KIDNEY STONES

Treating patients with kidney stones has changed significantly during the last 10-15 years with the advancement of technology and medical knowledge. Treatment can now be tailored to the individual patient based on a variety of factors including the size and location of the stone, the symptoms caused by the stone and patient's overall medical condition. Mayo Clinic's comprehensive, multidisciplinary kidney stone program is designed for patients who suffer from any type of renal stone disease—from simple to complex, using the latest technology available for treatment and prevention of stone formation. The three main treatment options are:

• Extracorporeal shock wave lithotripsy (ESWL)
• Ureteroscopy with laser fragmentation of stones
• Percutaneous nephrolithotomy

Our researchers are investigating the latest breakthroughs and discoveries to learn more about treating stones in the future, why stones form and how they might damage the kidneys. This research is being conducted in patients as well as in the laboratory, and is quickly translating new medical discoveries - and old discoveries applied in new ways - into effective treatment for patients. The following are summaries of recent and current areas of research on kidney stones.

• The efficacy of percutaneous ultrasonic lithotripsy (PUL) following shock wave lithotripsy (SWL) and the differences between the patients undergoing PUL alone and those undergoing PUL after SWL failure.
• The endoscopic management of upper urinary tract transitional cell carcinoma as a first-line treatment in patients with a normal contralateral kidney.
• Predicting kidney stone composition using radiographic appearance as a means to help choose between shock wave lithotripsy and percutaneous/endoscopic procedures.
• Safely dissolving gallbladder stone fragments using methyl tert-butyl ether immediately after extracorporeal shock-wave lithotripsy.
• Percutaneous nephrostomy placement as the initial procedure in renal or ureteral calculus removal.
• Percutaneous extractions of renal pelvic stones using of the Wolf percutaneous universal nephroscope. The advantages of this technique are that a skin incision of only 1 to 2 cm is required to remove the stone, hospital days are fewer than with open procedures, and postoperative morbidity is minimal. In selected situations, this method represents a significant advance over standard open surgical procedures for removal of renal pelvic stones.