Living and Wellness Causes and Surgical Treatment of Kidney Stones By Urology, February 16, 2014 Kidney stones are common, and there are many different types. Stones can form from urine that contains too much of certain substances that form crystals. These substances can include: Uric acid Struvite Cystine Certain medicines Calcium Oxalate Carbonate Phosphate Minimally Invasive Surgery Percutaneous nephrolithotomy is a minimally invasive procedure used to remove large kidney stones or stones in difficult-to-reach places. During the procedure, the patient is placed under anesthesia and a small incision is made on the back, creating a tunnel to the kidney. Through this tunnel, a number of tools can be used to crush, laser, break, or fragment the stone to make extraction easier. The stone is then retrieved through the same tunnel. “Percutaneous nephrolithotomy uses fragmentation tools to break up the large stone, and then draw it out,” says Timothy Averch, MD, director of endourology and the UPMC Kidney Stone Center. “Really, that is our standard of care for dealing with large stones.” Typically, this minimally invasive procedure has fewer complications and higher success rates than open surgery, and as with other minimally invasive procedures, recovery time is usually shorter. Although it can vary, the typical hospital stay is only a few days. “The benefits of the procedure are that the patient has the best opportunity to have complete stone removal, and hopefully only one hospital visit,” Dr. Averch says. Dr. Averch stresses that multidisciplinary follow-up is important to determine the cause of the kidney stone, so that these problems can be addressed to prevent stone reoccurrence. “It is a disease like any other, and we certainly believe it should be treated as one,” he says.