Open surgery used to be the only option for kidney stone removal. Now it accouns for less than one percent of all kidney stone removal procedures. Photo: Shutterstock

Open surgery to treat kidney stones is rarely performed these days. Photo: Shutterstock

So far, I’ve discussed the three most common options for treatment of kidney stones—ureteroscopy, shock wave lithotripsy, and percutaneous nephrolithotomy. But there is one more treatment that deserves mention: open surgery.

Open surgery is the most invasive option for kidney stone removal. Twenty years ago, it was the only option, but it is a rare treatment today, accounting for less than one percent of all kidney stone removal procedures.

Who is a candidate for open surgery?

Patients whose stones have not been successfully removed by less invasive methods may need to have surgery to have their stones removed. It’s also an option if there is an abnormality in the urinary system that has disrupted urine flow in the bladder, kidneys, or urethra. And finally, it can be a chosen method if you have kidney stones caused by an infection.

The open surgery procedure

Open surgery is an inpatient procedure that requires a large incision to your abdomen or side to provide the surgeon access to the ureter and kidney. Once the stone is removed, a catheter is temporarily placed near the kidney to help drain urine. Recovery is longer than other types of treatment and may include a long hospital stay and four to six weeks before returning to normal daily activity.

What to expect after open surgery

After the surgery, you will be monitored in the recovery room to ensure you have no signs of complications and that your vital signs are within the normal range. You will be sleepy once the anesthesia wears off. Anesthesia may also cause nausea, which can be treated with medication. You will be transferred to your hospital room once you are fully awake. You may have an IV in place for several hours to give you necessary fluids and pain medication.

You may experience post-operative pain around your kidney for a few days; this can be controlled by pain medication. You will receive support to begin walking before being discharged home. Walking can prevent blood clots, so it’s best to walk as much as you can tolerate. Before you go home, the urinary catheter that was placed during surgery will be removed.

Pain medication will be prescribed. You will be advised to switch to extra-strength Tylenol once your prescription runs out. Fatigue may continue for up to a month after surgery. Bathe following the instructions provided to you when you were discharged from the hospital, and be sure to schedule your follow-up appointment with your surgeon when recommended.

Risks of open surgery

The risks of open surgery include severe bleeding, infection, and risks associated with anesthesia. There’s also a risk of damage to the kidney requiring it to be removed entirely, and increased possibility of developing a hernia at the location of the surgical incision.

When to call the doctor

Call your surgeon immediately if you have the following symptoms:

  • Sudden pain that intensifies
  • Fever
  • Nausea and/or vomiting
  • Heavy bleeding during urination or from the drainage tube
  • Swelling or redness around your incision, which may be a sign of infection
  • Chest pain
  • Difficulty breathing

If you want to avoid open surgery—or avoid kidney stones altogether—pick up a copy of my book, Even Urologists Get Kidney Stones. Not only will you learn about how kidney stones are diagnosed and treated, you’ll get some helpful tips on how you may be able to prevent kidney stones entirely.