How big kidney stones need surgery

  For stones below 6mm, oral lithotriptic drugs can be chosen. For stones above 6mm, how to choose the treatment plan is mainly based on the size and location of the stones.  Extracorporeal shock wave lithotripsy can be performed for kidney stones up to 2cm in diameter. Extracorporeal shock wave lithotripsy locates the stone by X-ray or ultrasound, and uses high-energy shock waves to focus and then act on the stone, causing it to fracture until it is crushed into fine sand and excreted with urine.  For kidney stones over 2cm, ureteroscopic lithotripsy or percutaneous nephrolithotripsy is recommended. Percutaneous nephrolithotomy is performed under X-ray or ultrasound localization through the skin and subcutaneous tissue to the renal cortex to establish a puncture channel with a fine needle. After the channel is established, the stone is removed or lithotripsy is performed under the nephroscope. The stones in the renal pelvis are broken up and removed using ultrasound, laser or pneumatic ballistics. The indications for percutaneous nephrolithotomy for stone extraction are as follows: all kidney stones requiring open surgical intervention, including complete and incomplete deerstalker stones, kidney stones ≧2 cm, stones that are difficult to crush with extracorporeal shock waves and stones that have failed treatment.  For stones <2 cm, transilluminated X-rays, and stones that are difficult to be crushed by extracorporeal shock waves, ureteral soft-scope lithotripsy is an option. The stone is removed after retrograde access to the pelvic calyces via the ureter and crushing.