keller EX, Somani B et al.Complications of ureteroscopy: a complete overview.World J Urol.2020 Sep;38(9):2147-2166. doi:10.1007/s00345-019-03012-1de la Rosette J, Assimos D, Desai M et al.The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients.J Endourol. 2011 Jan;25(1):11-7. doi:10.1089/end.2010.0424Assimos D, Krambeck A, Miller NL.Surgical Management of Stones: American Uological Association/Endourological Society Guideline, Part II.J Urol.2016 Oct;196(4):1161-9. doi: 10.1016/j.juro.2016.05.091University of Utah.What to expect at your kidney stone surgery.Pierre S, Rivera C, Le Maître B et al.Guidelines on smoking management during the perioperative periods.Anaesth Crit Care Pain Med.2017 Jun;36(3):195-200. doi:10.1016/j.accpm.2017.02.002Wollin DA, Joyce AD, Gupta M et al.Antibiotic use and the prevention and management of infectious complications in stone disease.World J Urol.2017 Sep;35(9):1369-1379. doi: 10.1007/s00345-017-2005-9Pais VM, Smith RE, Stedina EA, Rissman CM.Does Omission of Ureteral Stents Increase Risk of Unplanned Return Visit? A Systematic Review and Meta-Analysis.J Urol.2016 Nov;196(5):1458-1466. doi:10.1016/j.juro.2016.05.109Fulgham PF, Assimos DG, Pearle MS, Preminger GM.Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA technology assessment.J Urol.2013 Apr;189(4):1203-13. doi:10.1016/j.juro.2012.10.031Harvard Health Publishing. Harvard Medical School.How to prevent kidney stones.Additional ReadingCakici OU, Ener K, Keske et al.Open stone surgery: a still-in-use approach for complex stone burden.Cent European J Urol.2017 Jun 30; 70(2): 179–184. doi:10.5173/ceju.2017.1205Johns Hopkins Medicine.Percutaneous nephrolithotomy (PCNL).Torricelli FCM, Monga M, Marchini GS, Srougi M, Nahas WC, Mazzucchi E.Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta-analysis of randomized controlled trials.Int Braz J Urol.2016 Jul-Aug; 42(4): 645–654. doi:10.1590/S1677-5538.IBJU.2015.0696
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Preminger GM. Kidney stones in adults:Surgical management of kidney and ureteral stones. Goldfarb S, O’Leary MP eds. UpToDate. Waltham, MA: UpToDate.Neisus A, Lipkin ME, Rassweiler JJ, Preminger GM, Knoll T.Shock wave lithotripsy; the new phoenix?World J Urol.2015 Feb;33(2):213-21. doi:10.1007/s00345-014-1369-3Johns Hopkins Medicine.Ureteroscopy.National Kidney Foundation.Ureteroscopy.Assimos D, Krambeck A, Miller NL et al.Surgical Management of Stones: American Urological Association/Endourological Society Guideline, Part II.J Urol.2016 Oct;196(4):1161-9. doi: 10.1016/j.juro.2016.05.091Mayo Clinic.Percutaneous nephrolithotomyUniversity of Michigan Medicine.Open surgery for kidney stones.National Kidney Foundation.Kidney stone treatment: shock wave lithotripsy.Johns Hopkins Medicine.Lithotripsy.De Coninck V, Keller EX, Somani B et al.Complications of ureteroscopy: a complete overview.World J Urol.2020 Sep;38(9):2147-2166. doi:10.1007/s00345-019-03012-1de la Rosette J, Assimos D, Desai M et al.The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients.J Endourol. 2011 Jan;25(1):11-7. doi:10.1089/end.2010.0424Assimos D, Krambeck A, Miller NL.Surgical Management of Stones: American Uological Association/Endourological Society Guideline, Part II.J Urol.2016 Oct;196(4):1161-9. doi: 10.1016/j.juro.2016.05.091University of Utah.What to expect at your kidney stone surgery.Pierre S, Rivera C, Le Maître B et al.Guidelines on smoking management during the perioperative periods.Anaesth Crit Care Pain Med.2017 Jun;36(3):195-200. doi:10.1016/j.accpm.2017.02.002Wollin DA, Joyce AD, Gupta M et al.Antibiotic use and the prevention and management of infectious complications in stone disease.World J Urol.2017 Sep;35(9):1369-1379. doi: 10.1007/s00345-017-2005-9Pais VM, Smith RE, Stedina EA, Rissman CM.Does Omission of Ureteral Stents Increase Risk of Unplanned Return Visit? A Systematic Review and Meta-Analysis.J Urol.2016 Nov;196(5):1458-1466. doi:10.1016/j.juro.2016.05.109Fulgham PF, Assimos DG, Pearle MS, Preminger GM.Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA technology assessment.J Urol.2013 Apr;189(4):1203-13. doi:10.1016/j.juro.2012.10.031Harvard Health Publishing. Harvard Medical School.How to prevent kidney stones.
