Treatment of kidney stones and ureteral stones

Treating ureteral stones

This video is about the treatment of ureteral stones, i.e. stones that have fallen from the renal pelvis into the ureter and can get stuck there.

• Spontaneous passage: Small, smooth stones (<3–4 mm) have a high chance (70–80%) of reaching the bladder on their own. Larger or sharp-edged stones often require treatment.
• Active treatment: Two procedures are available:
1. ESWL (shock wave treatment): Stones are broken up from outside the body, but success is limited.
2. Endoscopic treatment: The stone is removed directly via the urethra and bladder or broken up with a laser; advantages: fast, effective, stone-free after approx. 30–40 minutes under general anaesthesia.

Endoscopic treatment of ureteral stones

Today's topic is the endoscopic treatment of ureteral stones, i.e. the removal of stones under direct vision using fine endoscopes, baskets and lasers.

• Procedure: Under general anaesthesia, the ureteral orifice is first probed, a guide wire is placed and the ureter is advanced up to the stone using an endoscope.
• Stone removal: Small stones are captured with special baskets; larger stones are first fragmented with the holmium laser and then removed piece by piece.
• Aftercare: To prevent swelling of the ureter, a double-J catheter is inserted for about a week and removed again once the irritation has subsided.
• Advantages: The endoscopic method is painless under general anaesthesia, is completed in 30–40 minutes, enables reliable stone removal and has largely replaced ESWL (external shock wave treatment).

Removing renal calyx stones

In this video, you will learn everything important about the minimally invasive removal of kidney stones in the renal pelvis and calyx system.

• Definition: Stones in the hollow system of the kidney, often adhering to the tissue.
• Earlier method: ESWL breaks up stones from outside the body → fragments have to pass on their own, risk of urinary retention or residual stones.
• Modern method: Flexible endoscopy via the ureter, laser fragmentation of large stones, basket removal of small fragments.
• Aftercare: Double-J stent for approx. 1 week to protect the ureter, followed by simple removal.
• Advantages: Immediate, reliable stone clearance, minimally invasive, short operating time.
• Goal: Effective stone removal and avoidance of complications.

Removing a ureteral stone

This video explains why endoscopic removal of the stone is possible immediately in most cases and why long waiting times are not medically necessary. Why many clinics nevertheless wait 30 days – and how modern endoscopic treatment (URS) enables rapid stone clearance – is explained clearly and objectively in this video.

Removing a kidney stone

With modern flexible URS or Mini-PCNL according to Lahme

This video explains why a location in the lower renal calyx poses particular challenges and which modern endourological procedures are used today to achieve complete stone clearance.

• Why larger renal calyx stones are difficult to treat
• What are lower pole kidney stones?
• Why the location makes passage difficult
• Treatment 1: Shock wave therapy (SWL)
• Treatment 2: Flexible endoscopy (URS/FRS)
• Treatment 3: Mini-PCNL – highest stone-free rate
• Risks of the percutaneous technique
• New technique: Navigable ureteral access sheath

Small kidney stone

Remove immediately or wait?

Prof. Dr. med. Sven Lahme uses a sketch to explain the anatomical causes, risks and modern treatment options

• How do ureteral stones form?
• Where do stones get stuck?
• Symptoms & complaints
• When does a stone pass on its own?
• Waiting: advantages & risks
• Complications: hydronephrosis & infections
• Endoscopic treatment explained
• Risks of surgery & the doctor's experience
• Waiting vs. surgery – which is better?

Preventing kidney stones

This video is about the formation and prevention of calcium oxalate kidney stones.

• Causes: Frequently due to a modern diet with a high proportion of animal protein; rarely hormonal changes or intestinal diseases.
• Prevention:
1. Reduce animal protein → less acid in the urine, less calcium excretion, more citrate excretion.
2. Increase fluid intake → produce approx. 2 l of urine daily to prevent crystal formation.
3. Urine alkalinisation → drink mineral water rich in bicarbonate to increase citrate excretion, which keeps calcium oxalate in solution.
• Goal: Significantly reduce the risk of calcium oxalate stones through these measures.

An end to uric acid stones

This video is about uric acid stones – how they form and how they can be prevented.

