Which surgical interventions are used in the treatment of nephrolithiasis?

Updated: Jun 21, 2018
  • Author: Chirag N Dave, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

For an obstructed and infected collecting system secondary to stone disease, virtually no contraindications exist for emergency surgical relief either by ureteral stent placement (a small tube placed endoscopically into the entire length of the ureter from the kidney to the bladder) or by percutaneous nephrostomy (a small tube placed through the skin of the flank directly into the kidney).

Many urologists have a preference for one technique or the other. In general, however, patients who are acutely ill, who have significant medical comorbidities, or who harbor stones that probably cannot be bypassed with ureteral stents undergo percutaneous nephrostomy, whereas others receive ureteral stent placement.

In patients who are floridly septic or hemodynamically unstable, a percutaneous nephrostomy can be a faster and safer way to establish drainage of an infected and obstructed kidney, though airway concerns and other complicating factors such as anticoagulant use or sepsis-associated thrombocytopenia may sway providers towards retrograde stent placement. Ultimately when dealing with seriously ill patients requiring urologic decompression, discussion between urology, anesthesia and interventional radiology is key to determine the best course of treatment based on positioning and comorbid conditions. Broad spectrum antibiotics which are then tailored to sensitivities is also paramount whenever a UTI is suspected in conjunction with hydronephrosis or renal colic a septic patient.

The vast majority of symptomatic urinary tract calculi are now treated with noninvasive or minimally invasive techniques. Open surgical excision of a stone from the urinary tract is now limited to isolated atypical cases.


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