Preminger GM. Kidney stones in adults:Surgical management of kidney and ureteral stones. Goldfarb S, O’Leary MP eds. UpToDate. Waltham, MA: UpToDate.
Neisus A, Lipkin ME, Rassweiler JJ, Preminger GM, Knoll T.Shock wave lithotripsy; the new phoenix?World J Urol.2015 Feb;33(2):213-21. doi:10.1007/s00345-014-1369-3
Johns Hopkins Medicine.Ureteroscopy.
National Kidney Foundation.Ureteroscopy.
Assimos D, Krambeck A, Miller NL et al.Surgical Management of Stones: American Urological Association/Endourological Society Guideline, Part II.J Urol.2016 Oct;196(4):1161-9. doi: 10.1016/j.juro.2016.05.091
Mayo Clinic.Percutaneous nephrolithotomy
University of Michigan Medicine.Open surgery for kidney stones.
National Kidney Foundation.Kidney stone treatment: shock wave lithotripsy.
Johns Hopkins Medicine.Lithotripsy.
De Coninck V, Keller EX, Somani B et al.Complications of ureteroscopy: a complete overview.World J Urol.2020 Sep;38(9):2147-2166. doi:10.1007/s00345-019-03012-1
de la Rosette J, Assimos D, Desai M et al.The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients.J Endourol. 2011 Jan;25(1):11-7. doi:10.1089/end.2010.0424
Assimos D, Krambeck A, Miller NL.Surgical Management of Stones: American Uological Association/Endourological Society Guideline, Part II.J Urol.2016 Oct;196(4):1161-9. doi: 10.1016/j.juro.2016.05.091
University of Utah.What to expect at your kidney stone surgery.
Pierre S, Rivera C, Le Maître B et al.Guidelines on smoking management during the perioperative periods.Anaesth Crit Care Pain Med.2017 Jun;36(3):195-200. doi:10.1016/j.accpm.2017.02.002
Wollin DA, Joyce AD, Gupta M et al.Antibiotic use and the prevention and management of infectious complications in stone disease.World J Urol.2017 Sep;35(9):1369-1379. doi: 10.1007/s00345-017-2005-9
Pais VM, Smith RE, Stedina EA, Rissman CM.Does Omission of Ureteral Stents Increase Risk of Unplanned Return Visit? A Systematic Review and Meta-Analysis.J Urol.2016 Nov;196(5):1458-1466. doi:10.1016/j.juro.2016.05.109
Fulgham PF, Assimos DG, Pearle MS, Preminger GM.Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA technology assessment.J Urol.2013 Apr;189(4):1203-13. doi:10.1016/j.juro.2012.10.031
Harvard Health Publishing. Harvard Medical School.How to prevent kidney stones.
Cakici OU, Ener K, Keske et al.Open stone surgery: a still-in-use approach for complex stone burden.Cent European J Urol.2017 Jun 30; 70(2): 179–184. doi:10.5173/ceju.2017.1205Johns Hopkins Medicine.Percutaneous nephrolithotomy (PCNL).Torricelli FCM, Monga M, Marchini GS, Srougi M, Nahas WC, Mazzucchi E.Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta-analysis of randomized controlled trials.Int Braz J Urol.2016 Jul-Aug; 42(4): 645–654. doi:10.1590/S1677-5538.IBJU.2015.0696
Cakici OU, Ener K, Keske et al.Open stone surgery: a still-in-use approach for complex stone burden.Cent European J Urol.2017 Jun 30; 70(2): 179–184. doi:10.5173/ceju.2017.1205
Johns Hopkins Medicine.Percutaneous nephrolithotomy (PCNL).
Torricelli FCM, Monga M, Marchini GS, Srougi M, Nahas WC, Mazzucchi E.Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta-analysis of randomized controlled trials.Int Braz J Urol.2016 Jul-Aug; 42(4): 645–654. doi:10.1590/S1677-5538.IBJU.2015.0696
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