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The treatment of kidney stones depends upon many factors such as the size of stone, number, location and patients symptoms. Kidney stones may vary in size from few millimetres to larger than 3-4 centimetres. They may be present within the kidney or any part of the urinary passage including the renal pelvis, ureter, urinary bladder or urethra. The stones may sometimes be asymptomatic or may cause symptoms of pain, urinary obstruction, bleeding or infection in the urine.

Small stones less than 5-6 mm which are present in the kidney but not obstructing the urinary passage or causing any symptoms may be left untreated. Larger non obstructing stones which are not symptomatic may be left alone or removed prophylactically in the event that they cause obstruction later on which is based on the doctor’s discretion.

Small stones less than 5 mm within the urinary passage often cause symptoms but they can pass spontaneously on taking plenty of water and medication to relieve the pain and relax the urinary passage. Stones larger than 7-8 mm which are present in any part of the urinary passage including the renal pelvis, ureter, urinary bladder or urethra require urgent removal. These seldom pass spontaneously or with medication. These stones may cause any of the symptoms of pain, frequency of urination, blood or infection in urine or complete blockage of the urinary passage.

The location of the stone determines the surgical approach. Stones in the last part of the urethra are sometimes removed by a small incision over the penile urethra in case the stone is felt from the outside. Other urethral stones are first pushed back into the bladder with a cystoscope and then removed like bladder stones.

Bladder stones are removed by cystolithotripsy. It is an endoscopic surgery when a camera is passed through the urethra into the bladder and then the stone is visualised and fragmented using a lithotripter. The fragments are removed piecemeal and a catheter is placed.

Stones within the lower and mid ureter are removed using a ureteroscope which is a long and semi rigid camera which can be inserted through the ureteric opening to the site of stone. The stone is then visualised and fragmented with the same lithotripsy machine as in a bladder stone.

Stones in the upper ureter or pelvis and also the ones in the kidney are removed with PCNL. In this , the camera is directly inserted into the collecting system by a small puncture over the kidney and the stone is retrieved either whole or piecemeal.

A stent may be placed at the end of ureteric or renal surgery for stone for healing of the urinary passage and removed after a period of 2-4 weeks.

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