The incidence of urinary stones (urolithiasis) is steadily increasing in Germany. The lifetime risk of developing kidney stones in Germany is around 4%. The main risk factors for the formation of urinary stones are diet, lifestyle habits, but also the presence of other risk factors. A single factor that leads to the development of urinary stone disease can rarely be identified. It is often a multifactorial process that needs to be investigated in detail in order to recognise and treat the causes.
Kidney stones can form again even after they have been removed. In the absence of preventive measures (metaphylaxis), the recurrence of the disease is very high and is 50-60%. Men are about four times more likely to suffer from kidney or ureteral stones than women. Thanks to modern diagnostic procedures such as ultrasound and computer tomography, urinary stones can now be diagnosed very accurately and treatment planning can be tailored precisely to the patient.
We specialise in the diagnosis and treatment of kidney and ureteral stones as well as in diagnostics and endoscopic therapy. We follow the latest scientific findings and guidelines. Our competent and experienced team is available to you during our consultation hours for advice and further treatment planning if you have been diagnosed with a kidney or ureteral stone or if another disease of the upper urinary tract (kidneys and ureters), such as a tumour, is suspected.
We offer you state-of-the-art medicine combined with trustworthy care:
- Detailed consultation and personalised treatment planning
- Comprehensive diagnostics with high-resolution imaging procedures
- Endoscopic therapy using ureteroscopy and renal pelvis endoscopy (URS) for simple to highly complex stone diseases
- Minimally invasive endoscopic treatment using miniaturised or conventional percutaneous stone surgery (PCNL) for large kidney stones through to kidney stones that fill the entire renal pelvis
- Optimised extracorporeal shock wave therapy (ESWL) for suitable stones in the upper urinary tract using X-ray or ultrasound localisation under the supervision of an experienced team
- Modern, gentle high-frequency laser therapy for all stones at all locations in the urinary tract
- Precise endoscopic diagnostics and, if applicable, endoscopic laser ablation therapy for tumours of the upper urinary tract
- Comprehensive consultation and close interdisciplinary collaboration with our cooperation partners in the post-operative planning of prophylaxis for your urinary stone disease to assess and minimise the risk of stone recurrence (recurrence), including clarification of your metabolic risk factors.
How and where do urinary stones form?
The exact mechanism of stone formation has not been clarified and various theories are discussed among experts. Irrespective of the mechanism of formation, urinary stones usually form in the kidney unnoticed by the patient and do not initially cause any symptoms. However, this can change immediately as soon as a kidney stone enters the ureter and leads to an acute blockage of the urine outflow. This is called acute urinary retention. The ureter contracts and tries to transport the stone into the bladder by contracting its smooth muscles. The patient's symptoms are characterised by sudden, severe colicky flank pain, nausea and vomiting. The overall symptoms are known as renal colic. This must be treated in a clinic.
After pain treatment, further diagnostic imaging is required in almost all cases. This is carried out using a computer tomogram (CT scan). Depending on the stone parameters (size, number, location, nature) and the clinical condition of the patient, further treatment is planned. These can vary and are planned individually.
What does "conservative stone therapy" mean?
The smaller a stone is and the further the stone has already travelled from the ureter towards the urinary bladder, the more likely it is that the stone will pass spontaneously without intervention. If the stone does not pass within 24-48 hours and/or the symptoms are more severe, either external fragmentation using shock waves (ESWL) or active endoscopic removal of the stone (URS) from the ureter is recommended.
In an emergency situation, in the presence of risk factors and potential danger to the patient or pain that cannot be controlled with medication, the urinary tract is drained via a so-called ureteral stent. The ureteral stent (so-called double-J (DJ) stent) is a thin plastic tube that is inserted into the ureter or renal pelvis of the affected side by means of cystoscopy. The purpose of the ureteral stent is to relieve the usually blocked kidney, i.e. it ensures that urine can flow freely from the kidney into the bladder again. The stone is usually still present in the ureter or it has been pushed back into the kidney by the manipulation. Once a ureteral stent has been inserted and the acute situation has been successfully treated, further treatment must be planned. In many cases, endoscopic stone removal (e.g. URS) or shock wave therapy (ESWL) will be necessary to successfully remove the stone. The patient can often be discharged home following the ureteral stent insertion until the planned stone therapy.
We offer the entire spectrum of surgical endoscopic stone treatments, including highly complex stone situations, and plan the therapy individually.
The following treatment methods are used:
Extracorporeal shock wave lithotripsy (ESWL):
ESWL offers the possibility of breaking up urinary stones into spontaneously disintegrating fragments using shock waves generated outside the body. ESWL therapy does not usually require a general anaesthetic. The sound waves are generated electromagnetically, electrohydraulically or piezoelectrically, depending on the shock wave device used, and are focussed on the stone after X-ray or ultrasound localisation. Approximately 2500 - 3500 sound waves are applied to the stone. The average duration of the treatment is approximately one hour. The initial treatment of a stone using ESWL takes place under inpatient conditions. In many cases, a single ESWL session is sufficient to treat the stone. If larger stone fragments remain in the kidney or ureter and the first ESWL treatment was well tolerated, any necessary further treatments can be carried out on an outpatient basis.
