Important parameters in the management of ureteral stones are the size, number of stones and their composition. The elimination of controlled risk factors and behavioral changes are the initial general recommendations for patients harboring renal stones. Depending on the composition of the stone, oral treatment can be administered for dissolution of the stone. Depending on the size of the stone different minimally invasive procedures are indicated for the treatment of renal stones. Currently open surgeries are performed in only 1-2% of all renal stone cases.

– Extracorporeal shock wave lithotripsy
Exytracorporeal shock wave lithotripsy is a method of choice for the treatment of 1-2cm renal stone. But the success of the method depends on many factors including the size, location, composition and hardness of the stone. In addition, in important role predicting the outcomes is the patient’s body mass (i.e obesity). During extracorporeal lithotripsy, the patient lies on a device called Lithotripter. Fluoroscopy is used to identify and target the stone. The shock waves are generated outside the body and directed to the target (in this case stone). The latter leads to the fragmentation of the stone. Thereafter, the fragments are expelled with the urine. The procedure usually does not require any anesthesia. The duration of the procedure is 45-60 minutes. Patients can then go home if no side effects are observed. During the first post-procedural hours patients can have some minor discomfort or bloody urine (hematuria). Serious complications (such as renal trauma) are extremely rare after shock wave lithotripsy and are usually treated conservatively.

– Flexible ureteroscopy
Flexible ureteroscopy is another treatment modality for renal stones of 1-2cm size in diameter. This procedure is especially preferred for stones localized in lower calyx. This method is performed by the introduction of a tool called ureteroscope through the urethra and bladder into the ureter. The stone is identified and fragmented or dusted using a laser lithotripsy device. Current lasers allow fragmentation of stones with any composition. The generated fragments are removed by using a special endoscopic basket. In most of the cases stents are placed in the ureters in the end of the surgeries allowing easier passage of the stone fragments. The use of flexible ureteroscope allows to reach renal stone in any localization. The use of ureteroscope by an experienced urologist gives solutions to many problems with minimal burden to the health of the patient. The patient is usually dismissed from the hospital the next day after the surgery. If a ureteral stent is placed during the surgery patients are advised to return in 3-4 weeks for its. The removal procedure is done under local anesthesia, lasts about 5 minutes and is not painful.The main postoperative complications of ureteroscopy are hematuria and urinary tract infection leading to prolonged hospitalization. Symptoms such as urinary frequency, minor hematuria or minor discomfort during urination in postoperative period are generally associated with ureteral stents and pass when the stents are removed.

– Percutaneous lithotripsy
Percutaneous nephrolithotripsy is the preferred treatment modality for renal stones > 2cm. The procedure is fast and is associated with the best stone clearance results. This method is performed by percutaneous puncture of the kidney under fluoroscopic guidance, introduction of special endoscopic wires and placement of a special sheath that provides a channel between the skin and kidneys. Through this channel a tool called nephroscope is introduced, the stone is recognized and disintegrated by the use of ultrasonic lithotripter. The fragments are removed with the aid of an endoscopic forceps.The above instruments method provide solution to renal calculi with minimal burden on the health of the patient and treat successfully even large stones that occupy the entire cavity of the kidney drainage (staghorn stones). Renal stones that have failed conservative or extracorporeal lithotripsy treatment have also indication for percutaneous nephrolithotripsy. The patient is dismissed from the hospital on the fourth day after the surgery. A nephrostomy tube remains in place for the above time period and removed the day of discharge. The removal process takes 1 minute and is not painful. The procedure is associated with a number of complications which in experienced-hands are rare. Complications that might be encountered are bleeding, pneumothorax and infection leading to prolonged hospitalization. Most of the complications are managed conservatively only 1% of patients requiring any additional intervention.