Stone Disease

A comprehensive program for the diagnosis, treatment and prevention of urinary stone disease is offered.

Diagnosis

The initial evaluation of a patient with stone disease is carefully performed to determine the number, size and location of the stone burden. Imaging studies are performed to demonstrate kidney function, the patient's anatomy and the CAT scan characteristics of the stone(s) degree of "hardness". The number, size, location and "hardness" of the stones provide vital information for planning the most efficient treatment strategy for each individual patient

Treatment of Urinary Stones

Today, there are many choices for removing urinary stones. We offer all the available options for treatment:

Medical Expulsive Therapy - use of medication and hydration to pass small stones (85% of stones can be safely managed in this manner)
Medical Dissolution of Stones - stones of uric acid composition, that are not obstructing can be dissolved over time by increasing the alkalinity of the urine with dietary modification and medication
Shock Wave Lithotripsy - the fragmentation of stones by high energy shock waves generated outside the body. This technique is performed under a "twilight" anesthesia, as an outpatient. SWL is ideal of smaller stones, too large to pass, in the kidney and ureter. It is the most commonly used treatment of symptomatic stones.
Ureteroscopy and Laser Lithotripsy - for stones in the ureter or kidney that are not candidates for shock wave lithotripsy due to their size or hardness. For this technique, general anesthesia is used. A very thin fiber optic instrument, equipped with video capability to generate high resolution magnified images is advanced into the ureter or kidney. Stones identified are fragmented wit laser energy. The small fragments can be extracted or left to pass spontaneously, depending on size.
Percutaneous Nephrolithotomy - for large kidney or upper ureteral stones. This technique, performed under general anesthesia, calls for the placement of a fine needle, under ultrasound/x-ray guidance, into the kidney. A balloon dilator is placed over the needle/safety wire in order to dilate a tract from the skin to the inside of the kidney. A sheath is placed over the balloon so that a safe passageway is established for the introduction of a video-scope that allows the surgeon to directly view the stones in the kidney. To break up the stones ultrasound energy, laser energy, or a "jack-hammer" type device is used. The small resultant fragments are then safely removed with graspers through the access sheath. An overnight hospital stay is required for this technique.
Robotic/Laparoscopic Stone Surgery - for very large stones that are not amenable to treatment by the above techniques and would otherwise require open surgery; also for stones associated with structural abnormalities of the ureter or kidney that require surgical correction at the time of stone removal.
Open Surgery - the option of last resort. Rarely used in today's practice

Prevention of Stone Disease

Emphasis is placed on a complete metabolic work up to identify the reasons for recurrent stone formation in each individual patient. The work up includes a review of the patient's past stone history, family history, with special attention paid to diet, eating habits and food preferences, physical activity and fluid intake.

One or two 24-hour urine collections are performed at home to assess the balance of stone promoters and stone inhibitors present in the patient's urine. Additional specific blood tests may be required to complete the metabolic evaluation.

Taken together, this information allows the generation of a specific plan for stone prevention for each individual patient. Dietary and fluid intake recommendations are made; if necessary medication is used to further decrease to the risk of stone formation.