Ureteroscopy and renal pelviscopy (URS) is a procedure that is being used more and more frequently due to the miniaturisation and improvement of endoscopic instruments.
Rigid and flexible ureterorenoscopic stone removal (URS):
Ureterorenoscopy (URS) is an endoscopic procedure for endoscopy of the ureter (ureter) and kidney. The procedure makes it possible to closely inspect the urethra and bladder as well as the ureter and renal pelvis via the existing body orifices and to penetrate directly to the stone or other diseases (e.g. tumours) and treat them on site. Small stones can be removed directly using miniature forceps. If the stone is too large for primary removal, it is broken up using special laser light (holmium laser) or with a small pneumatic hammer (Lithoclast) under direct vision. The resulting fragments of the stone are then removed in the same way using miniature forceps or small catch baskets. Progress in laser technology has brought about a significant improvement in stone treatment. In our clinic, we use state-of-the-art laser procedures that allow stones of any composition to be crushed safely and without loss of blood or high risk of injury to neighbouring organs.
Percutaneous stone surgery is used in the case of a large stone load or stones that are not suitable for removal via the ureter. The miniaturisation of instruments and the development of powerful high-frequency lasers have also expanded the scope of this procedure.
Percutaneous (mini) nephrolitholapaxy (PNL):
Larger stones (from approx. 1.5 cm in diameter) can be removed by PNL. A stable access to the renal pelvic caliceal system through the skin is required to perform the procedure. Under general anaesthetic, the renal pelvis is punctured with a thin needle. The renal pelvis and the renal calices can be examined with an endoscope and stones can be removed using various instruments (e.g. holmium laser, Lithoclast, ultrasound probe (sonotrode)). The choice of instruments, whether miniaturised (mini PCNL) or conventional (PCNL), and the choice of surgical technique required is the responsibility of the doctor performing the operation. A detailed discussion will be held with you before the operation.
Stone aftercare:
Once stone therapy has been successfully carried out, the second phase of stone therapy takes place. In this phase, the focus is on reducing your risk of developing a urinary stone again. In addition to general lifestyle changes (e.g. increasing the amount you drink), the following diagnostic steps may be necessary: Analysis of the collected stone material (IR spectroscopy), laboratory analysis of the blood and special urine diagnostics (24-hour urine collection). This serves to clarify the metabolic situation and the question of whether there is an increased risk of a new urinary stone forming. In some cases, factors can be identified whose treatment prevents or at least delays the formation of new stones. Not all patients with a urinary stone require a full investigation. However, if certain risk factors are present, we recommend an extended metabolic work-up. We will be happy to advise you on this.
Other procedures can be used at any time. A combination of different procedures often leads to the goal of being stone-free. We will work with you individually to select the procedures and advise you on which procedure is most suitable and promising for you.
In principle, any stone that can be located can be treated with ESWL. Stones that are composed exclusively of uric acid are generally not suitable for treatment with ESWL. These can possibly be dissolved with medication. However, there are some restrictions that must be taken into account. Kidney stones that are smaller than 1.5 cm and are not located in the lower calyx group of the kidney are suitable for ESWL. Larger stones up to approx. 2 cm in diameter can also be treated with ESWL. It should be noted that the larger the stone, the more likely it is to cause problems due to stone fragments breaking off.
The inpatient stay for a ureteroscopy (URS) is usually 1-2 nights and depends on several factors, which will be discussed with you during your stay or during pre-inpatient preparation.
As a rule, URS is a gentle and uncomplicated procedure. However, there are some factors that can complicate the procedure. The most common side effect of URS is the presence of blood in the urine. This is usually mild to moderate and not dangerous. Severe bleeding or haematoma around the kidney are rare. Inflammatory complications are also rare. The urine is checked for sterility before the procedure and, if necessary, antibiotic therapy is started before the procedure. Specific possible risks associated with the procedure will be explained to you during the consultation.
The surgeon decides at the end of the operation whether a ureteral stent needs to be inserted again after an operation or whether it can be dispensed with. As a rule, it is not necessary to insert a ureteral stent again after an uncomplicated procedure without significant manipulation. In many cases, the insertion of a ureteral stent is only necessary for 1-2 days and the stent can be removed before discharge without anaesthesia. If a longer urinary diversion using a ureteral stent is required, you will be discharged with the ureteral stent in place. The splint will be removed either by your urologist or, if desired, by us.
In the case of a tumour in the area of the renal pelvis or ureter, the diagnosis should be confirmed. This is usually carried out endoscopically using URS. Due to the good image quality, an exact visualisation of the suspicious tissue is possible. Tissue is removed using miniaturised biopsy forceps or tissue collection baskets. The tissue is retrieved and sent to the pathologist for histological analysis. If kidney-preserving therapy is possible, this can be carried out using URS. However, whether such local treatment of the tumour in the renal pelvis or ureter, e.g. by laser ablation of the tumour tissue, is an option must be discussed in detail beforehand and decided in your individual case.