• Cause: Uric acid stones form mainly when the urine is acidic (low pH value), not primarily due to elevated uric acid in the blood.
• Risk factor: pH < 7 promotes stone formation; pH ≥ 7 prevents it.
• Prevention:
• Eat little animal protein (meat)
• Drink mineral water rich in bicarbonate
• If necessary, alkaline effervescent tablets (Alkalitrat) to artificially raise the urine pH
• Goal: Raise urine pH to ≥ 7 → practically prevent new uric acid stones.

Avoiding infection stones permanently

Learn everything important about one of the most common types of kidney stones – infection stones. They form when urinary tract infections make the urine alkaline and calcium and phosphate compounds are deposited, often embedded in bacteria.

• Risk: If stone fragments remain after treatment, there is a high probability (up to 90%) that a new infection stone will form quickly. New formation usually occurs much faster than with other types of stone.
• Treatment: Complete removal of the infection stones, usually minimally invasively via percutaneous nephrolitholapaxy (PCNL or Mini-PCNL).
• Aftercare: Antibiotic measures are then recommended for about three months to eliminate any remaining germs. In addition, acidifying the urine can help prevent new infection stones from forming.
• Goal: Stone clearance, eliminating infections and preventing renewed stone formation.

Kidney stones – a hidden cause in the neck

Kidney stones and the parathyroid gland – how are they connected?

In this video, you will learn how an overactive parathyroid gland can lead to recurrent kidney stones and how it is treated.

• Description: Recurrent kidney stones can be caused by overactive parathyroid glands. These small glands next to the thyroid regulate the calcium level. If they are overactive, they produce too much hormone, the calcium level rises, excess calcium is excreted via the kidneys and can thus lead to kidney stones. In the long term, there is also a risk of bone decalcification.
• Diagnosis: Made by blood tests: if both calcium and parathyroid hormone levels are elevated, there is an overactivity.
• Treatment: The overactive parathyroid gland is surgically removed, which normalises calcium levels, bones and stone formation.
• Goal: To identify the cause of stone formation, avoid secondary problems such as bone fragility and prevent renewed kidney stone formation.

Blood in the urine

Why see a urologist immediately?

Blood in the urine is a warning sign and should always be investigated by a urologist. Prof. Lahme explains the most common causes of blood in the urine, including cystitis, kidney stones, bladder cancer, tumours of the urinary tract and changes in the renal pelvis or ureter.

• Blood in the urine: why have it investigated immediately?
• Where can blood in the urine come from?
• How is urine produced in the kidneys?
• Pain vs. painless bleeding
• Common causes: inflammation, stones, tumours
• Examination by the urologist
• Cystoscopy explained
• CT, MRI and further diagnostics
• When no cause is found

How do kidney stones form?

This video is about how the different types of kidney stones form.

• Calcium oxalate stones: Form in the kidney tissue at the renal papilla, adhere there, grow and only later detach into the renal pelvis before reaching the ureter or bladder.
• Uric acid stones: Formation depends on a low pH value in the urine; high acidity promotes crystallisation.
• Infection stones: Caused by bacteria that make the urine alkaline, causing phosphate-containing stones to precipitate.
• Cystine stones: Genetically caused by a disorder of amino acid metabolism; crystals are deposited in the renal collecting system.

What to do about cystine stones?

In this video, you will learn everything important about cystine stones: how they form, who is affected and what treatment options are available. Also: which measures help prevent new stones from forming.

• Definition: Rare, inherited kidney stones caused by a metabolic disorder with increased cystine excretion.
• Treatment: Minimally invasive procedures such as flexible endoscopy via the ureter or Mini-PNL for safe removal of the stones.
• Prevention: High fluid intake, alkaline urine (pH ≥ 7.4) and a targeted diet reduce new formation; in special cases, medication can reduce cystine excretion.
• Goal: Stone removal, avoidance of secondary problems and long-term control of stone formation.

Calcium oxalate kidney stones?

How they form in the intestine in Crohn's disease!

This video explains why calcium can help prevent calcium-containing kidney stones, who is affected and how the treatment works.

• Definition: Calcium is given specifically with meals to bind excess oxalic acid in the intestine and thus prevent the formation of calcium oxalate stones.
• Indication: Particularly in patients with inflammatory bowel diseases such as Crohn's disease or after bowel surgery, in whom oxalate absorption is increased.
• Goal: Significantly reduce the new formation of calcium oxalate stones and lower the risk of recurrent kidney stones.