A nephrolithotomy is a surgical procedure that removes kidney stones.

Kidney stones are made

of crystallized minerals found in urine and are formed when urine is super-saturated with certain
minerals that can cause stones. They can form in patients who have low urinary output, excrete a
lot of salt or have acidic urine. Kidney stones range in size from microscopic crystals to the size of
a golf ball, and they may sometimes pass out of the body in a urine stream. If they are large, their
passage from the kidney, through the urethra, and out of the body can be very painful.A
nephrolithotomy is performed to relieve a patient’s pain or to remove blockages caused by kidney
stones. The surgery is usually performed on patients who have kidney stones that are larger than
1 inch (2 cm) in diameter, that block the flow or urine from the kidney, and that cannot be treated
by other means. The first nephrolithotomy was performed in 1973, and the surgery has a 95%
success rate.Patients undergoing nephrolithotomy receive general, regional, or spinal anesthesia
before the procedure begins. First, the kidney stone’s location must be determined, and then a
small incision is made in the patient’s lower back. A needle is passed through the incision into the
kidney and a guide wire is passed through the needle. A tube is then passed over the guide wire,
and the stone is removed through the tube.Patients who undergo nephrolithotomy can often
expect to remain in the hospital for two or three days after the procedure. A patient will also most
likely have a catheter in his or her kidney that will remain to drain urine until the kidney heals.
Patients will be encouraged to drink large quantities of water during the healing process; it is
normal to have some blood present in the urine. Most patients can return to work after a few
weeks
The risks of a nephrolithotomy include bleeding, kidney perforation, and injury to other abdominal
organs. Bleeding may occur if there is injury to blood vessels during the surgery. The kidney may
be nicked by a scalpel, but this complication is not serious and it usually corrects itself. A rare, but
more serious, complication is injury to organs near the kidneys. In some cases, there has been
damage to the spleen, liver, or gallbladder.

General advice
The operation should not be underestimated, but practically all patients are back to their normal duties
within two months. These notes will help you through your operation. They are a general guide. They do
not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems,
please ask the doctors or nurses. Possible complications As with any operation under
general anaesthetic, there is a very small risk of complications related to your heart
and lungs. The tests that you will have before the operation will make sure that you
can have the operation in the safest possible way and will bring the risk for such
complications very close to zero.
Complications are relatively rare. If you think that all is not well, please let the
doctors and the nurses know. Bruising and swelling may be troublesome. The
swelling may take four to six weeks to settle down. A wound infection happens in 1-
2% of cases and settles down with antibiotics in a week or two.
The drainage tube near the wound may drain old blood for up to a week. This
drainage settles down. Very rarely, it doesn’t settle down or gets worse in the first
few hours/days after the operation. This means that some damage has occurred
during the operation in one of your blood vessels or other organs of your abdomen
and you will most likely need another operation to fix the problem.
Chest infections may arise, particularly in smokers. Do not smoke. Getting out of bed
as quickly as possible, being as mobile as possible and co-operating with the
physiotherapists to clear the air passages is important in preventing a chest
infection.
Aches and twinges may be felt in the wound for up to six months. Occasionally there
are numb patches in the skin around the wound which get better after two to
threemonths.Sometimes (2-3%of cases) there is a leak of urine through the wound or from the
drain site. This settles down within a week or so. Very rarely, you will need another operation to
fix this problem. Sometimes stones reform. This will be discussed with you.
Nephrolithotomy - removal of kidney stone
There are one or more stones in your kidney. Stones cause pain, infection or bleeding,
and can damage the kidney. The stone(s) need to be taken out. This operation is called
a nephrolithotomy. You have two kidneys. They lie deep in your back on either side of
your spine, in front of the lowest rib on each side. The kidneys make urine which passes
down a tube (ureter) on each side to the bladder just below your tummy button. The
stones usually lie where the ureter joins the kidney and can be taken out through an
opening in the top of the ureter. Sometimes the kidney is so badly damaged by the
stone(s) that it needs to be taken out as well. Sometimes just part of the kidney is taken
out with the stone(s) to help the urine drain out of the kidney better. You will have
enough kidney tissue after the operation to make urine properly.

The operation

You will have a general anaesthetic, and will be asleep for the whole operation. A cut is
made in the skin over your kidney, usually round the back in the line of your lowest rib.
Sometimes the cut is made in the front of the tummy, especially when the kidney is to be
taken out. The stone(s) are taken out, with or without the kidney. The wound is stitched
up. Usually within 10 days you will feel fit enough to leave hospital provided there is
someone to look after you.

Ureterolithotomy

There is a stone in the tubing, in the ureter, that runs from your kidney to your bladder. You have
two kidneys, a left and a right one. They are each about the size of a fist. They lie deep in your
back on each side of your spine, in front of the lowest rib on each side. They make the urine
which passes down the ureter on each side to the bladder just below your navel. Stones from the
kidney can pass down the ureter causing pain, blood in the urine, infection, or can block the
ureter causing pressure on the kidney. Often the stones pass right through by themselves. In your
case, however, the stone has stuck in the ureter. It needs to be taken out with an operation.

The Operation

You will have a general anaesthetic, and will be asleep for the whole operation.
Sometimes the stone in the ureter can be pulled out by a special telescope passed up
into your bladder through the normal urine passage. Otherwise a cut has to be made into
the skin. The stone is then taken out through an opening in the side of the ureter. The
wound is then stitched up. If the stone can be removed with the special telescope, you
should be able to leave hospital within 24 hours. Otherwise you should allow seven days
or so in hospital.
Possible Complications

As with any operation under general anaesthetic, there is a very small risk of
complications related to your heart and lungs. The tests that you will have before
the operation will make sure that you can have the operation in the safest
possible way and will bring the risk for such complications very close to zero. For both
types of operations, complications are relatively rare. If you think that all is not well,
please ask the doctors and the nurses.

Chest infections may arise, particularly in smokers. Do not smoke. Getting out of bed as
quickly as possible, being as mobile as possible and co-operating with the
physiotherapists to clear the air passages is important in preventing a chest infection.

Sometimes there is blood in the urine. If the doctors expect this, a catheter is usually put
in at the time of the operation. It may take some days to clear. You will need to stay in
hospital until it gets better.

Sometimes you can have an infection which is either localised in your urinestream or gets
into the bloodstream. You will be given antibiotics to treat the infection.