By: Leslie Peard, MD & Julie Cheng, MD, MAE, FAAP
Kidney stones have become more common in children and teens in recent years. Most children who get kidney stones can pass the stones on their own and do not need surgery. However, some stones need to be treated with surgery. Here's what parents need to know.
When is kidney stone surgery needed?
Your child may need surgery for their kidney stone if:
the stone is causing very bad pain or vomiting,
the stone is very large, or
your child also has an infection with the stone.
How is kidney stone surgery performed in children?
There are different types of surgery for kidney stones (see below). These surgeries are performed by urologists, or doctors specialized in surgery of the kidneys and bladder. Your child's doctor will discuss options for your child before surgery.
For kidney stone surgeries, your child will need to be asleep with general anesthesia.
Kidney stone surgery options for children & teens include:
- Ureteral stent. A ureteral stent is a small tube that travels from the kidney, through ureter (the tube that drains the kidney) and into the bladder. A stent is usually placed to drain pee out if your child has severe pain or an infection, after a surgery that breaks up the stone, or to prepare for another kidney stone surgery. To place the stent, your urologist will place a small camera into the bladder, so no incisions are needed. It is important to know that the stent is
temporary and will be removed at some point.
Sometimes, the stent is removed with a short procedure in the operating room under anesthesia, and sometimes a small string is left on the stent so it can be removed without your child going to sleep.
- Ureteroscopy & laser lithotripsy. Ureteroscopy uses a very thin camera that can travel into the bladder and up the ureter. No incisions are needed. Once the stone is found, it is broken into small pieces with a laser beam and the pieces are removed. Often, a ureteral stent is left in place temporarily after surgery. In children, sometimes the ureter is so thin that the cameras will not fit. If this is the case, a ureteral stent will be placed, which will help open up the ureter; your child will need a later surgery to treat the stone.
- Shockwave lithotripsy. In shockwave lithotripsy, a machine is placed on your child's back that directs soundwaves to the stone. These soundwaves break the stone up into small pieces that can then be passed in the pee on their own.
- Percutaneous nephrolithotomy. In this surgery, a camera is placed through a small (about half an inch) incision in the back directly into the kidney. The stone is then broken up into small pieces and removed from the body through this small incision. This procedure is usually only used in children with large stones. Children typically stay in the hospital after this surgery.
What happens around the time of surgery?
Sometimes, surgery for kidney stones is planned, or elective, and sometimes, surgery is unplanned, or urgent/emergent.
With planned kidney stone surgery, your urologist's office will give you specific details about the day of surgery. They will also tell you when your child needs to stop eating and drinking before surgery. Most children go home the same day after a planned kidney stone surgery.
If your child is having severe pain or an infection related to the stone, surgery may be recommended urgently or emergently. In this case, your child may require a hospital stay. If your child is having fevers (over 101.5 degrees F) or is diagnosed with a urinary tract infection, you may also need to stay in the hospital for antibiotics.
What will recovery after kidney stone surgery look like for my child?
Instructions for care after surgery may be different based on what type of surgery your child had.
You can expect the discomfort to last at least a couple days after surgery. However, this depends on what procedure your child has had. Your child may experience discomfort in the back, where their kidney is, or in the low belly due to bladder discomfort. Some children will have pain or burning when they pee. If a ureteral stent was placed, some children take medicine for comfort until the stent is removed.
Pain after surgery is managed with over-the-counter medicine like acetaminophen and ibuprofen. Your doctor may prescribe stronger pain medications if needed. Your doctor may also prescribe some special medicines for the bladder.
Blood in the urine is expected after surgery, and urine color may range from yellow to red. If your child has had a stent placed, you can expect the blood to come and go until the stent is removed. You should call your doctor if your child's urine is thick (like ketchup) or has large blood clots.
What are reasons to call your doctor after surgery?
You should call your doctor if your child has:
Vomiting and is unable to stay hydrated
Pain not well controlled by the medicine prescribed by your doctor
Temperature over 101
Trouble peeing
Thick blood in the urine or large blood clots
Will my child need to see the doctor after surgery?
You should let your pediatrician know that your child was diagnosed with kidney stones and had surgery, as they will want to continue to see you regularly.
Your urologist or pediatrician may also recommend you see a nephrologist, who is a doctor specializing in medical treatments for the kidneys. They may discuss additional tests that can be done and ways to prevent your child from getting more kidney stones.
More information
About Dr. Peard
 Leslie Peard, MD, is an Assistant Professor of Urology in the division of pediatric urology at the University of Kentucky in Lexington. Dr. Peard is a member of the American Academy of Pediatrics (AAP) Section on Urology, serving on its Education Committee.
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About Dr. Cheng
 Julie Cheng, MD, MAE, FAAP, is an assistant professor of urology at the University of Washington and Seattle Children's Hospital in Seattle, WA. She is a member of the AAP Section on Urology. She is currently the co-chair of the Education Committee for the Section on Urology.
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