​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 such that the skin incision can be as small as possible.

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 in 1 - 2 days, which will be decided 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

Sometimes, more than one incision may be necessary to reach all the stones in the kidney. In some cases, there may still be remaining kidney stone fragments, which may require further procedures.

Advances in technology have allowed us to expand the treatments options for certain diseases. With better equipment, your kidney stones can be treated with a more personalised approach. For example, patients with many large kidney stones may require endoscopic combined intrarenal surgery (ECIRS), which involves concurrent PCNL and ureteroscopy, in order to achieve stone clearance in a minimal operative time.

​An important aspect of treating urinary stones is the prevention of stone formation. Certain individuals may be more susceptible to stone formation than others. As such, the Department of Urology has teamed up with our renal medicine colleagues to offer a multi-disciplinary stone clinic service, which is aimed at treating patients with complex recurrent or metabolic stone diseases.

Here are some advice to help reduce your risk of urinary stone formation:

• 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
  

​A small instrument (ureteroscope) will be passed from the urethra into the ureter, where the stone is seen and fragmented with high-power laser. There are no cuts on the skin and the procedure is considered minimally invasive. This is a common operation used to treat ureteric or kidney stones, and will be performed under general anaesthesia. After the operation, you will usually be warded overnight for observation.

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 insert a temporary ureteric stent for a few weeks to allow healing. A ureteric stent is a flexible hollow tube usually made of polyurethane or silicon that allows urine to drain from the kidney into the bladder. You may have lightly blood-stained urine or experience slight discomfort in the bladder or kidney for the first few days after stent insertion. This stent can be removed when you next see the doctor.