Open Surgery for Kidney Stone Removal

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What is open surgery for kidney stone removal? 

In an open surgery to remove kidney stones, the surgeon creates an incision on your side or back to access your kidney or ureter and to remove the kidney stones. This is an invasive procedure and takes about 2.5 hours to complete. The procedure is performed under general anaesthesia.

Nowadays, open surgery for kidney stones is less common. It is an option only if the patient has a very large stone or suffers from an abnormal anatomy, such as skeletal deformity.

The cost of open surgery for removal of kidney stones in India ranges between Rs. 40,000 to Rs. 70,000. 

This procedure requires hospitalization for about 6 to 9 days and the recovery period is longer when compared to other types of kidney stone removal procedures.

How is an open surgery performed?

An open surgery to remove kidney stones involves the following steps:

  1. At the outset, the anaesthetist administers the required dosage of general anaesthesia.
  2. Once the anaesthesia takes effect, the urologist or an attendant nurse paints the operative area (which can be either from your back or your side) with an antimicrobial solution to prevent infection.
  3. Depending on the position of your stone in the kidney or the ureter, the surgeon makes an incision either on your back or on your side.
  4. Once the surgeon is able to access your kidney or ureter through the incision, he makes another incision on the location of the kidney or ureter where the stone is lodged and removes the stone.
  5. Once the stone is removed, the surgeon sutures the area.

Please Note: Post surgery a soft tube or catheter may be left through the incision to drain the urine directly from the kidney into a drainage bag, till the time the kidney heals. You will be monitored closely until the time the doctor decides to remove the catheter.

Am I eligible for open surgery? 

You are eligible for open surgery if:

  • Alternative methods have failed.
  • you have very large stones.
  • you suffer from constant, severe pain.
  • you suffer from a blockage in the flow of urine caused by the stone.
  • you suffer from kidney damage and bleeding caused by the stones.
  • the size of the stone keeps growing larger.
  • you are severely obese
  • you suffer from a skeletal deformity or a comorbid medical disease.

You may not be eligible for open surgery if:

  • you take blood thinners
  • you are pregnant
  • Ongoing urinary infection
  • suffer from uncontrolled diabetes.

Please Note: Eligibility criteria for various medical procedures differs from patient to patient and depends on their general health, medical history, and medical conditions. Please consult a doctor to know more about your eligibility or ineligibility for any medical procedure. 

What risks will I face while undergoing the open surgery?

The risks of open surgery for kidney stone removal include but are not limited to:

  • Injury to surrounding organs.
  • risks related to anaesthesia.
  • excessive bleeding during surgery.

How will I benefit after undergoing an open surgery?

The benefits of an open surgery for kidney stone removal include:

  • Relief from painful conditions related to kidney stones
  • No repeat procedures needed with the other kidney stone removal procedures.

What are my alternatives to open surgery?

Depending on the size of the kidney stone, alternatives to open surgery include:

What are the pre-operative guidelines I should follow for open surgery?

The pre-operative guidelines which are followed prior to an open procedure are:

  • A complete physical examination by your doctor to ensure you are in good health before undergoing the procedure. The doctor will also ask for your medical history prior to the procedure.
  • You may have to undergo blood tests or other diagnostic tests. The tests performed may include:
    • blood test
    • an electrocardiogram (ECG)
    • a comprehensive set of metabolic tests
    • a urine test
    • and tests that measure the speed of blood clotting
  • Tests are done to determine the number, location, and size of the stone(s). These may include:
    • X-ray
    • Ultrasound
    • Intravenous pyelogram (IVP)
  • Sign a consent form expressing your consent for the procedure by taking responsibility for the risks related to it. You will be made aware of any risks related to the procedure by your doctor.
  • You may be asked to drink only clear fluids (chicken or beef broth, clear fruit juices, or water) for 24 hours prior to surgery, with nothing taken orally after midnight before the day of the procedure.
  • Let your doctor know all the medications you take (prescription and over-the-counter). Especially if you take any anticoagulant (blood-thinning) medications, aspirin, or any other medication that affects blood clotting. Your doctor may ask you to stop taking the medicines 7 to 10 days prior to the procedure.
  • Your surgeon may ask you to take a laxative the day before surgery to minimize the risk of constipation during the first few days of recovery.
  • You need to inform your doctor if you have a known sensitivity or allergy to any medications, latex, tape, or anaesthetic agents (local and general).
  • If you have missed your periods, you need to inform your doctor without fail as it could mean you are pregnant. An open surgery is not advisable if your are pregnant.
  • Notify your doctor if you suffer from any heart conditions or bleeding disorders.
  • Based on your medical condition, your doctor may request other specific preparations.
  • If you smoke, you will be advised by the doctor to stop smoking at least a week or two prior to the procedure.
  •  Follow the instructions of your doctor. 

What are the complications of open surgery? 

Complications of open surgery for kidney stone removal include but are not limited to:

  • hernia which can occur at the spot where the incision was made for the surgery.
  • injury to the ureter.
  • infections.

What are the post-operative guidelines I need to follow after undergoing an open surgery procedure?

  • Promptly take all medication as prescribed by your doctor after the surgery.
  • Post the operation, a soft tube or catheter may be left through the incision to drain the urine directly from the kidney into a drainage bag for a couple of days. The catheter remains in place until the time the kidney heals. If deemed necessary by your surgeon, you may be discharged from the hospital with the catheter and will have to continue wearing it for a few days.
  • You will be advised to drink extra fluids to maintain good kidney health. It will help to dilute your urine. Drinking plenty of water will also reduce the chances of recurrence of kidney stones. So, make water your most frequent drink.
  • You may observe blood in the urine after your open surgery procedure. This is a temporary condition which clears up after a few days.
  • You may experience constipation for several days or weeks following the surgery. Stool softeners prescribed by the doctor can help with this problem.
  • You will be advised by the doctor to refrain from smoking and also from drinking alcohol for several weeks. Smoking and drinking alcohol can impede the healing process.

What is the recovery period after undergoing an open surgery procedure?

It can take up to 10 weeks to recover completely from the surgery depending on your overall health status. You can resume work about 4 weeks after the surgery, as long as it is not physically demanding. 

Are the results of open surgery permanent? 

The results of open surgery are more or less permanent. New kidney stones may form until the underlying cause is rectified. The procedure required for the removal of the newly formed stones will be determined by your treating urologist. 

How do I know if the open surgery procedure I underwent is a success? 

Medical imaging is performed immediately following the surgery to assess stone clearance. If there are no signs of stones, the procedure will be determined as a success. 

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References

1. Madhy S. Agrawal H. Management of multiple/staghorn kidney stones: Open surgery versus PCNL (with or without ESWL). PubMed Central (PMC). 2018.  Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2710093/. Accessed March 5, 2018.

2. El-Husseiny T, Buchholz N. The role of open stone surgery. 2018. Available at: https://www.sciencedirect.com/science/article/pii/S2090598X1200054X. Accessed March 5, 2018.

3. Paik M, Wainstein M, Spirnak J, Hampel N, Resnick M. CURRENT INDICATIONS FOR OPEN STONE SURGERY IN THE TREATMENT OF RENAL AND URETERAL CALCULI. 2018. Available at: http://www.jurology.com/article/S0022-5347(01)63922-3/abstract. Accessed March 5, 2018.

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Patient Experiences

Basant Kumar
Effective Kidney Stone Surgery
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