Care at NUH

Services for Kidney Stones

Extracorporeal Shock Wave Lithotripsy (ESWL)

ESWL is a non-invasive method for treating both kidney and certain ureteric stones. This procedure involves using targeted high-energy shock waves to shatter the stone into tiny pieces. The smaller fragments can then be naturally passes out in urine. Sedation or light anaesthesia is typically required, and on-demand intravenous painkillers may be administered as the shock waves can be painful. 

Services for Kidney Stones

What are the possible complications?

Some complications that may occur with ESWL include:

  • Blood in the urine
  • Bruising on the back or side of treatment
  • Bleeding around the kidney and adjacent organs
  • Discomfort as stone fragments pass through the urinary tract
  • Blockage of urinary tract from stone fragments, which will require another procedure

What should you expect?

On the day of the treatment, you will be asked to lie on an operating table, and a soft cushion will be placed behind your body to position the stone ideally. The entire treatment lasts approximately 60 minutes, after which you will be monitored for an hour before discharge. 

In certain cases, a second round of ESWL (or alternative methods for stone removal) will be required, as the stones may not be completely fragmented. It may also take up to a few weeks to months for fragments to pass completely after treatment. 
Although this is a common option for kidney stones, larger and harder stones may not respond well. Also, X-ray is used to locate the stone; hence, pregnant women or those with stones that are not visible on X-ray will not be suitable to undergo ESWL. 

Percutaneous Nephrolithotomy (PCNL)

When the kidney stones are too large or complex for Extracorporeal Shock Wave Lithotripsy (ESWL), another treatment option is Percutaneous Nephrolithotomy (PCNL). This operation involves a small incision over the side, where an instrument called a nephroscope is passed into the kidney, and the stone is directly visualised and broken down with either an ultrasonic, pneumatic or laser device. Depending on the size and type of stone, there is also an option of newer miniaturised access techniques, allowing the skin incision to be as small as possible. 

Services for Kidney Stones

After the operation, you will usually need to be warded overnight for observation. You may also have a temporary catheter placed in your side, which can be removed after a day or two, a decision made by the doctor. 

What are the possible complications?

Some complications that may occur with PCNL include:

  • Bleeding, in rare occasions needing blood transfusion
  • Urinary tract infection
  • Injury to the kidney and surrounding organs

In some cases, more than one incision may be necessary to reach all the stones in the kidney. In cases with kidney stone fragments remaining, further procedures may be required. 

With improved technology and equipment, kidney stones can be treated with a more personalised approach. In cases where patients present with many large kidney stones, a tailored solution involves using endoscopic combined intrarenal surgery intrarenal surgery (ECIRS), which integrates concurrent PCNL and ureteroscopy to optimize sone clearance within a minimal operative timeframe. 

Stone Prevention Clinic Service

An important aspect in the treatment of urinary stones involves the prevention of their formation, especially considering that certain individuals may be more susceptible to stone formation than others. In collaboration with our renal medicine colleagues, we have established a multi-disciplinary stone clinic service designed to address the needs of patients with complex recurrent or metabolic stone diseases. 

To minimise the risk of urinary stone formation, consider the following advice: 

  • Increase fluid consumption (urine should be lightly-coloured)
  • Reduce salt intake
  • Reduce meat intake
  • Reduce intake of oxalate-rich food (e.g. peanuts, tea, coffee, spinach, etc.)
  • Moderate consumption of calcium
Ureteroscopy and Laser Lithotripsy

A ureteroscope will be carefully inserted through the urethra into the ureter, enabling visualisation and fragmentation of the stone using high-power laser. This procedure is minimally invasive, involving no cuts on the skin. It is routinely performed for the treatment of ureteric or kidney stones, conducted under general anaesthesia. Following the procedure, an overnight stay for observation is typically recommended. 

Services for Kidney Stones

What are the possible complications?

Some complications that may arise with this procedure are:

  • Blood in the urine
  • Urinary tract infection
  • Incomplete stone clearance, which require additional procedures
  • Narrowing of the ureter in future due to scarring
  • Rare, ureteric injuries including avulsion

What else should you expect?

Depending on the condition of the ureter after stone clearance, the doctor may introduce a temporary ureteric stent for several weeks to allow healing. A ureteric stent is a flexible hollow tube typically made of polyurethane or silicon, allowing urine to drain from the kidney into the bladder. Expect the possibility of lightly blood-stained urine or slight discomfort in the bladder or kidney for the first few days after stent insertion. This stent can be removed during the next visit to the doctor. 

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