Extracorporeal shock wave lithotripsy (ESWL) is used to treat a wide range of patients with stones in the kidney or the ureter.
ESWL uses shock waves (sound waves) to break the stones into small pieces. The pieces then leave your body naturally during urination, so no incisions are needed. ESWL is an outpatient procedure, but anesthesia is required. You may be given a light sedative or a full general anesthetic, if necessary.
To be a good candidate for ESWL, you must be in reasonably good health, not have infected urine or a bleeding disorder and be able to take some type of anesthesia. It is also necessary that the stone being removed be no larger than two centimeters and that you have a direct flow of urine to the bladder.
This treatment option is not used if the stone is larger than two centimeters, or very hard, if there is a narrowing of the urinary tract below the stone, or if the patient is very overweight or has certain medical conditions.
The Minimally Invasive Urology Institute specializes in treating patients who have failed previous treatments and/or have very large stones, strictures or tumors. The Institute also treats children, patients with bleeding disorders or those who are extremely overweight.
Ureteroscopy is a minimally invasive endoscopic surgery that allows the surgeon to do surgery inside the ureter without making an incision. The ureteroscope enters through the natural opening of the body into the bladder and the ureter. Ureteroscopy is used for stones in the ureter, narrowing of the ureter (strictures), tumors and removal of foreign materials. The URS is an outpatient procedure performed under local, intravenous or general anesthesia. It has nearly a 100% success rate for ureter stones, and complications are very rare (fewer than 1%).
The Minimally Invasive Urology Institute specializes in using URS for difficult-to-treat cases, such as:
- Failed previous treatment attempts
- Stones too large for ESWL (lithotripsy)
- Strictures
- Tumors
- Stones in children
- Patients with bleeding disorders
- Patients with gross obesity
Retrograde Intrarenal Surgery (RIRS) allows the surgeon to do surgery inside the kidney without making an incision. The instrument for RIRS enters through the body's natural opening, through the bladder and the ureter, into the kidney.
RIRS is used for patients with stones in the kidney, narrowing of the outlet of the kidney or within the kidney (strictures) and tumors in the kidney. The RIRS is an outpatient procedure using local, intravenous or general anesthesia. Between 70 and 90% of kidney stones are successfully removed this way. Complications are very rare (fewer than 1%).
The Minimally Invasive Urology Institute specializes in using RIRS for difficult-to-treat cases, such as:
- Failed previous treatment attempts
- Stones too large for ESWL (lithotripsy)
- Strictures
- Tumors
- Stones in children
- Patients with bleeding disorders
- Patients with gross obesity
A combination of RIRS and ESWL is a unique treatment option offered at Cedars-Sinai Endourology Institute. It allows a wider range of kidney problems to be treated using minimally invasive procedures.
Percutaneous renal surgery is a minimally invasive endoscopic surgery method that allows the surgeon to do surgery within the kidney through a small tract. A tract is an opening created by a small incision through the skin and tissues directly into the kidney. A sleeve bridges the distance from the skin into the kidney. The surgeon guides endoscopic instruments through the sleeve into the kidney to operate. Candidates are patients with large kidney stones (too large for ESWL, RIRS or combination RIRS/ESWL), with both stones and strictures in the kidney and certain kidney tumors. Children with similar conditions are also candidates.
PCNL is usually performed under general anesthesia, and patients spend one night in the hospital. Between 80 and more than 90% of patients are stone-free after having this procedure, depending on stone size, location and the patient's anatomy. PCNL complications are rare (fewer than 3% of all cases).
The Minimally Invasive Urology Institute specializes in patients whose previous treatments failed or who have strictures, gross obesity, tumors, stones too large for other treatment options and children with these same conditions. Patients with bleeding disorders may not have PCNL treatment, but can usually be treated with RIRS.
