Treatment methods

Kidney stones: Treatment without surgery

Many stones can be excreted in the natural way, quite simply at home. The process can also be supported by appropriate fluid intake. It may be necessary to administer pain relief. 
The stone should then be analysed to find out the causes. 

In general, kidney stones should be removed if a chronic urinary tract infection is due to a blockage caused by a stone. The patient must then be carefully monitored until the infection is cured.

The medical intervention should only take place if other possibilities have failed or are not allowed to be applied. This may be necessary if a kidney stone has not spontaneously been passed after a certain period of time and causes permanent pain if it is too large or stuck for spontaneous passage. The same applies if it prevents urine flow or causes permanent urinary tract infections. An increase in size on the X-ray or permanent blood in the urine are further reasons for an intervention. 

Extracorporeal shockwave therapy (ESWL)

ESWL is most commonly used for kidney stones. During this, pressure waves are generated outside the body, which are focused on the stone from the outside through the skin and tissue and break it up into sand-like particles. The stone can then easily be excreted in the urine through the urinary tract. The locating and positioning process is performed with the aid of ultrasound or X-rays. This does not require a general anaesthetic; immobilisation with pain medication is usually sufficient. In some cases, the treatment can be carried out on an outpatient basis. A thin ureteral splint may be necessary to prevent the ureter from being blocked by pieces of the stone. 

The recovery time following the ESWL treatment is usually so short that you can perform your daily tasks again after a few days. If a stone cannot be destroyed, the treatment is repeated.

Removing kidney stones with ureteroscopy

Stones in the middle and lower ureter can be removed with ESWL as well as with ureteroscopy. The doctor pushes a ureteroscope through the urethra into the bladder and, from there, into the ureter. This allows us to locate the stone, capture it with a basket and remove it or crush it on site with special instruments. A ureteral splint may sometimes also be necessary to allow the inner tissue of the ureter to heal better. 

Percutaneous nephrolithotomy (PCNL)

If the stone is in a position that does not allow ESWL to be performed, or if it is too large for ESWL treatment, what is known as PCNL is often recommended. In this minimally invasive endoscopic procedure, a small incision is made in the skin to form a tunnel directly to the kidney. Via this tunnel, we can use the endoscope (nephroscope) to penetrate to the kidney, and locate and remove the stone. In the case of larger stones, it may be necessary to crush the stone in the kidney. Probes are used to apply energy to the stone (electrohydraulic, ultrasound). This procedure generally requires a hospital stay of several days. A nephrostomy catheter remains in the wound during the healing process. In contrast to ESWL, PCNL actively removes the stones and does not have to follow their natural path.