Emory University Urology Comprehensive Stone Clinic
Emory University Urology Comprehensive Stone Clinic
Directors: Dr. John Pattaras and Dr. Kenneth Ogan
Appointments: 404-778-4898
Kidney stones (nephrolithiasis) are a tremendous source of pain, and if left untreated, may lead to infections, kidney damage and even death.
Emory University in Atlanta, Georgia, is situated in the heart of the "stonebelt" where there is a high incidence of stone disease due to the weather and southern diet. The Emory University Urology Comprehensive Stone Center, under the direction of Dr. John Pattaras and Dr. Kenneth Ogan, is dedicated to the diagnosis, treatment and prevention of kidney stones. Our team combines experts in the field of stone disease with the latest treatment technologies to provide optimal care to our patients.
- Kidney & Urinary Tract
- Kidney Stones (Nephrolithiasis)
- Diagnosis
- Treatment Options
- Prevention
- Research in Stone Disease
The Kidney and Urinary Tract
The urinary tract helps to maintain proper water and salt balance throughout the body. The urinary tract is composed of two kidneys, two ureters, the bladder and urethra. The two kidneys function to make urine, which drains into the ureters. The ureters are long narrow tubes that connect the kidneys to the bladder. The urine is stored in the bladder and eventually expulsed with urination by traveling through the urethra.
Kidney Stones (Nephrolithiasis)
Kidney stones are one of the most common disorders of the urinary tract. Approximately one half million stones are reported in the United States each year. Kidney stones affect about 12 percent of men and 5 percent of women by the age of 70. The peak age for a stone is between 20 and 40 years old. Caucasians have an increased incidence compared to African-Americans. Stones are more common in hot climates, and the peak incidence occurs one to two months after the hottest months.
There are multiple reasons why kidney stones form. Essentially, there is a delicate balance of electrolytes in urine. When this balance is disrupted, kidney stones form. The primary reason for kidney stone formation is dehydration (not drinking enough water). Dehydration causes the salts and electrolytes to precipitate in the urine to form crystals, which grow to eventually become kidney stones. The most common type of stone is composed of calcium oxalate. Other less common stones are composed of calcium phosphate, uric acid, struvite (infection) and cystine.
Stones form in the kidney and may travel to anywhere along the course of the urinary tract down to the urethra. When kidney stones get lodged in the ureter, they block the flow of urine from the kidney. This can produces severe flank pain, which has been described as worse than the pain of childbirth. Other symptoms include nausea, vomiting, fever, chills, and blood in the urine. While the pain may be unbearable, worse even is that stones can damage the kidneys and, when combined with an infection, can be deadly.
Diagnosis
- History and Physical Exam by your doctor
- Blood Tests
- Electrolytes to assess kidney function
- Complete blood count to look for infection
- Urine Tests
- Diagnose urinary tract infection
- Help identify type of stone
- X-ray Studies to localize stone
- Plain X-ray (KUB)
- Computed Tomography (CT Scan)
- Intravenous Pyelography (IVP)
Treatment Options
- Observation
- Extracorporeal Shock Wave Lithotripsy (SWL)
- Ureteroscopy
- Percutaneous Nephrostolithotomy (PNL)
- Open Stone Surgery
|
OBSERVATION |
|
Waiting for the stone to pass on its own without intervention (spontaneous passage). The rate of spontaneous passage is determined by the stone size and location.
- High rate of passage: < 4 mm size and distal ureter (near bladder)
- Low rate of passage: > 6 mm size and proximal ureter (near kidney)
During observation, pain medications are prescribed and the patient is instructed to drink a lot of water (> 2 liters/day) and strain the urine to catch the stone if it passes.
Observation is not an option with a coexisting infection, severe pain not controlled with medications, intractable nausea and vomiting, and in patients with underlying kidney disease.
If observation is not indicated or the stone does not pass while on observation for two to three weeks, then intervention is necessary. |
|
EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (SWL) |
|
Shock waves from a machine (lithotriptor) are focused onto stones in the kidney or ureter. The shock waves pass through the body and hit the stone, causing it to fragment into small pieces.
Because of possible discomfort from the procedure, patients will receive anesthesia during lithotripsy. A stent may have to be placed in the ureter through the urethra prior to SWL to help stone fragments pass down the ureter after treatment.
- Success rates: 50-80 percent depending on stone size and location.
- Possible complications: Bleeding in kidney (renal hematoma), obstruction during passage of stone fragments ("steinstrasse"), hypertension, adjacent organ injury and bruising of skin.
- Hospital stay and recovery: This is the least invasive intervention and is performed as an outpatient procedure (no overnight hospital stay). Recovery time is short and most people are back to normal activity in a few days.
|
|
URETEROSCOPY |
|
Treating stones in the ureter and kidney with a small fiberoptic telescope (ureteroscope) inserted through the opening in the urethra (No incision). Stones are either grasped and removed or broken into tiny pieces with a laser. After the procedure a small tube (stent) may be placed in the ureter for a few days to allow the lining of the ureter to heal. The doctor will remove the stent at a follow up appointment.
- Success rates: 75-100 percent depending on stone size and location.
- Possible complications: Damage to the ureter, infection, bleeding, ureteral stricture (narrowing).
- Hospital stay and recovery: Most cases performed as an outpatient procedure. Recovery time is short and most people are back to normal activity in a few days.
|
|
PERCUTANEOUS NEPHROSTOLITHOTOMY (PCNL) |
|
Treating stones in the kidney by making a one-inch incision in the back and creating a tunnel through the kidney to the stone.
Through the tunnel the doctor uses a fiberoptic telescope (nephroscope) to either remove the stone or break it up into tiny pieces using a laser, ultrasound probe, or pneumatic device (jack-hammer).
After the procedure, a tube is placed in the kidney (nephrostomy tube) and the ureter (stent) to drain the kidney and allow it to heal. The doctor will remove these after X-rays have shown that the kidney has healed and all the stones have been removed.
X-rays will be done on the day after surgery to confirm that all of the stones have been removed. If stones are still present, then another procedure (2nd look) will be performed on the second postoperative day to remove any remaining fragments.
- Success rates: 70-99 percent depending on stone size and location.
- Possible complications: Bleeding, infection, urinary injury, adjacent organ injury.
- Hospital stay and recovery: Several day hospital stay with two to four weeks until back to full activity.
|
|
OPEN STONE SURGERY |
|
Making an incision with a knife to remove stones. While this was the original form of treatment for all stones, today it comprises < 5 percent of all treatments for renal stones.
Because of the expertise of our faculty in removing stones in a minimally invasive fashion at Emory, we rarely if ever resort to this treatment option. |
Prevention
LIFESTYLE AND DIETARY CHANGES
- Increase water consumption to produce urine volume of 2 liters/day
- Reduce animal protein to one serving.
Avoid: organ meats, shellfish, brewer's yeast, baker's yeast, herring, sardines, mackerel and anchovies
- Reduce foods high in oxalate content (Turnip greens, almonds, peanuts, beet greens, parsley, spinach, rhubarb, black tea, cocoa, chocolate and figs)
- Avoid the use of table salt
- Reduce caffeine intake
- Increase fiber intake
- Smoking cessation
- Daily exercise program
MEDICATIONS
Some patients are unable to reduce their risks of forming recurrent kidney stones with dietary changes. These patients will need to be placed on daily medications to prevent future stones.
|
