Kidney stones, Part II: Surgery is but one of several options

There are several surgical treatment options available today that are less inva´sive and require a much shorter recovery time.

By: Lorraine Seabrook with Alexander P. Vukasin, MD
   While there are preventative methods for dealing with
kidney stones, they are not foolproof. Every day people
develop stones that must be treated. Alexander P. Vuka´
sin, M.D., a board-certified urologist on staff at the Uni´
versity Medical Center at Princeton, explains when you
should seek treatment and what options are available to´
   Dr. Vukasin notes that the following symptoms may
suggest the presence of a kidney stone and you should contact your
doctor if you experience a combination of:

  • Extreme pain in your back or side that will not go away;
  • Blood in your urine (the urine will appear pink);
  • Urine that smells bad or looks cloudy;
  • Nausea and vomiting, and
  • A burning sensation when you urinate.

   If you suspect you have a stone and your symptoms are accompanied by fever and chills, you require immediate medical attention.
These symptoms may also represent other more serious diseases.
   If prevention has failed and medical therapy is not providing
you with the necessary relief, your physician may recommend you
for surgical treatment.
   The National Institute of Diabetes and Digestive and Kidney
Diseases notes the following instances where surgery may be neces´
sary to remove a kidney stone: The stone does not pass and is caus´
ing constant pain; it is too large or caught in a difficult place; it pre´
vents urine from flowing; it causes an ongoing urinary tract
infection; it damages kidney tissue or causes constant bleeding, or it
has grown larger (a follow-up X-ray would determine this).
   In the past, kidney stone removal surgery was quite painful and
the patient could expect to spend at least four weeks recovering.
Fortunately, there are several surgical treatment options available
today that are much less invasive and require a much shorter recov´
ery time.
   The most frequently used procedure for stones that are smaller
than 2 centimeters (.08 inches) uses shock waves that begin outside
the body and travel through the skin and tissue until they reach their
destination: dense stones. The waves shatter the stones into sand-
like particles that the body easily passes in the urine. This procedure
is called extracorporeal shockwave lithotripsy (ESWL) and it is
now available at the University Medical Center at Princeton.
   A patient receiving ESWL at the University Medical Center at
Princeton can expect the following.
   After receiving heavy sedation, the patient will lie on a stretcher
and gel will be applied to the patient’s side. A soft plastic bubble
that is similar in size to a large balloon will be brought up against
the patient’s flank. Inside the bubble is a spark gap generator sur´
rounded by three gallons of water. The shockwave produced travels
through the water, through the skin, and ultimately to the kidney
stone, breaking it down. The actual procedure takes about an hour.
   After the procedure, the patient will be asked to stay for
a short time before leaving the hospital and can expect to re´
sume normal activities within several days.
   After the treatment, it is typical for patients to have
blood in their urine and to experience some bruising and
have minor pain in the back or abdomen for several days.
To help reduce this complication, patients should avoid tak´
ing aspirin and any other medications that affect blood clot´
ting for several weeks prior to receiving ESWL. Some pa´
tients may also experience discomfort as the particles of
stone pass along the urinary tract.
   If the stone is not completely shattered in one treatment,
additional treatments may be required.
   If a patient has kidney stones that are located in the mid and
lower ureter, an intervention known as ureteroscopy may be neces´
sary. During this procedure, a ureteroscope, a tiny fiber optic instru´
ment (7 mm. circumference), will be inserted through the urethra
and bladder and into the ureter. Once the surgeon locates the stone,
he or she will either remove it or shatter it with special shockwave-
producing instruments.
   The University Medical Center at Princeton has several state-of
the-art stone breaking instruments, including a Holmium laser,
electrohydraulic lithotripsy (EHL), and the Swiss lithoclast (effec´
tively a miniature pneumatic jackhammer). No incision is required
and a small tube (stent) may be left in place to help heal the lining
of the ureter. Patients typically go home the same day.
   If a stone is quite large or is located in a place that makes it dif´
ficult for ESWL or ureteroscopy to be effective, a surgical treatment
called percutaneous nephrolithotomy is used.
   A surgeon will make a tiny incision in the patient’s back and
place a small tube directly into the kidney. Using a nephroscope
through this tunnel, the surgeon will breakup and remove the stone
and any stone fragments. A small tube will remain in the kidney
during the healing process. Following this procedure, patients can
expect to spend several days in the hospital.
   So, while dealing with kidney stones is never painless or pleasant, it is comforting to know that there are treatment options that
can remove or shatter the stone while causing you little discomfort.