Urinary Tract Stone Disease: New Solutions for an Ancient Problem of Kidney Stone
The history of the diagnosis and management of urinary tract stones is as old as medicine itself. In fact, mention of stone disease is included in the Hippocratic Oath that physicians take before they are given the privilege of practicing medicine. In the 21st century we have very sophisticated and efficient ways of dealing with urinary tract stone disease. Most of these principles can be applied in our Ambulatory Surgery Center.
Kidney Stone Symptoms
Urinary tract stones are crystal-like structures that form in the kidney. Although these stones may cause pain within the kidney, pain usually occurs when they break lose and pass down the ureter. This pain is often described as the most severe back, flank or abdominal pain that a person can experience. A kidney stone attack is usually diagnosed by this pain onset, often associated with other symptoms, including nausea, vomiting and blood in the urine. Not all kidney stones require treatment; approximately 80% are passed spontaneously. However, when a kidney stone attack occurs, the pain is frequently so severe that medical consultation is almost always necessary.
Kidney Stone Treatments
The current treatment for many kidney and ureteral stone cases is ESWL—Extracorporeal Shock Wave Lithotripsy—a type of non-invasive treatment that can break stones into small particles that either pass or be easily removed. Another treatment to control the pain of a kidney stone attack involves the placement of a stent—a small tube passed up the ureter on the side that is involved with the stone. This is done with the use of an instrument called a cystoscope.Another approach involves use of a ureteroscope. This is a very small scope introduced through the urethra, which is the tube through which urine passes. The ureteroscope is guided into the bladder and finally into the small tube called the ureter, that drains the involved kidney.
In this treatment, a laser fiber is frequently passed thru the ureteroscope, with laser energy focused on the stone to break it into very small pieces that can be passed or removed. If the kidney stone is large and is located either within the kidney or at the junction of the kidney with the ureter, a technique called percutaneous nephrostolithotripsy may be used.
This procedure is usually performed under general anesthesia. In it, a small needle is passed through the skin of the flank and into the involved kidney. A guide wire is then passed through the needle, and the tract is enlarged using a dilating balloon passed over the guide wire. A small scope is then inserted through this passage, with the stone visualized broken apart with laser treatment. The stone fragments are then removed through use of the nephroscope.
Our Practice: We currently treat most kidney stones in our Ambulatory Surgery Center.
Often, a patient can receive treatment the first day symptoms develop, with the stone problem solved and the patient returning to normal activities in short order. It is not uncommon today, with the availability of centers like The Knightsbridge Ambulatory Center, where Dr. Riemenschneider practices, that a patient’s kidney stone problem can be resolved in the time that might otherwise be spent awaiting treatment in a hospital emergency room.At Riverside Urology, we have long experience with the management of urinary tract and kidney stone problems. You can benefit from a very rapid solution to this painful and disabling disease. We welcome your questions and are available to serve you promptly. Please contact us through this website for more information.