By Ilya Sobol, MD –
Advances in minimally-invasive treatments to remove kidney stones should encourage more patients to take preventive action against what could turn into dangerous and excruciatingly painful ureteral obstructions.
Here’s the scenario no one wants: a patient arrives at the hospital in agony, but physicians can’t safely operate to remove a stone until they have a negative, bacteria-free urine culture – which might take up to three days to confirm. In the meantime, patients usually require a stent to drain urine around the stone.
Therefore, preemptively destroying potentially problematic stones still in the kidneys, using Extracorporeal Shock Wave Lithotripsy (ESWL), ureteroscopy, or Percutaneous Nephrolithotomy (PCNL), frequently makes sense based on a simple risk/benefit calculus.
Kidney stones are common, affecting about 10 percent of Americans in their lifetimes. Furthermore, Hampton Roads is part of the so-called “Kidney Stone Belt”, a region in the southeastern United States that has higher-than-average rates.
Factors may include hot and humid weather that raises the risk of dehydration; the prevalence of obesity and related chronic conditions such as diabetes; and diets often rich in animal fats, sugar, sodium, and high-oxalate foods such as tea, nuts and chocolate.
Should a physician discover that a patient has one or more kidney stones through a CT scan, ultrasound or other diagnostic test, I recommend referral to a urologist for any deposit that measures 3 millimeters (mm) or larger.
The smaller the stone, the more likely it is to pass without medical intervention. Stones 3 mm or less have a 98 percent chance of spontaneously passing; that percentage drops to 65 percent for 5 mm stones, 33 percent for 6 mm, and less than 10 percent for larger than 7 mm. Even if people do manage to pass a large stone, they are at risk for kidney damage and infection.
Symptoms such as pain, nausea and blood in the urine typically occur only with obstruction, or after a stone has moved out of the kidney and lodged in the ureter. Patients with a 9 mm stone but no urinary blockage could be totally asymptomatic, yet each also has a 20 percent chance of developing an obstruction within five years.
Optimal treatment is based on the number, size and location of stones, along with a patient’s co-morbidities, need for anti-coagulants, and input regarding side effects. In general, ESWL is best for single, smaller stones, ureteroscopy with laser lithotripsy works well for medium-sized deposits, and PCNL is reserved for bigger stones.
While PCNL still typically requires an overnight hospital stay, the surgery has become much less invasive – the incision for directing a needle and tiny camera into the kidney is only about a centimeter wide – and is very effective at clearing out all stones and fragments.
With open surgery for kidney stones a thing of the past, my hope is that more physicians and patients will be aware of, and open to, these elective procedures, rather than waiting for an emergency to strike.
Dr. Sobol is a fellowship trained endourologist with Urology of Virginia, specializing in kidney stones and benign prostatic hyperplasia. He is based in the practice’s Suffolk office. urologyofva.net
