|
STONE DISEASE
Originating as microscopic particles, kidney stones are hardened mineral deposits that
form over time in 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. Irby's subspecialty of endourology offers three approaches for the treatment of stone disease:
- Extracorporeal Shockwave Lithotripsy (ESWL) - This technique employs shockwaves to break up stones in the kidney or ureter. A 45-minute procedure, ESWL imparts energy in the form of shockwaves to the stone. Following ESWL, the fragmented stone material passes as dust or sediment. Dr. Irby follows up with patients within two weeks to take an X-ray and determine whether the stone has fragmented and passed. This procedure is used in about 15 percent of stone disease cases, depending on the size and composition of the stone.
- Ureteroscopy - This treatment for acute stone disease involves the use of a mini-telescope with advance fiber-optic capabilities. The telescope passes through the ureter and uses a laser to break up a stone that has reached the lowest part of the ureter. Available on a daily basis, ureteroscopy takes about 60 - 90 minutes, and it is performed at Carolinas Medical Center on an outpatient basis. Ureteroscopy is performed in about 70 percent of stone disease cases. The procedure has a 98-99 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+), which are typically found in the kidney. PNL is performed on an inpatient basis, and it takes about 3 hours. The procedure employs a telescope to deliver ultrasonic waves and fragment 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
Once a patient has had a kidney stone, the patient has a 50 percent chance of recurrence within 5-8 years. Additionally, the longer that patient lives, the greater the chance of recurrence. 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 is indicative of the McKay Urology philosophy, and one of the many aspects that sets the practice apart.
To minimize the chance of recurrence, Dr. Irby conducts an automated 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 stone former'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.
|
