Options in the management of renal and ureteral stones in adults
- Glenn M Preminger, MD
Glenn M Preminger, MD
- Section Editor — Renal Ureteral Stones
- Professor of Urologic Surgery
- Duke University Medical Center
- Director of Education
- Endourological Society
- Section Editors
- Stanley Goldfarb, MD
Stanley Goldfarb, MD
- Editor-in-Chief — Nephrology
- Section Editor — Mineral and Bone Metabolism; Renal Ureteral Stones
- Professor of Medicine
- University of Pennsylvania School of Medicine
- Michael P O'Leary, MD, MPH
Michael P O'Leary, MD, MPH
- Section Editor — Urology
- Professor of Surgery, Harvard Medical School
- Senior Urologic Surgeon, Brigham and Women's Hospital
Considerable progress has been made in the medical and surgical management of nephrolithiasis over the past 20 years. Approximately 10 to 20 percent of all kidney stones require surgical removal, which is determined based upon the presence of symptoms and the size and location of the stones. Larger stones and proximal ureteral stones are less likely to pass spontaneously. (See 'Facilitation of stone passage' below and "Diagnosis and acute management of suspected nephrolithiasis in adults", section on 'Stone passage'.)
Stone removal is also indicated for pain or obstruction or for an infected struvite stone. On the other hand, no specific surgical therapy is required for asymptomatic stones, particularly those that are less than 5 mm in diameter.
Three minimally invasive surgical techniques that significantly reduce the morbidity of stone removal are available:
●Percutaneous nephrolithotomy (PNL)
●Rigid and flexible ureteroscopy (URS)
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- PERCUTANEOUS NEPHROLITHOTOMY
- - Procedural complications
- Rigid ureteroscopy
- Flexible ureteroscopy
- Indications for stent placement
- SHOCK WAVE LITHOTRIPSY
- OPEN STONE SURGERY
- MEDICAL THERAPY
- Prevention of new stone formation
- Facilitation of stone passage
- INFORMATION FOR PATIENTS