Is open surgery still used for kidney stones?
Open surgery has been replaced by percutaneous nephrolithotomy (PCNL) and ureteroscopy.
PCNL is performed by placing a nephroscope through the patient’s flank into the renal pelvis. Stones can be directly visualized and fragmented, and fragments removed through the scope.
PCNL most often is used for large stones (>2 cm), stones in a lower pole of the kidney, or stones that have been resistant to ESWL. Ureteroscopy is used for stones in the ureter and some stones in the renal pelvis.
The ureteroscope is introduced through the urethra, into the bladder, and then the ureter. Stones may be removed using a basket or destroyed using a laser. The choice of surgical approach depends on the type of stone, location of the stone, and expertise of the urologist.