Kidney Stone Treatment: Experienced Kidney Stone Specialists in NYC
Dr. Alex Shteynshlyuger is a board-certified urologist. He treats men and women with kidney and ureteral stones.
Dr. Shteynshlyuger has performed hundreds of ureteroscopy and lithotripsy procedures for large kidney stones, in addition to ESWL procedures. He is among a select number of urologists in the United States who performs PCNL for large kidney stones.
When Should Kidney Stones Be Treated?
All patients with kidney stones and signs of infection (fever, chills, malaise, weakness) need emergency treatment for kidney stones. All patients with infection and kidney or ureteral stones need to be treated by a urologist as it can be a dangerous combination.
Patients with abnormal kidney function, those predisposed to infection (immunocompromised patients, transplant patients, HIV/AIDS patients, diabetic patients) may require prompt treatment.
At New York Urology Specialists, kidney stone treatment encompasses prevention through behavioral and dietary modifications, pharmacological treatment for kidney stones and surgical treatment and lithotripsy.
All ureteral stones regardless of size need to be treated as they can block the kidneys (even in the absence of pain or other symptoms) and damage the kidney. Treatment may involve an attempt to pass the stone or a surgical procedure such as lithotripsy, stent insertion or ureteroscopy.
Small kidney stones may cause no symptoms and may be monitored. Many small kidney stones that are less than 3-5 mm are passed by patients, often without the patient being aware of it or only with mild transient discomfort. Many people just ignore mild back or abdominal discomfort and never attribute the symptoms to kidney stones.
Passing Kidney Stones
When ureteral stones are relatively small and have managed to pass into the distal ureter close to the bladder, many patients may be able to pass kidney stones spontaneously. Patients who do not have too much pain or if pain can be controlled with pain medications and who do not have signs of UTI (urinary tract infection) such as fever, chills or malaise (weakness) are often good candidates for passing stones on their own.
Approximately 90% of stones <5 mm and >80% of stones between 5 and 8 mm pass spontaneously within 4 weeks of dietary modification and medications such as Flomax, while most stones larger than 8-10 mm require urological intervention. Not all patients may be able to tolerate pain or other symptoms for a sufficient duration of time to allow kidney stones to pass and may require surgical intervention.
The lower the stone is in the ureter the higher the chances one may be able to pass it. As stone size increases the chances of spontaneous passage decrease.
If stones are not passed after a month, surgical treatment is necessary as prolonged obstruction can cause damage to the kidneys. It is important to repeat kidney ultrasound after 4-6 weeks to make sure that the kidney is not blocked even if there is no pain
Patients with kidney stones that are larger than 5 mm or with other risk factors without symptoms are usually advised treatment since if left untreated, over 70% of stones are likely to increase in size, dislodge or cause symptoms during the passage. Stones smaller than 3-5 mm can often be observed and many may pass spontaneously without significant symptoms. In general, all stones that cause symptoms need treatment or management by a urologist.
Larger stones usually >5 mm often cause pain when they pass. When stones block urine flow they cause symptoms and may require removal with procedures such as lithotripsy or ureteroscopy with holmium laser lithotripsy. Many patients may be able to pass stones smaller than 7-8 mm spontaneously but others may require a minimally invasive surgical procedure.
Big Stones: Bust them up!
In general, for most patients it is advisable to break larger stones (>5-7 mm) and remove them from the body even if they do not cause symptoms because if left untreated they can affect the functioning of the kidneys (lead to renal insufficiency), cause frequent urinary tract infections, and lead to obstruction.
When stones increase in size, the chances of breaking them with one procedure decreases and the likelihood of needing multiple procedures to break them increases. As a result, it is often advantageous to break stones when they are relatively small in size.
For some patients, close monitoring with renal ultrasound and observation may be a reasonable option for non-obstructive kidney stones especially in patients who are not optimal candidates for anesthesia or surgery.
Most Frequently Performed Procedures For Kidney Stones:
PCNL (percutaneous nephrolithotomy)
PCNL is a minimally-invasive procedure in which an instrument called the nephroscope is passed into the kidney through a tiny incision to retrieve kidney stones. PCN is a very effective procedure for multiple large stones in the kidney including staghorn calculi.
This procedure is performed under general anesthesia and usually requires a 1-3 day hospital stay. PCNL may not be an option for some people, for example, patients who have a bleeding disorder or who cannot come off their Coumadin (warfarin) or other blood-thinning medication may be better candidates for ureteroscopy with laser lithotripsy.
ESWL (extracorporeal shock-wave lithotripsy)
Lithotripsy is a noninvasive procedure in which high-frequency sound waves are used to break up a stone into smaller pieces so that they can pass out from the body with the urine. The procedure is performed either under general anesthesia or with deep sedation. It is the first choice treatment for kidney stones less than 1 cm in size that are located in the kidney. The procedure typically takes about an hour to perform. The patient is able to go home the same day. Patients may return to normal activities the next day.
Ureteroscopy with Holmium laser lithotripsy
Ureteroscopy is an outpatient minimally-invasive procedure in which an instrument called a ureteroscope is passed up through the urethra (peeing hole) and up to the ureter and into the kidney to retrieve a stone that is stuck in the ureter or the kidney. There are no cuts on the body for this procedure. Holmium Laser may be used to break up the stone into smaller pieces which can drain into the bladder. A stone sample is often obtained with a special ‘stone basket’ for biochemical analysis to determine stone composition. Ureteroscopy is done under general anesthesia or spinal anesthesia. The procedure can take anywhere from half an hour to three hours for large stones.
Choice of Procedure for Removal of Kidney and Ureteral Stones
The choice of procedure to remove kidney and ureteral stones depends on stone size, stone location, and patient preferences. In general least invasive procedures are less effective than more invasive procedures but for small stones, even the least invasive procedures have excellent efficacy.