Charlotte and North Carolina in general have the decidedly less-than-ideal distinction of being in the stone belt, an area of the United States stretching from the mid-Atlantic states to the Southeast where kidney stones are most common. Why is this? Well, this is mainly due to the extreme heat we experience throughout the summer and the dehydration that comes with it. This summer heat increases the chances of symptomatic kidney stones, which, if you haven’t already heard, have been likened to childbirth as one of the most important painful events in a person’s life.
While some kidney stones, especially those smaller than 4 mm, can be seen and often pass in the urine naturally, many of us develop significantly larger kidney stones that cannot fit into the ureter – the connecting tube between the kidneys and the bladder. bladder. There are a few reasons why kidney stones can become symptomatic.
- They pass out of the kidney but are trapped in the ureter. Obstruction of the ureter increases back pressure on the kidney, causing inflammation and possibly infection. Regardless of the cause, this inflammation and distension is the cause of the extreme pain that kidney stone patients will experience. Kidney stones in the ureter can be up to 5 mm and cause significant discomfort.
- Kidney stones within the kidney itself can grow quite large before becoming symptomatic. I usually see kidneys that are more stones than tissue. Here too, these stones disrupt kidney function and create severe symptoms.
So, to learn more about treatment, let’s discuss the three main kidney stone procedures we use today:
ESWL or extracorporeal shock wave lithotripsy
ESWL is one of the newest and most exciting procedures we offer. ESWL is unique because it requires no access to the body and is not even minimally invasive or endoscopic. Instead, a specialized machine fires targeted shock waves directly at the kidney stone, breaking it up so it can be flushed out of the body through urine. While we often treat kidney stones using this procedure, ureteral stones can also be treated in some cases.
ESWL is a patient favorite because it is not invasive at all. However, the patient must understand that ESWL is less effective and may leave behind some stone fragments, which, over time, will likely form into new symptomatic stones.
Ureteroscopy with laser lithotripsy
For somewhat more complicated or challenging kidney stones, a procedure known as ureteroscopy with laser lithotripsy is a star. First, a vaccine passes through the urethra, through the bladder, and up the ureter. It is the ureteral stones for which laser lithotripsy is best indicated. Stones inside the kidney are usually not treated with lasers. Once visualized, the laser lines up and deploys, striking the stone with enough energy to shatter it. Because we can image the kidney stone during laser lithotripsy, we can usually remove most of the fragments and leave the patient stone-free or very close, reducing the chance of future kidney stones.
PCNL or Percutaneous Nephrolithotomy
For the most complex and large kidney stones, PCNL comes to the rescue. PCNL involves a radiologist inserting a tube, known as an access, into the kidney before the procedure. This access allows us to enter the kidney directly through the skin and target the kidney stone with mechanical therapy or laser therapy to break it up. Once visualized, the stone is broken up and allowed to pass. In some cases, stone material can be retrieved from the body, and most patients leave PCNL stone-free.
Bottom line
As you can see, there are a myriad of options for treating kidney stones. Some, such as ESWL, may not be suitable for harder stones. Others, such as PCNL, are reserved for complex or very large kidney stones and are not suitable for the typical stone within the ureter. With that said, we’ve never had more or better options for treating kidney stones, and such patients are in good hands with Dr. Associates. Natale and Carolina Urology.
