Stone procedures glossary

What the common procedure names mean

Ureteroscopy uses a slim camera placed through the urethra and bladder, then into the ureter and sometimes the kidney, so the surgeon can see the stone directly. A laser can break the stone into pieces that are removed or are small enough to pass. It is one of the procedures we perform at Johns Creek. There is no incision in the flank.

Laser lithotripsy is the step, during ureteroscopy, in which a laser fiber is used to break the stone. People sometimes say “laser the stone” to mean this combination. The laser is a tool inside the ureteroscopy, not a separate visit.

Shock wave lithotripsy, often shortened to SWL, aims acoustic pulses at the stone from outside the body so fragments can later pass in the urine. It is a good fit for some stones and a poor fit for others, depending on size, location and hardness. If we recommend it, we will explain why it fits your stone rather than treating it as the default for every case.

Percutaneous nephrolithotomy, or PCNL, is an operation for larger kidney stones. The surgeon makes a small tract through the back into the kidney and removes the stone through that tract. It is a bigger undertaking than ureteroscopy and is reserved for stones that would not be well treated by a scope or by shock waves alone.

A ureteral stent is a slim, hollow tube placed from the kidney down to the bladder so urine can keep moving after a procedure, or when swelling or a fragment would otherwise block flow. Stents can cause urinary urgency, frequency and a dull flank ache until they are removed. If a stent is part of your plan, we will tell you how long it is expected to stay and how it comes out.

Cystoscopy is a look into the bladder with a scope. It is used for blood in the urine, bladder symptoms, and sometimes as the first portion of a stone procedure. It can take place in the office or at the surgery center, depending on the reason and the type of scope.

Medical expulsive therapy means trying to let a ureteral stone pass with pain control, fluids and, in selected cases, a medicine that may relax the ureter. It is not a procedure. We use it when the stone has a reasonable chance of passing and you can be followed in clinic, with clear instructions about fever, vomiting and pain that is no longer manageable at home.

KUB, CT and ultrasound are the imaging studies you will hear us name. A CT scan is the most precise way to locate a stone in an acute episode. Ultrasound avoids radiation and is useful in follow-up and in pregnancy. A KUB is a plain X-ray of the abdomen that can follow certain visible stones. We choose the study that answers the question we have, rather than repeating every test you have already had.

Where these procedures are done at our Johns Creek and Cumming offices

Clinic decisions and follow-up can happen at Johns Creek or at Cumming. Operating-room stone procedures are performed at the Johns Creek Clinic & Surgery Center, 10730 Medlock Bridge Road. If you were first seen in Cumming, the urologist who already knows your case is the one who performs the procedure whenever that is how the plan was made. Read the clinical overview on our kidney stones page before you try to memorize every term on this list.