Urologists often recommend kidney stone removal surgery when the size of the stone is either too big or when non-surgical procedures are ineffective against the stone. There are different techniques such as shockwave lithotripsy (ESWL), ureteroscopy (URSL), laser procedure (RIRS), and minimally invasive surgery (PCNL) for kidney stones removal.

The size of our ureter is around 3-4mm. When the size of the stone is large enough to pass on its own, it may get stuck in the kidneys, ureter, urinary bladder, etc. resulting in unbearable pain. In such cases, kidney stone removal surgery becomes inevitable. Modern kidney stone removal surgeries are usually done as daycare procedures which means the patient does not require more than 1-day hospitalization. However, in case of any complications, the doctor may ask you to stay back until your recovery.

Hence, doctors can recommend RIRS, URSL, ESWL for stone sizes less than 14mm to 15mm and minimally invasive surgery or PCNL for stone sizes greater than 15mm. The cost of kidney stone treatment can vary depending on the type of procedure. Here is the approximate cost of different kidney stones removal procedures –

• ESWL– Rs. 40,000 – Rs. 50,000
• PCNL– Rs. 65,000 – Rs. 75,000
• RIRS– Rs. 95,000 – Rs. 1,05,000
• URSL– Rs. 40,000 – Rs. 65,000

However, the cost of surgery can vary depending on the choice of surgeon or urologist, selection of hospital, number of stones, size of stones, cost of non-medical items, insurance coverage, post-consultation charges, etc.

RIRS (Retrograde Intrarenal Surgery)

RIRS is an advanced procedure to treat kidney stones with sizes between 8mm to 15mm. First, the anesthesia doctor will administer either spinal or general anesthesia. In spinal anesthesia, the patient is sedated below the waist, whereas, in general anesthesia, the patient is asleep throughout the surgery. The urologist then uses a thin, flexible endoscope fitted with a tiny laser on the other end. The location of stones is determined by the x-rays and imaging tests that guide the surgeon inside the patient’s body. The stones are either removed using forceps or subsequently broken into smaller fragments with tiny lasers. The stone pieces are then expelled from the body through urine. 

The surgeon may insert ureteral stents through your urethra into the ureter. Stents enlarge the passage of the urinary tract for smooth movement of stones. Stents are usually kept for 10-14 days depending on how long it takes for stone fragments to fully flush out of the body. Stent removal can be done on the same day or during the subsequent visit to the surgeon. In the case of staghorn calculus(a type of kidney stone that resembles the horns of a stag), you may require two to three sittings to completely get rid of stones in the case of RIRS.

ESWL (Extracorporeal Shock Wave Lithotripsy)

ESWL is also known as extracorporeal shockwave lithotripsy. It is a non-invasive surgery where the doctor uses external shock waves to break the kidney stone into smaller pieces. The patient is administered spinal anesthesia to reduce the pain when the stones are expelled from the body. ESWL is a conventional procedure that may require multiple sittings to break the stones completely.

URSL (Ureteroscopic Lithotripsy)

In URSL, the patient is administered spinal or general anesthesia. The surgeon, then, uses a thin tube called a ureteroscope that is passed into the ureter with a camera and laser on the other end. The camera locates the stones while the laser subsequently breaks the stone into smaller fragments. These smaller pieces are flushed out through urine. The urologist inserts stents into the ureter to enlarge the ureter opening for smooth movement of stones. The stents are kept inside until the stones are thoroughly flushed out of the body. 

PCNL (Percutaneous Nephrolithotomy)

Percutaneous Nephrolithotomy is a minimally invasive surgery for treating kidney stones with a size greater than 15mm. It is also known as tunnel surgery due to the nature of tiny incisions. The anesthesiologist administers general anesthesia before the surgery so the patient feels no pain. The patient will be asleep throughout the surgery. Then, the surgeon will make a minor incision (around 1cm) on the flank area (lower back area). The surgeon uses a nephroscope to locate and break the stones into pieces. The stone can be removed in its intact form or if the size of the stone is too large, it is broken into smaller pieces and flushed out. 

A kidney stone procedure can be stressful, but if you know what to expect, it becomes easier for the patient emotionally and mentally. Here are some tips that can help you prepare for the kidney stone removal procedure –

• You must inform your urologist about any ongoing medications and current health conditions before the procedure. 
• It is also important to inform the surgeon about any history of allergies related to anesthesia.
• Do not smoke tobacco or anything else before your kidney stone removal surgery.
• Consult your doctor before taking any medicines prior to the kidney stone procedure. Some medications such as blood thinners can result in complications during the surgery. 
• Patients must not eat or drink 8 to 9 hours prior to the surgery.
• Have someone drive you home after the surgery as you may feel tired and exhausted after the procedure.
• The doctor may insert stents in your ureter via the urethra, which may be kept there for two to three weeks to enlarge the ureter and help drain the kidneys.

After the diagnostic tests, the kidney stone specialist recommends the course of procedure based on the size, location, and the number of stones. Therefore, depending on the type of kidney stone removal procedure, the surgeon may perform different methods and techniques. Here is what you can expect during the kidney stone removal procedures –

ESWL – 

• The doctor will administer spinal anesthesia before the procedure.
• You will be made to sit inside a water-filled tub or cushion. 
• The doctor will use external shockwaves/soundwaves to break the stones into smaller pieces. 

URSL and RIRS

• You will be given spinal or general anesthesia before the procedure. 
• A medical device called a ureteroscope will be inserted inside the ureter through the urethra to reach the location where the stone is present. 
• The doctor may also insert stents which may be kept until the stones are completely flushed out of the body. 
• Once the stones are removed, the doctor may remove stents on the same day or during the consecutive visit to the doctor. 

PCNL

• The anesthesia doctor administers general anesthesia before the procedure. 
• The surgeon then makes a tiny incision (about 1cm) in the flank area to access the site where the stone is located. 
• Once the stones are removed, the surgeon seals the site of the incision using sutures. 
• The surgeon may also insert stents if it is deemed necessary.

• The urologist will prescribe you medicines such as pain relievers and alpha-blockers to relax and open your ureter for a certain period after the kidney stone removal procedure. This allows the smooth movement of stones and reduces pain and discomfort. 
• There may be mild bleeding during urination due to stent insertion. However, this is normal and you can expect little bleeding in the urine for the first few days after the surgery, especially if there are ureteral stents present. In case you suspect heavy bleeding, contact your medical professional. 
• The surgeon may examine your kidney stone pieces for lab tests. This helps the doctor in understanding the primary composition of the stones to avoid certain diets and prevent a recurrence.
• The stents may be kept inside the ureter for a desired period of time after the surgery. Once the surgeon is convinced that stone fragments are fully flushed out of the body, he or she may remove the stent in the same sitting or during the post-surgery consultation. 
• In the case of ESWL, the patients may feel slight soreness and bruise around the area where the lithotripter was in contact with the skin. 
• You may also experience pain and nausea as the remaining stone fragments pass through the urinary tract.