KIDNEY AND STONES

Laser Surgery for Kidney Stones: How It Works and What to Expect

Laser surgery for kidney stones is one of the most effective and minimally invasive treatments available for removing stones from the urinary tract.

Laser surgery for kidney stones, known as ureteroscopy with laser lithotripsy, uses a thin telescope passed through the urinary tract and a laser to break stones into tiny fragments or dust.

There are no cuts on the skin, and most patients go home the same day or the next morning. It is used for stones that are unlikely to pass on their own, or that are causing pain, blockage or infection. Kidney stones are common. According to NICE, the lifetime prevalence of kidney stone disease is 13%, which means more than 1 in 10 people will develop a stone at some point in their life. Laser treatment has become one of the most widely used ways of treating them in the UK.

Mr Ammar Alanbuki is a Consultant Urological Surgeon at University Hospitals Sussex NHS Foundation Trust, with subspecialty training in endourology and stone disease from Norfolk and Norwich University Hospitals. He treats patients with kidney stones privately in Brighton, Hove, Haywards Heath, Gatwick and London.

What Is Laser Surgery for Kidney Stones?

Laser surgery for kidney stones is a minimally invasive procedure. A thin telescope called a ureteroscope is passed through the urethra and bladder and up into the ureter (the tube that drains urine from the kidney to the bladder) or into the kidney itself. When the stone is reached, a fine laser fibre passed through the telescope breaks it into small pieces or dust.

There are two main types of ureteroscope:

Semi-rigid ureteroscope: used mainly for stones in the lower and middle parts of the ureter
Flexible ureteroscope: can bend to reach stones higher in the ureter and inside the kidney. When used to treat stones within the kidney, the procedure is sometimes called retrograde intrarenal surgery (RIRS)

Because the telescope uses the body’s natural opening, no incisions are needed, and recovery is usually quicker than with keyhole surgery through the skin.

Its use has grown steadily. According to NICE guidance on renal and ureteric stones, the number of ureteroscopy treatments for kidney and ureteric stones in England rose by 49%, from 12,062 in 2009/10 to 18,066 in 2014/15.

Who Might Need Laser Stone Surgery?

Many small kidney stones pass on their own with pain relief and plenty of fluids. Research published in the British Journal of General Practice reports that stones smaller than 4 mm have a 95% chance of passing naturally within 40 days. Larger stones are much less likely to pass without help.

Laser surgery may be recommended when:

The stone is too large to pass naturally, or has not passed after a period of monitoring
The stone is blocking the flow of urine from the kidney
Pain is severe or keeps coming back
The stone is linked to repeated urine infections
You have only one working kidney, or reduced kidney function
Your job or circumstances make waiting for a stone to pass unsuitable, for example pilots or people who travel frequently for work

What is renal colic?

Renal colic is the severe pain caused when a kidney stone moves into the ureter and blocks the flow of urine. It usually starts suddenly in the side or back, below the ribs, and can spread to the lower tummy or groin. The pain often comes in waves and may be accompanied by nausea, vomiting, blood in the urine or needing to pass urine often.

Renal colic is usually assessed with a low-dose CT scan, which shows the size and exact position of the stone. It is treated first with pain relief, with anti-inflammatory medicines usually recommended as first-line treatment in NICE guidance. Some patients with a smaller stone in the lower part of the ureter may be offered a medicine called an alpha blocker to help it pass. If a stone does not pass, or keeps causing pain, laser surgery may be recommended.

How does laser surgery compare with other stone treatments?

The best treatment depends on the size, position and type of stone, as well as your general health. The main options are:

Shockwave lithotripsy (ESWL): shockwaves are focused on the stone from outside the body to break it up. No anaesthetic is usually needed, but fragments can take weeks to pass and more than one session may be required
Ureteroscopy with laser lithotripsy: the stone is treated directly through a telescope. NICE recommends it as the first-line treatment for ureteric stones of 10 to 20 mm, and as an option for kidney stones up to 20 mm
Percutaneous nephrolithotomy (PCNL): a keyhole operation through the back, recommended by NICE as the first-line treatment for kidney stones larger than 20 mm, including large branching (staghorn) stones

Mr Alanbuki will explain which option is best suited to your stone and why.

