Kidney Stone Removal Surgery: Procedure, Recovery Time & Complications

What is a Kidney Stone?

A kidney stone is a hard pebble-like deposit that can form in the kidneys. It is made of minerals and salts that crystallize in the urine. Kidney stones can be divided into four types; calcium oxalate stones, struvite stones, uric acid stones and cystine stones. Kidney stones can be unbearable and may also cause blood in the urine. In some cases, they can block the flow of urine and cause infection or damage to the kidneys.

Kidney stones can be quite serious. If a stone gets lodged in the urinary tract, it can cause a lot of pain and even lead to infection. Therefore, in some cases, it may be necessary to have surgery to remove the stone.

Why is Kidney Stone Surgery Required?

When you are diagnosed with kidney stones, one of the first questions you may ask is, 'Why do I need surgery?'

Sometimes, kidney stones can pass from your body without surgery. But, if the stones are large and located in a difficult place, or are causing discomforting symptoms, then surgery is required.

Stones larger than 0.5 centimetres (5 mm kidney stones) cannot pass without surgery. Kidney stone surgery is necessary when conservative methods fail to offer relief. Complications such as bleeding or kidney injury can increase the need for immediate surgery.

When kidney stones are left untreated, they can grow bigger in size and can get trapped in the ureter and block urine from coming out of your body, causing hydronephrosis. Further, hydronephrosis can lead to kidney failure resulting in death. 

Kidney stones smaller than 5 mm pass through the body without surgery. Depending on the size of the kidney stones, the doctor can prescribe you medications or suggest surgical removal of kidney stones. Kidney stone medications help relieve the discomforting symptoms of the condition. For example, alpha-blockers relax the ureter muscles and allow stones to flush out smoothly without complications. 

Home remedies include dietary restrictions to avoid the minerals that can lead to kidney stones more often. Increasing citrate levels can lower the chances of the formation of kidney stones. So, you must limit oxalate-rich foods, increase your dietary calcium intake, avoid salty food, and minimise the consumption of vitamin C and animal protein.

Acupuncture can relieve the congestion and allow small stones to pass down the ureter. 

Surgical methods include Retrograde Intrarenal Surgery (RIRS), Extracorporeal Shock Wave Lithotripsy (ESWL), Ureteroscopic Lithotripsy (URSL), and Percutaneous Nephrolithotomy (PCNL).

The type of surgery you will have will depend on the size, location, and the number of stones. The surgeon will also consider your overall health and other factors that may impact the surgery.

The goal of kidney stone surgery is to remove the stones and relieve the pain and other symptoms that they are causing. In most cases, after the surgery is successful, the patient can return to their normal activities within a few weeks.

Your doctor will discuss the best option for you based on your individual situation.

Preoperative Preparation

• Before your kideny stone surgery, the team will give you some preoperative instructions. It will ensure that you are fully aware of what to expect and are ready for surgery.

• Stop drinking fluids and eating anything a few hours before your surgery, as prescribed by your doctor. It is because you will need to have an empty stomach for the surgery to avoid complications. 

• You will also need to arrive at the hospital with an empty bladder. It is because, during the surgery, they will use a urinary catheter to keep your bladder vacant to avoid complications during surgery. 

Day Before Surgery

• On the day prior to your surgery, you will need to arrive at the hospital for a preoperative appointment. You will meet with the anesthesiologist and other surgical team members, and they will go over your medical history and answer any questions you may have.

• Stop taking any antibiotics or blood thinners. You can eat or drink during the day, but you cannot eat or drink after midnight.

• You will receive instructions on how to prepare for your renal surgery. It usually includes fasting for a certain period of time before the procedure. Be sure to follow all the instructions carefully, as preparation is key to a successful surgery.

Procedure Day

• On the surgery day, you can arrive at the hospital early. You shall be asked not to drink or eat anything before the surgery. After a few quick tests, the surgery team will prepare an operating room for your kidney stone surgery.

• You will receive a local anaesthetic to numb the area of the incision or urethra.

Methods/Techniques of Kidney Stone Surgery

There are different methods of kidney stones treatment and each has its own benefits and drawbacks. Let's look at all kidney stone surgery procedures and compare them.

1. ESWL (Extracorporeal Shock Wave Lithotripsy)

Extracorporeal Shock Wave Lithotripsy uses shock waves to fragment kidney stones into smaller pieces. The patient receives local anaesthesia in the spinal area that prevents pain during the procedure. The patient might require multiple sessions of ESWL to get rid of kidney stones completely. This ESWL procedure is a non-invasive method of kidney stones treatment.

2. RIRS (Retrograde Intrarenal Surgery)

Retrograde Intrarenal Surgery treats larger kidney stones that are 8mm to 15mm big. This surgery is less invasive, and patients often recover quickly. At the time of surgery, the patient receives local anaesthesia in the spinal area below the waist or general anaesthesia to numb the whole body, depending on the type of pain. The X-rays determine the location of the kidney stones in the patient's body, helping the urologist operate on the right spot. A tiny laser fitted on a flexible endoscope breaks the kidney stones into smaller fragments and allows them to pass through urine. The doctor inserts stents (temporary tubes) into the patient's urethra to expand the urinary tract passage. The urologist can also use a pair of forceps to remove kidney stones from the body. This surgery to remove kidney stones is minimally-invasive.

