Kidney stones

Kidney stone disease is a common disorder that affects 10%-15% of the population.  This disorder is more common in man and is rare in children.  Urinary stones are crystalline particles that forms in the kidneys due to dehydration, anatomical variation of the Ureteral system or an underlying metabolic disorder.  Urinary stones often produce pain when they obstruct urine drainage from the kidney.  Other clinical consequences of kidney stone are renal failure, recurrent urinary tract infection and even life threatening infections.  Approximately 50% of stone formers will develop a second kidney stone in 10 years. 

  During the past three decades, due to improvements in endoscopic instruments and surgical technique, the management of urinary stones has shifted from open surgeries to minimally invasive procedures.  Patients with risk factors for urinary stones formation should undergo a profound metabolic evaluation and start medical treatment to prevent recurrence.

Stones which are smaller than 4mm will generally pass spontaneously without any need for intervention.  However this process will be probably accompanied with pain and will necessitate pain killer use.  Larger stones might obstruct urine drainage and increase the risk for complications as mentioned above. 

Currently, most urinary stones can be managed without open surgery.  Urinary stones can be treated with extracorporeal shock-waves that break them to smaller fragments that then pass spontaneously through the urinary system.  This kind of treatment is suitable for adults (excluding pregnant women) and children with kidney or Ureteral stone smaller than 2cm.

In case if larger stones other endoscopic treatments (Ureteroscopy of percutaneous nephrolithotomy-PCNL) can be use.  In these procedures the surgeon inserts a scope to the kidney or to the ureter and break the stone under direct vision using a variety of instruments such as LASER or US.

Extracorporal Shock Wave Lithotripsy – ESWL

This is a non-surgical treatment in which shock wave energy is use to break the stone into smaller fragments which then can pass more easily through the urinary system.

However, this treatment has some limitations.  These includes:

- Large stones

- Very hard stones

- Impacted stones (Ureteral stones that has not been treated for more than 2 months)

- Treatment in overweight patients

- In patients with bleeding disorder or taking blood thinners like warfarin or aspirin

- In women during pregnancy.

Complications are relatively rare in this procedure and include infection, bleeding and the formation of hypertension years after treatment.  The success rate is 70-90% and is related to the size, location and composition of the stone.

During the last two decades more than 15000 treatments where done in our institution using this method.

Ureteroscopy 

Ureteroscopy is a procedure in which a narrow telescope is passed through the urinary bladder into the ureter toward the kidney.  Ureteroscopy is performed most often for removal of large or impacted Ureteral or kidney stones.  Investigation and treatment of other urinary tract anomalies may also require ureteroscopy.  This procedure has above 90% success rate.

Percutaneous Nephrolithotomy (PCNL)

In this procedure kidney stone is removed using a scope passed through a small skin incision (10-12mm) made in the flank or the back into the kidney.  This procedure is generally recommended for large kidney stones (>2cm).  The success rate is 70-100% depends on stone size, shape and kidney anatomy.  In rare occasions a second look procedure or a complementary extracorporeal shock wave treatment will be required.

The evaluation, treatment and follow-up for urinary stone disease are performed by Dr. Mordechai Duvdevani, a specialist that was trained in an important well-known referral center in Canada, and is currently responsible for the Endo-Urology and lithotripsy Unit in Hadassah Hebrew University Hospital.

For appointment with Dr. Duvdevani, Please call:

Front desk:  02-5842111, 02-6778899

The Endo-Urology and Lithotripsy unit: 02-6777061