University Hospitals Plymouth NHS Trust provides kidney stone treatment services for Plymouth and the surrounding region, and as a tertiary referral centre for Cornwall and Devon.
After a clinical review, our expert stone surgeons suggest a management plan that is individually tailored for each patient. Management decisions are typically based upon:
- stone factors (type, size and location),
- kidney factors (number, function, previous surgery)
- and patient factors (other illnesses or factors that may make surgical intervention higher risk).
The stone services offered:
Onsite extra-corporeal shockwave lithotripsy (ESWL)
This treatment uses machine generated shock waves to break up urinary stones. The treatment sessions are carried out as outpatient procedures and last for approximately 30-40 minutes. You should be sent home within 2-4 hours. We have an onsite lithotripter and a dedicated lithotripsy team who meet weekly to plan stone treatments. We offer an emergency or 'hot' shock wave lithotripsy service for patients admitted in the hospital or who are seen through the emergency department. Patients typically have a maximum of 3 shockwave treatments for kidney stones and 2 shockwave treatments for ureteric stones. If this treatment fails to clear the stones, patients may need more invasive procedures such as uretero-renoscopy and laser lithotripsy or percutaneous nephrolithotomy.
Uretero-renoscopy and laser lithotripsy
This treatment is carried out under a general anaesthetic and involves a thin camera passing through the urethra, bladder and into the ureter and/or kidney. A tiny laser is then passed through the camera and is used to break up stones into smaller pieces. These procedures are typically carried out as daycase procedures. You may have a plastic tube (stent) left inside to help protect the drainage of the kidney after this procedure.
This treatment is carried out under a general anaesthetic and typically involves a small incision in the skin near the kidney affected by kidney stones. A needle is then inserted into the kidney by an interventional radiologist under ultrasound guidance. The needle entry is then stretched enough to allow a special camera instrument to pass into the kidney and retrieve the stone fragments. This type of treatment is typically reserved for larger kidney stones (greater than 1.5 cm - 2 cm) or stones which are difficult to access with a flexible uretero-renoscope. Following this procedure you may have a stent (plastic tube in the ureter) or a nephrostomy (plastic tube connected from the kidney to skin) and stay in hospital for 1 to 5 days.
Laparoscopic and open renal stone surgery
This treatment is rarely used and is always carried out under general anaesthetic. Laparoscopic surgery involves multiple keyhole incisions in the abdomen. An open operation involves a large incision (10-15 cm) over the flank, to expose over the site of the kidney or ureter. This treatment may be offered, for example, if other stone treatment methods have not been successful or there is little or no remaining kidney function in a kidney with stone disease.
Metabolic stone service
We work alongside our colleagues in the renal (kidney) service, biochemistry and microbiology departments in order to identify reasons why patients form recurrent kidney stones. The aim of metabolic tests is to prevent stone recurrence. Currently, we run monthly metabolic stone clinics which involve analysing why individuals are at risk of forming recurrent stones. Due to demand we aim to prioritise patients at high risk of forming further renal stone disease. In general, 50% of patients with kidney stones will get a further recurrence in the next 5 to 10 years.