Endo-Urology and Kidney Stones

Endo-Urology and Kidney Stones

Kidney Stones
Kidney stone disease is a common disorder which affects 10%-15% of the general population. This disorder is more commonly among men and rarely found in children. Urinary stones are crystalline particles that form in the kidneys due to dehydration, anatomical variation of the ureteral system, or as a result of an underlying metabolic disorder. Kidney stones often cause pain when they obstruct urine drainage from the kidney. Other issues resulting from the formation of kidney stone are renal failure, recurrent urinary tract infection, and even life threatening infections. Approximately 50% of people who suffer from kidney stones will suffer from recurrent kidney stones in 10 years.

During the last three decades management of kidney stones has shifted from traditional, invasive surgeries to minimally invasive procedures, thanks to improvements in endoscopic instruments and surgical techniques. Patients who exhibit tendencies for developing kidney stones should undergo a metabolic evaluation and start medical treatment to prevent recurrence.

Stones smaller than 4mm will generally pass on their own without any need for medical intervention. However, this process will likely be painful and may necessitate the need for painkillers. Larger stones might obstruct urine drainage and increase the risk for complications, such as those as mentioned above.

Currently, most kidney stones can be treated without the need for traditional, invasive surgery. Kidney stones can be treated with extracorporeal shock-waves, which break them into smaller fragments that then can pass through the urinary system. This kind of treatment is suitable for adults (not including pregnant women) or children with kidney or ureteral stones smaller than 2cm.

In case of larger stones, there are other endoscopic methods avilable for treatment, such as ureteroscopy of percutaneous nephrolithotomy-PCNL. In these procedures the surgeon inserts a scope into the kidney or into the ureter and shatters the stone(s) using a variety of instruments such as LASER or US.

Extracorporal Shock Wave Lithotripsy - ESWL
This is a non-surgical treatment where shock-wave energy is use to break the stone(s) into smaller fragments, which can then pass more easily through the urinary system.

However, this treatment cannot be used in certain instances, such as:

  • 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 following this procedure and can 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(s).

During the last two decades more than 15,000 treatments were performed at Hadassah, using this method.

Ureteroscopy is a procedure in which a narrow telescope is passed through the urinary bladder into the ureter toward the kidney. Ureteroscopy is generally used for removing large or impacted ureteral or kidney stones. Treatment of other urinary tract anomalies may also require ureteroscopy. This procedure has above 90% success rate.

Percutaneous Nephrolithotomy (PCNL)
In this procedure the kidney stone(s) 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% depending on the size and shape of the stone(s) as well as the kidney anatomy. In rare occasions a follow-up procedure or a complementary extracorporeal shock-wave treatment will be required.

The evaluation, treatment and follow-up for kidney stones are performed by Dr. Mordechai Duvdevani.

For appointment with Dr. Duvdevani:
972-2-5842111, 972-2-6778899