Kidney Stones Specialist

What is a kidney stone?

Kidney stones are deposits of minerals and salts that form when the urine is heavily concentrated allowing for these substances to form hard shells inside the kidney. Stones can also form secondary to an infection or can become a source of urinary tract infections in other patients. A kidney stone itself does not usually cause pain; it is the passage of kidney stones that can be painful. Smaller stones, usually up to 5 mm can pass on their own with adequate hydration. Larger stones, however, require surgery.

What causes a kidney stone to develop?

While several factors can lead to the development of a kidney stone, the formation of kidney stones is most often the result of dehydration from not drinking enough water. When an individual is not drinking enough, it makes acidity levels in the kidneys very high. The acidic environment is extremely conducive to the formation of these mineral deposits. This is caused when excessive levels of uric acid build up in an individual’s urine because there is not enough water available to dilute it. Some medical conditions including UTIs or urinary tract infections, hyperparathyroidism, medullary sponge kidney, and Crohn’s disease can also increase the risk.

How are kidney stones addressed?

Dr. Movassaghi offers all surgical approaches to stone disease including combination procedures:

• Extracorporeal Shock Wave Lithotripsy (ESWL) - This approach involves breaking the stone into small fragments through the use of shock waves transmitted from the outside of the body. This is a minimally invasive approach done under general anesthesia. This approach is appropriate for stones no greater than 1 cm which is visible on plain X-ray. Patients who are pregnant or on blood thinners are not candidates for ESWL.
• Ureteroscopy with Laser Lithotripsy - In this approach the patient is placed under general anesthesia, and a camera is used to enter the urinary tract through the urethra (urine tube). Once the stone is located in the ureter or the kidney, a laser fiber is used to vaporize the stone, or break it into small fragments that are removed using a stone basket. This procedure is best for stones no larger than 1.5 cm. At times, multiple sessions may be needed to treat large stones. A ureteral stent is usually left in place after the procedure to ensure small fragments do not obstruct the ureter and to ensure the ureter heals properly after manipulation with instruments and laser.
• Percutaneous Stone Surgery - In this approach, direct access is made to the kidney through a small incision in the back. This is done under image guidance. Once a tract has been created, a camera is used to enter the kidney and identify the stone. Once the stone is found, it is fragmented using laser or ultrasound energy and the fragments are removed. A nephrostomy tube is left in place after the procedure and removed in the office. The tract usually seals within one day once the tube is removed. For stones that are larger than 1.5 cm, this is the best option.

Dr. Movassaghi is endourology fellowship trained and offers services for stone prevention that include:

• Full scope treatments at Saint John’s including digital ureteroscopy with a laser, ESWL (shockwave), and percutaneous approaches.
• Prevention consultation with personalized patient urine and serum stone analysis.