As one of the most common urological diseases, urolithiasis represents the largest field of work in urology. It is not without reason that „stone cutting or lithotomy“ is an operation that has been known for a long time and was already performed in the Middle Ages by „Doctor“ Eisenbarth for bladder stones. Times have changed and nowadays, fortunately, open surgical stone removal can almost always be dispensed with.

Stones form most frequently in the area of the renal calices and can generally occur in anyone. The most common cause that leads to the formation of kidney stones is a lack of fluid intake. The body notices the lack and the kidneys concentrate the urine to a level where the substances dissolved in the urine can precipitate. Small crystals form that adhere to the mucous membrane of the renal calices. If there are frequent phases of thirst, these crystals become larger and larger due to the accumulation of further crystals – a stone develops.

Other causes of stone formation include malnutrition, immobility or, rarely, hereditary disorders.
If a stone in the kidney grows beyond a certain size, flank pain can occur, which ultimately leads the patient to a urologist.

In most cases, however, the stone detaches from its place in the renal calyx and is flushed into the ureter by the flow of urine. The result is severe, wavelike pain called colic. This is triggered by the ureter trying to move the stone into the bladder. Dull flank pain is caused by the obstruction of the outflow of urine from the kidney and the resulting pressure. Our patients usually present in an emergency with just these colics.

In the diagnostic work-up, an ultrasound of the kidney almost always reveals urinary retention and a urinalysis reveals blood in the urine. Further diagnosis is made by X-ray examinations, in which most stones can already be identified. Depending on the location and size of the stone, further therapy is planned. Many smaller stones can be removed spontaneously with medication, so that no operation is necessary.

If there is permanent pain that cannot be treated with medication, or if the stone is too large to pass spontaneously as expected, removal of the stone through the urinary tract is recommended. In this case, the stone is removed from the ureter with an instrument that is brought under visual control via the urethra into the bladder and from there into the ureter by means of a catch basket that is brought to the stone via the instrument (ureteroscopic stone extraction).

If the stone is too large, it can be crushed on the spot with a laser and then removed piece by piece (internal laser lithotripsy).

Larger stones that are in the kidney can be removed through a stab canal that is passed from the skin to the kidney to the stone (percutaneous nephrolitholapaxy or PCNL/PNL).

Large incision operations, which were used in the past for almost all kidney stones, are almost a thing of the past and are only used for very large stones (nephro- or calicolithotomy).

Bladder stones usually do not develop in the kidney, but due to disturbances in the emptying of the bladder and can be up to the size of a tennis ball. Symptoms would be bladder emptying disorders due to valve-like mechanisms, blood in the urine and lower abdominal pain as well as recurrent bladder infections.
In most cases, bladder stones can also be removed after mechanical disintegration (punch lithotripsy) or laser disintegration through the urethra. Only in very rare cases is open surgical removal (incision surgery through the abdominal wall) necessary for large specimens.