Carolinas HealthCare System

Stone Disease

Originating as microscopic particles, over time, kidney stones become hardened mineral deposits within the kidney. Typically, kidney stones develop when waste materials in the urine do not dissolve completely. For more information on stone disease, the Urology Channel provides excellent educational resources.

Treatment Approaches for Stone Disease

Dr. Pierce Irby’s subspecialty of endourology offers three stone disease treatment approaches:

Extracorporeal Shockwave Lithotripsy (ESWL) – Shockwaves break up stones in the kidney or ureter. A 45-minute procedure, ESWL imparts energy to the stone in the form of shockwaves. Following ESWL, the fragmented stone material passes as dust or sediment. Dr. Irby takes an X-ray two-weeks following treatment to determine whether the stone has fragmented and passed. Depending on stone size and composition, this procedure is appropriate for about 15 percent of stone disease cases.

Ureteroscopy – Physicians use a mini-telescope with advance fiber-optic capabilities. The telescope passes through the ureter and deploys a laser to break up a stone that has reached the lowest part of the ureter. Ureteroscopy takes about 60 - 90 minutes, and is available on an outpatient basis every day at Carolinas Medical Center. Ureteroscopy is performed in about 70 percent of stone disease cases. The procedure has a 98 to 99 percent success rate for stones in the lowest part of the ureter.

Percutaneous Nephrolithotomy (PNL) - This procedure is designed to break up large stones (15mm+), typically found in the kidney. PNL requires hospitalization, and takes about three hours. A telescope is used to deliver ultrasonic waves to break up large stones. Because large stones are relatively rare, PNL is performed in only about 15 percent of all stone disease cases.

Other treatments for stone disease include laparoscopy and open surgery. However, these approaches are typically used only in cases of very large stones, and they are becoming increasingly rare as endourology advances.

Medical Management of Stone Disease

A kidney stone patient has a 50 percent chance of recurrence within five to eight years. Odds of recurrence increase with age. Recognizing this risk, Dr. Irby evaluates and works with patients to reduce the rate of stone recurrence. This approach is successful in 85 percent of cases. Dr. Irby's commitment to patient education, prevention and medical management reflects the McKay Urology philosophy – one of the many aspects that sets the practice apart.

To minimize recurrence, Dr. Irby conducts a computer analysis of the patient's metabolism. Working with a dedicated laboratory in San Antonio, Texas, Dr. Irby provides analysis of 16 chemical factors in the patient's urine. Through this analysis, abnormalities in the former stone patient’s metabolism are discovered 90 percent of the time. Once identified, the patient's particular metabolic abnormalities can usually be managed with diet and fluids. Throughout the process, Dr. Irby educates patients and helps them take an active role in preventing recurrence of stone disease.

 

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