3. PCNL (Percutaneous Nephrolithotomy)

Percutaneous Nephrolithotomy surgery for kidney stones is an endoscopic procedure of renal surgery. PCNL surgery for kidney stones can treat kidney stones larger than 15mm. It is a type of keyhole surgery for kidney stones. The patient receives general anaesthesia before the surgery. The surgeon makes a small incision on the lower back area of the patient and uses a nephroscope to track down the kidney stones and break them into smaller fragments.

4. URSL (Ureteroscopic Lithotripsy)

Ureteroscopy is a method of kidney stone removal involving a ureteroscope equipped with a camera and laser. The doctor passes the ureteroscope through the patient's ureter. The camera helps to locate the kidney stones and the laser breaks them into smaller pieces. Temporary stent is used to enlarge the urinary tract passage allowing smoother movement of kidney stones. 

These are the main four types of kidney stone surgery, but the doctor decides the method after a comprehensive review of the patient's condition. Kidney stone removal surgery costs can range from Rs. 50000 to Rs.1 Lakh depending on the seriousness of the surgery. Kidney stone laser surgery cost can vary from region to region. Various cities offer different ranges of medical expenses. You should discuss the best renal treatment option for you with your doctor. 

Recovery After Kidney Stone Surgery

Kidney stone laser surgery, in particular, takes place under general anaesthesia, so you can feel no pain during the surgery.  Different types of kidney stone surgery have different requirements and recovery time. Laparoscopic kidney stone surgery can take up to six weeks to recover. In kidney stone open surgery, the surgeon cuts a part of the patient's abdomen and removes the stone through the opening. Kidney stone surgery recovery time depends on the seriousness of the patient's condition. 

Pain after kidney stone surgery is common, but you can manage it with a few medications. Complications can increase the chances of a kidney stones treatment surgery failure. Laser surgery for kidney stones is less invasive compared to others. 

Even though some of the side effects of kidney stone removal can appear alarming, they are typically normal. These comprise:

• Any minor soreness at the incision sites: Find out from your doctor how to take the best possible care of these areas, including when you can safely take a shower.

• Nausea and pain: As kidney stone pieces exit your body through your urine tract, pain and nausea are frequent side effects. To alleviate these symptoms, your doctor may advise you to use painkillers and antiemetic drugs. 
• Soreness at the site of the tube insertion: If you have a nephrostomy tube put in, make sure to follow your doctor's directions for maintaining dry, clean skin around the tube.

You don't have to panic or get stressed when you face these situations. You should heed your doctor's instructions to cope with these situations. If the problem gets severe, then it is highly recommended for you to consult with your doctor. 

Post Procedure

After your kidney stone surgery is complete, you will be shifted to the recovery room for a short period of time. Some patients with minor renal surgery can go home on the same day. Once you are awake and alert from the effects of anaesthesia, you will be able to go home. Recovery time from person to person, but most people recover within a few days of kidney stone surgery.

There are a few things that you will need to keep in mind as you recover. For the first few days after the surgery, it's essential to take it easy and avoid any strenuous activities in your recovery period. You may also experience some pain and discomfort, which can be managed with OTC pain medication. Finally, drink plenty of fluids and eat healthy foods to help your body heal. Adding fresh lemon juice to your diet can speed up the recovery process. You must avoid fizzy drinks after your surgery and restrict the salt intake in your daily diet.

It may take at least two weeks to recover from any kidney stone surgery. You can get a complete recovery within seven weeks of your treatment if you follow the post-surgery instructions correctly and take timely medications. With a little bit of patience and care, you will be on your way to a quick and successful recovery.

Risk and Complications

Laser and laparoscopic removal are the two most common procedures for kidney stone surgery. Both of these approaches have their own risks and benefits, so it's essential to discuss them with your doctor before making a decision.

Stent discomfort is the most reported complication after kidney stone surgery, followed by Urinary Tract Infection (UTI). The risk of life-threatening complications is very low.

Some of the risks associated with laser surgery include the following:

• Infection

• Increased blood in the urine

• Urinary tract injury

• Shifting of the temporary stent

• Need of an additional surgery procedure to remove the remaining stone pieces

• Bleeding 

• Damage to the surrounding tissue

Some factors that can increase the complications of your kidney stone surgery are:

• Smoking

• Drinking

• Chronic Diseases

• Diabetes

• Obesity

The benefits of laser surgery include a shorter recovery time and less pain. 

Laparoscopic surgery has risks that include:

• Higher risk of injury to the bowel or other internal organs. 

• Prolonged urinary leakage

• The difficulty of friable pelvis closure

• Slipping stone in other cavities

• Abscess formation

• Prolonged ileus

• Urinary Tract Infections

The benefits of laparoscopic surgery also include a shorter hospital stay and less pain.

Treatment of large kidney stones can cause complications, and your surgeon should brief you about the procedure and the risks involved in removing large kidney stones.

Overall, the complications of a kidney stone surgery include:

• Sepsis

• Blocked Ureter

• Ureter Injury

• Pneumothorax

• Wound Infection

• Recurrent UTI

• Bleeding

• Pain

Both procedures also carry a risk of recurrence, so it's important to discuss your case with your doctor and choose the option that best suits your needs.