What to expect

Before your first appointment

1. Referral

   Your GP faxes or emails a referral to the rooms. The referral triggers a same-day triage - urgent stone cases (obstruction, indwelling stent, recurrent formers with new stones) are prioritised.

2. Appointment booking

   Our staff contact you within a day or two to arrange an appointment at the location most convenient for you (St Vincent's Darlinghurst, Mater North Sydney, or Bowral).

3. Gather your imaging

   Contact the imaging provider who did your CT scan and request the images on disc or via secure link. The images are more useful than the written report alone.

Your consultation

A stone consultation typically lasts 30 to 45 minutes. It includes:

• A focused history - the story of the stone, your symptoms, any previous stones or operations, medications.
• A brief examination where appropriate.
• A detailed review of the CT scan on the consulting-room screen.
• A discussion of the realistic treatment options, the evidence for each, and what Dr Kooner recommends.
• Time for your questions.

At the end of the consultation you will have a clear plan - either conservative management, a planned operation, or further investigation such as a urine culture or blood tests. A letter is sent back to your GP.

Preparing for a stone procedure

1. Pre-admission checks

   A urine culture is done in advance - operating on an infected stone is unsafe, so a clear culture is confirmed before surgery. Blood tests (full blood count, kidney function, clotting) are organised as needed.

2. Medication review

   If you are on blood-thinners, a plan is made in conjunction with your cardiologist. Many patients can have flexible ureteroscopy without interrupting their anticoagulation.

3. Hospital admission paperwork

   You will receive admission forms and instructions from the hospital - fasting times, arrival time, what to bring.

4. Fasting

   Typically no food for 6 hours and no water for 2 hours before anaesthetic.

The day of your procedure

1. Arrival and admission

   At the admissions desk, then through to the pre-operative area where you meet nursing staff, the anaesthetist, and Dr Kooner again before theatre.

2. The anaesthetic

   General anaesthetic for ureteroscopy, PCNL, and most ESWL. You will have a conversation with the anaesthetist about your medical history, medications, and any previous anaesthetic issues.

3. The procedure

   Ranges from about 30 minutes (ESWL) to 1-3 hours (PCNL). Family members are welcomed back in the recovery area once you are awake and stable.

4. Recovery and discharge

   Ureteroscopy and ESWL are often same-day or overnight. PCNL typically involves a one- to two-night stay.

Going home

Standard discharge instructions include:

• Analgesia - simple oral pain relief (paracetamol, NSAID where safe) and a small supply of stronger pain relief for the first few days.
• Fluids - aim for a clear urine colour and a urine output of around 2.5 L a day.
• Activity - light activity immediately, desk work often within days, strenuous exercise after stent removal (URS) or about 4 weeks (PCNL).
• Warning signs - fever, uncontrolled pain, heavy bleeding, or inability to pass urine. Ring the rooms or go to ED if any occur.
• Stent removal appointment - booked before you leave hospital, usually 7-14 days later.

Follow-up and long-term plan

1. Stent removal (URS, PCNL, or emergency stents)

   Quick office procedure under local anaesthetic gel. Stent symptoms resolve quickly afterwards.

2. Post-operative imaging

   Ultrasound or low-dose CT at 4-12 weeks to confirm stone clearance.

3. Review appointment

   In the rooms, typically at 4-8 weeks post-operatively, to go over the imaging result and plan ongoing prevention.

4. Metabolic pathway (if applicable)

   For recurrent or young stone formers, referral to a renal physician colleague for full metabolic assessment and tailored prevention. See the prevention hub.

5. Long-term surveillance

   Yearly or biennial review with periodic imaging, depending on stone type and risk.

If something is not right

Between visits, you are welcome to phone the rooms at 02 8382 6980. After hours, for any of the red-flag signs - fever, uncontrolled pain, inability to pass urine, heavy bleeding - go directly to your nearest emergency department.

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