Editing Kidney stone disease (section)

=== Surgery ===
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| image1            = Ureterstent double J 3D legend.jpg
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| caption1          = [[X-ray computed tomography#Three-dimensional reconstruction|Three-dimensional reconstructed CT scan]] image of a [[Ureteric stent|ureteral stent]] in the left kidney (indicated by yellow arrow), with a kidney stone in the inferior [[renal pelvis]] (highest red arrow) and one in the [[ureter]] beside the stent (lower red arrow)
| image2            = Kidney Stone Image 4172-PH.jpg
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| caption2          = A kidney stone at the tip of an [[ultrasound|ultrasonic]] stone disintegration apparatus
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Most stones under {{convert|5|mm|in|1|abbr=on}} pass spontaneously.<ref name=Parmar2004 /><ref name=Miller2007 /> Prompt surgery may, nonetheless, be required in persons with only one working kidney, bilateral obstructing stones, a urinary tract infection and thus, it is presumed, an infected kidney, or intractable pain.<ref name=Young2011 /> Beginning in the mid-1980s, less invasive treatments such as extracorporeal shock wave lithotripsy, [[ureteroscopy]], and [[percutaneous nephrolithotomy]] began to replace open surgery as the modalities of choice for the surgical management of urolithiasis.<ref name=Miller2007 />  More recently, flexible ureteroscopy has been adapted to facilitate retrograde nephrostomy creation for percutaneous nephrolithotomy.  This approach is still under investigation, though early results are favorable.<ref>{{cite journal | vauthors = Wynberg JB, Borin JF, Vicena JZ, Hannosh V, Salmon SA | title = Flexible ureteroscopy-directed retrograde nephrostomy for percutaneous nephrolithotomy: description of a technique | journal = Journal of Endourology | volume = 26 | issue = 10 | pages = 1268–74 | date = October 2012 | pmid = 22563900 | doi = 10.1089/end.2012.0160 }}</ref> Percutaneous nephrolithotomy or, rarely, [[lithotomy|anatrophic nephrolithotomy]], is the treatment of choice for large or complicated stones (such as calyceal staghorn calculi) or stones that cannot be extracted using less invasive procedures.<ref name=Anoia2009 /><ref name=Miller2007 />

==== Ureteroscopic surgery ====
[[Ureteroscopy]] has become increasingly popular as flexible and rigid [[optical fiber|fiberoptic]] ureteroscopes have become smaller. One ureteroscopic technique involves the placement of a [[Ureteric stent|ureteral stent]] (a small tube extending from the bladder, up the ureter and into the kidney) to provide immediate relief of an obstructed kidney. Stent placement can be useful for saving a kidney at risk for [[Acute kidney injury#Postrenal|postrenal acute kidney failure]] due to the increased hydrostatic pressure, [[edema|swelling]] and infection ([[pyelonephritis]] and [[pyonephrosis]]) caused by an obstructing stone. Ureteral stents vary in length from {{convert|24|to|30|cm|in|abbr=on}} and most have a shape commonly referred to as a "double-J" or "double pigtail", because of the curl at both ends. They are designed to allow urine to flow past an obstruction in the ureter. They may be retained in the ureter for days to weeks as infections resolve and as stones are dissolved or fragmented by ESWL or by some other treatment. The stents dilate the ureters, which can facilitate instrumentation, and they also provide a clear landmark to aid in the visualization of the ureters and any associated stones on radiographic examinations. The presence of indwelling ureteral stents may cause minimal to moderate discomfort, frequency or urgency incontinence, and infection, which in general resolves on removal. Most ureteral stents can be removed cystoscopically during an office visit under [[Topical anesthetic|topical anesthesia]] after resolution of urolithiasis.<ref name=Lam2007 /> Research is currently uncertain if placing a temporary stent during ureteroscopy leads to different outcomes than not placing a stent in terms of number of hospital visits for post operative problems, short or long term pain, need for narcotic pain medication, risk of UTI, need for a repeat procedure or narrowing of the ureter from scarring.<ref>{{cite journal | vauthors = Ordonez M, Hwang EC, Borofsky M, Bakker CJ, Gandhi S, Dahm P | title = Ureteral stent versus no ureteral stent for ureteroscopy in the management of renal and ureteral calculi | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | pages = CD012703 | date = February 2019 | issue = 2 | pmid = 30726554 | pmc = 6365118 | doi = 10.1002/14651858.CD012703.pub2 | collaboration = Cochrane Urology Group }}</ref>

More definitive ureteroscopic techniques for stone extraction (rather than simply bypassing the obstruction) include basket extraction and ultrasound ureterolithotripsy. [[Laser lithotripsy]] is another technique, which involves the use of a [[holmium]]:[[yttrium aluminium garnet]] (Ho:YAG) laser to fragment stones in the bladder, ureters, and kidneys.<ref name="Marks2011" />

Ureteroscopic techniques are generally more effective than ESWL for treating stones located in the lower ureter, with success rates of 93–100% using Ho:YAG laser lithotripsy.<ref name=Gettman2005 /> Although ESWL has been traditionally preferred by many practitioners for treating stones located in the upper ureter, more recent experience suggests ureteroscopic techniques offer distinct advantages in the treatment of upper ureteral stones. Specifically, the overall success rate is higher, fewer repeat interventions and postoperative visits are needed, and treatment costs are lower after ureteroscopic treatment when compared with ESWL. These advantages are especially apparent with stones greater than {{convert|10|mm|in|1|abbr=on}} in diameter. However, because ureteroscopy of the upper ureter is much more challenging than ESWL, many urologists still prefer to use ESWL as a first-line treatment for stones of less than 10&nbsp;mm, and ureteroscopy for those greater than 10&nbsp;mm in diameter.<ref name=Gettman2005 /> Ureteroscopy is the preferred treatment in pregnant and morbidly obese people, as well as those with [[Bleeding diathesis|bleeding disorders]].<ref name=Miller2007 />
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