Best kidney stone treatment depends on size, location

Dr. Keith Roach

Question: My urologist found two big kidney stones in my right kidney, too large to pass naturally. I thought that the option would then be to “crush” them to sand with laser or ultrasound and then flflush out the sand by drinking lots of water.

However, my urologist says that I am too big for this to work (I weigh close to 300 pounds), as they would not be able to focus the laser properly. So, his preferred option is to surgically remove the stones when/if they become a painful problem. Right now, we are monitoring them twice a year with CAT scan and ultrasound checks. ( The other alternative he suggested, of going up through my penis to crush the stones, sounds completely unappealing to me.)

Wouldn’t a surgical alternative also damage the kidney, if he has to cut into the kidney to take out the stones? — P.R.

Answer: I don’t have enough information to recommend the optimal treatment to remove your particular stones, since knowing the size and location of the stones in the kidney is necessary to make that determination. I can tell you that laser lithotripsy has been successfully used in people up to 420 pounds, according to a 2009 study, and ultrasound lithotripsy has been used in people over 300 pounds in an earlier study. Complication rates are higher in heavier people, due to diffifficulty getting the focus correct, as you suggested.

Ten to 20 percent of all stones still require surgical removal, and this can be done endoscopically in some cases. Surgical stone removal is safe and effffffffffffective in most cases, but has the potential for complications, like all procedures. I’d recommend a second opinion.