The overall goals of surgical stone management are relief of patient discomfort, clearance of infection, and reversal of kidney function impairment associated with kidney or ureteral stones. Important outcomes that should be discussed with patients when deciding upon surgery include treatment success (ie, stone-free rate [SFR]), risk of complications, and quality of life. In general, the main indications for surgical treatment of stones include pain, infection, and urinary tract obstruction. Asymptomatic stones can be removed in certain individuals, such as frequent travelers or pilots or those considering pregnancy.
Choice of surgical approach
The optimal approach to managing kidney and ureteral stones depends upon the size, location, and composition/hardness of the stone. Other patient comorbidities (such as concurrent infection, obesity, bleeding diathesis, or pregnancy) as well as patient preferences may also influence the choice of therapy:
•Emergency surgery
Patients with an infection associated with obstruction of the urinary tract require urgent drainage of the collecting system and antimicrobial therapy; a ureteral stent or a percutaneous nephrostomy tube can be used to drain the collecting system. Definitive stone management can proceed once the infection is treated and the patient is stable.
•Elective surgery
Shock wave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PNL) are the most commonly performed surgical modalities for patients who require elective removal of ureteral or kidney stones
