What Are the Different Types of Kidney Stone Surgery?

There are several types of kidney stone surgery, each suited for different sizes and locations of kidney stones. Here is an overview of the most common procedures:

Open Nephrolithotomy or Renal Stone Surgery
This is a traditional method where a 3-5 cm incision is made in the flank. The kidney is then opened, and the stone is removed directly. A stent is often placed through the kidney and into the ureter to aid healing and drainage. Although this method was once common, it is now rarely used due to its invasive nature, longer recovery time, and higher risk of complications such as significant blood loss.

Percutaneous Nephrolithotomy (PCNL)
This procedure is typically recommended for larger kidney stones, usually those greater than 2 cm in diameter. It involves making a small incision in the back and inserting a nephroscope directly into the kidney. For stones around 2-3 cm, a 16mm or 18mm access sheath is often sufficient. In cases of very large or complex stones, such as staghorn calculi, a larger access channel may be needed for more efficient stone removal. Recently, miniaturized techniques using a 4.8mm channel have also been developed for less invasive treatment of smaller stones.

Ureteroscopic Lithotripsy (URS)
For smaller kidney stones, especially those located in the lower part of the kidney, ureteroscopy is often the preferred method. A thin, flexible scope is passed through the urethra and bladder into the ureter and kidney. Using laser energy, the stone is fragmented into smaller pieces that can either be removed or passed naturally through the urine. This method is minimally invasive and allows for a quicker recovery compared to open surgery.

Each of these procedures has its own advantages and is selected based on the patient's specific condition, including stone size, location, and overall health.