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There is a stone in the tubing, in the ureter, that runs from your kidney to your bladder. You have two kidneys, a left and a right one. They are each about the size of a fist. They lie deep in your back on each side of your spine, in front of the lowest rib on each side. They make the urine which passes down the ureter on each side to the bladder just below your navel. Stones from the kidney can pass down the ureter causing pain, blood in the urine, infection, or can block the ureter causing pressure on the kidney. Often the stones pass right through by themselves. In your case, however, the stone has stuck in the ureter. It needs to be taken out with an operation.

The Operation

You will have a general anaesthetic, and will be asleep for the whole operation. Sometimes the stone in the ureter can be pulled out by a special telescope passed up into your bladder through the normal urine passage. Otherwise a cut has to be made into the skin. The stone is then taken out through an opening in the side of the ureter. The wound is then stitched up. If the stone can be removed with the special telescope, you should be able to leave hospital within 24 hours. Otherwise you should allow seven days or so in hospital.

Any Alternatives

Waiting and seeing if the stone will pass is a good idea if the stone is less than one third of an inch long. This has not happened in your case. Breaking up the stone with shock-wave treatment often works very well. If it has not worked, an operation is needed to find out why and deal with the problem. Drug and diet treatment are useful to stop more stones forming. They are not very helpful in dissolving stones which are already there.

Before the operation

Stop smoking and try to get your weight down if you are overweight. If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to the hospital with you.

On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible.. Please tell the doctors and nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.

After - In Hospital

If you have had the stone taken out with the special telescope, you will not have a cut in the skin nor any extra drainage tubes. If a cut was needed, you will have a drain tube coming out of the skin near the wound. This is to drain any residual blood or other fluid from the area of the operation and is usually removed one to two days after the operation. You may have a fine, thin plastic tube (drip) in an arm vein giving you blood or salt solutions. You will have a fine plastic tube (catheter) coming out of the front passage or penis to drain urine out of the bladder. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions during this time. If you have only had the special instrument, there is only some soreness in the front passage or penis. If you have had a cut, there is some discomfort on moving rather than severe pain. You will be given injections or tablets to control this as required. Ask for more if the pain is not well controlled or if it is getting worse.

You will most likely be able to get out of bed with the help of the nurses the day after the operation despite some discomfort. You will not do the wound any harm, and the exercise is very helpful for you. The second day after the operation you should be able to spend most of your time out of bed and in reasonable comfort. By the end of one week the wound should be virtually pain free. If you have only had the special instrument, and as long as you are not feeling sick, you will be able to start drinking within two to three hours of the operation. The next day you should be able to manage small helpings of normal food. If you have had the bigger operation, you will be able to start taking drinks once your tummy is soft. This is after about 24 hours. By the end of 48 hours you should be starting to eat more solid food. The arm drip tube will be taken out once you are drinking freely. You may have some blood in the urine catheter for a day or two. Once this clears and you are able to get out of bed easily the catheter will be taken out. It is important that you pass urine properly after the catheter is out and also after the special instrument has been used. The doctors and nurses will check this.

If you had the operation through a skin cut, the wound may have stitches or clips or may be held together with just stitches underneath the skin. You can wash as soon as the dressing has been removed but try to keep the wound area dry until the stitches/clips come out. If there are only stitches underneath the skin, try to keep the wound dry for a week. Soap and warm tap water are entirely adequate. Salted water is not necessary. You can shower or take a bath as often as you want. The nurses will talk to you about your home arrangements so that a proper time for you to leave hospital can be arranged. Some hospitals arrange a check-up about one month after leaving hospital. Others leave check-ups to the general practitioner. The nurses will advise about sick notes, certificates etc.

After - At Home

After the open operation, you are likely to feel very tired and need to rest two to three times a day for a week or more. You will gradually improve so that by the time a month has passed you will be able to return completely to your usual level of activity. After the special instrument procedure you should be back to normal duties inside a week. At first discomfort in the wound will prevent you from harming yourself by lifting things that are too heavy. After two months you can lift as much as you used to lift before the operation.. There is no value in attempting to speed the recovery of the wound with special exercises before this. You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about three weeks. You can restart sexual relations within three weeks or so, when the wound is comfortable enough. You should be able to return to a light job after about one month and any heavy job within two months.

Possible Complications

As with any operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero. For both types of operations, complications are relatively rare. If you think that all is not well, please ask the doctors and the nurses.

Chest infections may arise, particularly in smokers. Do not smoke. Getting out of bed as quickly as possible, being as mobile as possible and co-operating with the physiotherapists to clear the air passages is important in preventing a chest infection.

Sometimes there is blood in the urine. If the doctors expect this, a catheter is usually put in at the time of the operation. It may take some days to clear. You will need to stay in hospital until it gets better.

Sometimes you can have an infection which is either localised in your urinestream or gets into the bloodstream. You will be given antibiotics to treat the infection.

If you have the open operation

Bruising and swelling may be troublesome. The swelling may take four to six weeks to settle down. A wound infection happens in 1 to 2% of cases and settles down with antibiotics in a week or two. The drainage tube near the wound may drain old blood for up to a week. This drainage settles down. Very rarely, it doesn’t settle or gets worse in the first few hours/days after the operation. This means that damage has occurred during the operation in one of your blood vessels or other organs of your abdomen and you will most likely need another operation to fix the problem. Aches and twinges may be felt in the wound for up to six months. Occasionally there are numb patches in the skin around the wound which get better after two to three months.

Sometimes (2 to 3% of cases) there is a leak of urine through the wound or from the drain site. This settles down within a week or so. Very rarely, you will need another operation to fix this problem.

If you have the operation with the telescope

Extremely rarely the telescope or the other instruments used during the operation can create a hole (perforation) or an extensive scratch in the lining of the urethra (the tube that connects your bladder with your penis or the area in the front of your vagina), the bladder or the ureter. This problem is usually corrected by putting a catheter back in for one to two weeks to decompress the bladder and drain the urine until the hole or the scratch has healed. In addition, if the problem is in the ureter, a fine, thin plastic tube (stent) is placed in the ureter to allow the free drainage of the urine until the hole or the scratch has healed. You won’t feel the presence of the stent and it is removed using the telescope in after about six to eight weeks. Only in extreme circumstances will you need another operation to fix the problem.

Sometimes stones reform. This will be discussed with you. Sometimes the special instruments cannot get the stone out and you will eventually need the open operation to get the stone out. This possibility will be discussed with you.