KIDNEY AND STONES

Kidney Stone Laser Surgery: Benefits, Risks, and Results

Kidney stone laser surgery removes stones too large to pass on their own. Learn its benefits, risks and results, with insight from Mr Ammar Alanbuki.

If you have a kidney stone that has not passed on its own, laser surgery is one of the main treatment options. It treats the stone directly through a thin telescope, without any cuts in the skin, and most people go home within a day. Understanding its benefits, risks and likely results can help you decide, with your specialist, whether it is the right choice for you.

Kidney stones affect a large number of people. Research published in the British Journal of General Practice puts the lifetime risk of kidney stone disease at 10 to 15%, so many people will need to weigh up treatment options at some point.

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

What Is Kidney Stone Laser Surgery?

Kidney stone laser surgery, or ureteroscopy with laser lithotripsy, is a procedure in which a thin telescope is passed through the urethra and bladder to reach a stone in the ureter (the tube between the kidney and the bladder) or in the kidney itself. A laser then breaks the stone into small fragments or fine dust. Larger fragments are removed with a tiny basket, and the dust passes naturally in the urine.

The procedure is usually carried out under general anaesthetic. A thin, soft tube called a ureteric stent is sometimes left in place for a short time afterwards to help urine drain while the ureter heals.

For a step-by-step guide to the procedure itself, see Laser Surgery for Kidney Stones: How It Works and What to Expect.

Who Might Be Suitable for Kidney Stone Laser Surgery?

Not every kidney stone needs surgery. Small stones often pass on their own: according to the British Journal of General Practice, stones under 4 mm have a 95% chance of passing naturally within 40 days. Larger stones, or stones in awkward positions, are less likely to pass and may need treatment.

Laser surgery may be recommended if:

The stone is unlikely to pass because of its size or position
A stone has not passed after a period of monitoring
The stone is blocking the kidney or causing repeated episodes of severe pain (renal colic)
The stone is linked to repeated urine infections
You have only one working kidney or reduced kidney function
Shockwave treatment is unsuitable or has not worked

NICE guidance on renal and ureteric stones recommends ureteroscopy as the first-line treatment for stones of 10 to 20 mm in the ureter, and as an option for kidney stones up to 20 mm. Kidney stones larger than 20 mm are usually treated with percutaneous nephrolithotomy (PCNL), a keyhole operation through the back. Some smaller stones are suitable for shockwave lithotripsy (ESWL), which breaks stones using shockwaves from outside the body.

Your specialist will look at the size, position and density of your stone on a CT scan, along with your general health and preferences, before recommending the most suitable option.

What Are the Benefits of Kidney Stone Laser Surgery?

Laser surgery has several advantages compared with other stone treatments:

No incisions: the stone is reached through the body’s natural opening, so there are no wounds to heal
Treats stones in different positions: a flexible telescope can reach stones anywhere in the ureter and inside the kidney
Works on hard stones: the holmium laser can break all types of kidney stone, including hard stones that may not respond well to shockwave treatment
Short hospital stay: most patients go home the same day or the next morning
Stone treated during the procedure: the stone is broken up and larger pieces removed at the time, rather than waiting weeks for fragments to pass, as can happen after shockwave treatment
Suitable for more patients: it can be used in some people who are not suitable for shockwave treatment, such as those taking blood-thinning medicines, depending on the individual case
Stone analysis: fragments can be sent to the laboratory to find out what the stone is made of, which helps guide prevention advice

These benefits have contributed to its wider use. According to NICE, ureteroscopy treatments for kidney and ureteric stones in England increased by 49%, from 12,062 in 2009/10 to 18,066 in 2014/15.

What Are the Risks of Kidney Stone Laser Surgery?

Like any procedure, laser surgery carries some risks. Most side effects are mild and temporary, and serious complications are uncommon. Your surgeon will explain how these risks apply to you before you consent to treatment.

Common Side Effects

Blood in the urine for a few days
A burning feeling when passing urine
Needing to pass urine more often or urgently
Discomfort from a ureteric stent, if one is placed, including pain in the side or bladder, frequency and blood in the urine. These symptoms usually settle once the stent is removed

Less Common Risks

Urine infection, which can occasionally lead to sepsis, a serious infection in the blood that needs urgent treatment
Stone fragments remaining that need a further procedure, which is more likely with larger stones
Injury to the lining of the ureter, which is rare
Narrowing of the ureter (stricture) later on, which is rare
Being unable to reach the stone at the first attempt, for example if the ureter is narrow. In this case, a stent may be placed to widen it, and the procedure repeated a few weeks later

You should seek urgent medical help after surgery if you develop a high temperature, shivering, severe pain or are unable to pass urine.

What Results Can Patients Expect?

For most patients, laser surgery clears the stone completely or leaves only small fragments that pass naturally in the urine. Results depend on several factors:

Stone size: larger stones are more likely to leave fragments or need a second procedure
Stone position: stones in the ureter are generally cleared more easily than stones in the lower part of the kidney
Number of stones: treating several stones may take longer or need more than one session
Stone hardness and composition: some stone types break more easily than others

A follow-up scan is usually arranged a few weeks after surgery to check that the stone has cleared. Your surgeon will discuss the likely results for your particular stone before treatment.

Laser surgery treats the stones you have but does not prevent new ones forming. According to the British Journal of General Practice, kidney stones have a recurrence rate of 50% within 10 years. This is why prevention advice is an important part of your long-term care.

To lower your risk of another stone, it helps to:

Drink enough water through the day to keep your urine pale
Reduce salt in your diet
Avoid very high-protein diets
Keep a normal intake of calcium from food, rather than cutting it out
Keep to a healthy weight

Some patients are offered a stone analysis and urine tests so that advice can be tailored to the type of stone they form. You can read more in the NHS guide to kidney stones.

Recovery After Kidney Stone Laser Surgery

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

During recovery:

Drink plenty of fluids to help flush out stone dust
Take the pain relief you have been given
Expect some blood in your urine for a few days
Avoid heavy lifting and strenuous exercise until you feel comfortable

If a stent has been placed, it is usually removed after a few days to a few weeks. Some people find they need more rest until it is out. Your surgeon will advise you on when you can return to work, exercise and driving.

Taking the Next Step

If you have a kidney stone that has not passed, repeated episodes of renal colic, or are unsure which treatment is best for you, a specialist assessment can help. Mr Alanbuki will review your scans, explain all suitable options, including laser surgery, shockwave treatment and keyhole surgery, and help you choose the approach that suits you.

Book a consultation with Mr Ammar Alanbuki in Brighton, Hove, Haywards Heath, Gatwick or London.

If you have severe pain with a high temperature or shivering, or are passing very little urine, seek urgent medical help, as this can mean a blocked and infected kidney.