Kidney Stones

RIRS vs URS vs ESWL vs PCNL - Kidney Stone Surgery in India

There are several procedures to treat kidney stones. This short explains the main options, including how they work and the factors your specialist considers when recommending one.

Less invasive procedures

For smaller stones, your urologist may suggest one of these approaches, which are usually performed without any skin incisions.

• ESWL. Extracorporeal Shock Wave Lithotripsy uses focused sound waves from outside the body to break a stone into smaller pieces. These fragments can then pass out in your urine.
• URS. Ureteroscopy involves passing a thin scope through the urethra and bladder into the ureter. A laser is often used to break up the stone, and the pieces are removed or left to pass.
• RIRS. Retrograde Intrarenal Surgery is similar to URS but uses a flexible scope. This allows the surgeon to manoeuvre within the kidney to reach and treat stones.

Procedures for larger stones

When stones are very large, numerous, or in a difficult position, a different procedure may be needed.

• PCNL. Percutaneous Nephrolithotomy is for larger stones. A small incision is made in your back, allowing a surgeon to pass a scope directly into the kidney to break up and remove the stones.
• Open surgery. This is now uncommon for kidney stones. It may be considered in very complex situations or when other, less invasive methods are not an option.

How a choice is made

A urologist recommends a procedure based on several factors.

• Stone size and number. Larger or multiple stones often require more direct procedures like PCNL.
• Stone location. The position of the stone within your kidney or ureter can determine which instruments can reach it.
• Stone composition. Some stones are very hard and may not respond well to ESWL, making laser or surgical removal a better option.
• Your anatomy and health. Your urologist will consider your overall health and the specific anatomy of your urinary tract.

The most suitable treatment for you depends on your specific case. A final recommendation can only be made by a specialist after a full evaluation, including a review of your medical history and recent imaging.