Best treat­ment for kid­ney stones de­pends on size and lo­ca­tion

Cape Breton Post - - Obituaries/Advice/Games - Email ques­tions to ToYourGoodHealth@ med.cor­nell.edu (c) 2017 North Amer­ica Syn­di­cate Inc. All Rights Re­served

DEAR DR. ROACH: My urol­o­gist found two big kid­ney stones in my right kid­ney, too large to pass nat­u­rally. I thought that the op­tion would then be to “crush” them to sand with laser or ul­tra­sound and then flush out the sand by drink­ing lots of wa­ter.

How­ever, my urol­o­gist says that I am too big for this to work (I weigh close to 300 pounds), as they would not be able to fo­cus the laser prop­erly. So, his pre­ferred op­tion is to sur­gi­cally re­move the stones when/if they be­come a pain­ful prob­lem. Right now, we are mon­i­tor­ing them twice a year with CAT scan and ul­tra­sound checks. (The other al­ter­na­tive he sug­gested, of go­ing up through my pe­nis to crush the stones, sounds com­pletely un­ap­peal­ing to me.)

Wouldn’t a sur­gi­cal al­ter­na­tive also dam­age the kid­ney, if he has to cut into the kid­ney to take out the stones? It sounds rather risky to me. I would much pre­fer a laser so­lu­tion that crushed the stones to sand without cut­ting into me or my kid­ney. I ap­pre­ci­ate your opin­ion on this. -- P.R.

AN­SWER: I don’t have enough in­for­ma­tion to rec­om­mend the op­ti­mal treat­ment to re­move your par­tic­u­lar stones, since know­ing the size and lo­ca­tion of the stones in the kid­ney is nec­es­sary to make that de­ter­mi­na­tion. I can tell you that laser lithotripsy (from the Greek “lithos,” mean­ing “stone,” and “trip­sis,” mean­ing “rub­bing” or pos­si­bly “thryptein,” mean­ing “crush­ing”) has been suc­cess­fully used in peo­ple up to 420 pounds, ac­cord­ing to a 2009 study, and ul­tra­sound lithotripsy has been used in peo­ple over 300 pounds in an ear­lier study. Com­pli­ca­tion rates are higher in heav­ier peo­ple, due to dif­fi­culty get­ting the fo­cus cor­rect, as you sug­gested.

Ten to 20 per­cent of all stones still re­quire sur­gi­cal re­moval, and this can be done en­do­scop­i­cally in some cases. Sur­gi­cal stone re­moval is safe and ef­fec­tive in most cases, but has the po­ten­tial for com­pli­ca­tions, like all pro­ce­dures. I’d rec­om­mend a sec­ond opin­ion from some­one who has ex­pe­ri­ence in per­form­ing the pro­ce­dure.

Keith Roach

To Your Good Health

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