Stone Disease * Kidney Stones * Advanced Treatments
The evaluation and management of most patients with kidney stones falls within the purview of the general urologist. Most stones form within the kidney and only cause pain when they block or obstruct a portion of the urinary tract. Stones are usually diagnosed with one or more types of imaging tests: IVP, ultrasound, CT scan, or KUB. UANT is able to offer these services to most patients within one or more of our locations.
The management options for kidney stones include observation, ureteroscopy, ESWL (shock wave lithotripsy), and percutaneous surgery. Many patients with small stones in the lower urinary tract will pass the stone without the need for further treatment. Careful observation and follow-up by your physician is necessary until it has been documented that the stone has passed; failure to do so can occasionally result in silent (painless) damage to the urinary tract.
Ureteroscopy is a minimally invasive procedure that requires anesthesia in an outpatient surgical facility. Ureteroscopy is most commonly employed for stones in the lower urinary tract. The surgeon places a slender rigid or flexible telescope through the ureter to the level of the stone, where it is then managed with extraction, fragmentation, or both. It may be necessary to leave a temporary soft stent in the ureter to prevent postoperative obstruction by fragments or swelling; in uncomplicated cases, the stent is removed 1-5 days later in a simple office procedure. Ureteroscopy has a very high success rate; injury to the ureter is a rare (1%) but recognized complication.
ESWL is a non invasive therapy that also requires sedation or anesthesia in an outpatient facility. ESWL is the treatment of choice for stones in the upper urinary tract and also suitable for stones in the lower urinary tract that can be visualized with xray. The involved area of the urinary tract is targeted by xrays to send a series of focused shock waves on the stone and break it into fine particles; the particles then pass out with the urine. ESWL does not require stenting in most cases. ESWL has a high success rate and an excellent safety record; there is no significant risk of serious injury to the ureter in most cases. Potential complications include inability to completely fragment a very hard stone and complications related to obstruction by incompletely fragmented pieces (<10% overall). USMD|UANT surgeons perform more than 1000 ESWL procedures per year.
Percutaneous surgery is a minimally invasive procedure that requires anesthesia and usually an overnight stay in the hospital. This procedure is indicated for very large stones in the kidney, certain types of very hard stones, and some otherwise complicated patients who are not candidates for other therapies. A small telescope is placed through the skin and the kidney to enter the inside of the urinary tract; once in position, the surgeon fragments the stone and removes the pieces. After the procedure a catheter is left in the kidney (exiting the skin) for 1-3 days. Repeat procedures are sometimes necessary to completely clear the stone from the urinary tract. Potential complications include bleeding and injury to adjacent organs from passage of the telescope. At USMD|UANT specialists in this technique perform over 50 procedures per year.
Ureteral stents are small catheters inserted into areas of the ureter that transport urine from the kidney. The catheters can either assist with carrying the urine directly to the bladder or can be used to divert urine to an external collection system. The ureteral stents are frequently applied through the skin. When kidney stones or ureteral stones are present, the stents are best placed during cystoscopy.
Ureteral stents can be placed on a short or long-term basis (months or years).