How Does the Laser Stone Surgery Procedure Work?

The procedure is usually carried out under general anaesthetic and follows these steps:

Assessment: before surgery, a CT scan confirms the size and position of the stone, and a urine test checks for infection. Any infection is treated with antibiotics first
Telescope insertion: the ureteroscope is passed through the urethra and bladder to reach the stone. A thin guidewire is often placed first to guide the telescope safely
Laser treatment: the laser breaks the stone into fragments or fine dust
Fragment removal: larger fragments are removed with a tiny basket, and fine dust is left to pass naturally in the urine. Fragments may be sent for analysis to find out what the stone is made of
Stent placement: a thin, soft tube called a ureteric stent may be placed between the kidney and the bladder to help urine drain while any swelling in the ureter settles

Procedure time varies with the size, number and position of the stones. Your surgeon will give you an estimate based on your scan.

What Type of Laser Is Used?

The holmium laser is the most widely used laser for kidney stone surgery in the UK. It can break all types of kidney stone, including hard stones, while limiting damage to the surrounding tissue.

Newer thulium fibre lasers are also used in some centres. They are designed to break stones into finer dust, which can then pass more easily. Both types of laser are effective, and the choice depends on the stone and the equipment available.

What Is Recovery Like After Laser Surgery for Kidney Stones?

Most patients go home the same day or the following morning. Many people return to light activities within a few days, although this depends on the size of the stone, whether a stent has been placed and the type of work you do.

You will usually be advised to drink plenty of fluids to help flush out any remaining stone dust, and you will be given pain relief to take at home. A follow-up appointment, often with a scan, is arranged to check that the stone has cleared.

What Can You Expect in the Days After Surgery?

It is common to have some temporary symptoms after surgery, including:

Blood in the urine
A burning feeling when passing urine
Needing to pass urine more often or urgently
Mild discomfort in the side or back

If a stent has been placed, it can cause discomfort in the side or bladder, especially when passing urine, as well as frequency and some blood in the urine. Stents are temporary and are usually removed after a few days to a few weeks, depending on your situation. Some stents have a thread attached so they can be removed easily, while others are removed with a short telescope procedure. Your surgeon will tell you when yours will be removed.

Drinking plenty of fluids and taking the pain relief you are given will help your recovery.

Are There Any Risks Associated With Laser Stone Surgery?

Laser stone surgery is generally safe, but as with any procedure there are risks. These include:

Urine infection, which can occasionally lead to a serious infection in the blood (sepsis) and needs urgent treatment
Bleeding
Discomfort from a ureteric stent
Fragments of stone remaining, which may need a further procedure
Injury to the ureter, which is rare
Narrowing of the ureter (stricture) as a later complication, which is rare

Your surgeon will discuss these risks and how they apply to you before you consent to surgery.

Can Kidney Stones Come Back After Laser Surgery?

Laser surgery removes the stones you have, but it does not stop new ones forming. According to research published in the British Journal of General Practice, kidney stones have a recurrence rate of 50% within 10 years, which is why prevention is an important part of follow-up.

You can lower your risk by:

Drinking enough water through the day to keep your urine pale
Reducing the salt in your diet
Avoiding very high-protein diets
Keeping to a healthy weight
Not cutting out calcium, as a normal intake of calcium from food helps reduce the risk of the most common type of stone

Some patients are offered tests to analyse their stone and their urine, so that prevention advice can be tailored to the type of stone they form. The NHS guide to kidney stones has more information.

Finding a Kidney Stone Specialist in Brighton, Sussex and London

If you have symptoms of a kidney stone, or a scan has shown a stone that has not passed, a specialist can advise whether it is likely to pass on its own or needs treatment.

Seek urgent medical help if you have:

Severe pain in your side, back or groin that does not settle with pain relief
A high temperature, shivering or feeling very unwell alongside kidney pain
Very little or no urine
Kidney pain and only one working kidney

These can be signs that a stone is blocking the kidney with infection, which needs emergency treatment.

Ready to Find Out More?

If you have been diagnosed with a kidney stone or have symptoms that concern you, book a consultation with Mr Ammar Alanbuki to discuss your options and whether laser surgery is suitable for you.